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1 of 2 Property Alert Notification Subscription ID Verification: Date: Subscriber Name (First, Last): Phone: E-Mail Address: Street Address: City / Township: State: Zip: Search: Enter: Last Name, First Name, Middle Initial (Smith John Individual names may be entered as Smith John, or Smith J. Business or Trust names may be entered as RXB Business Corporation, or RXB Business Corp. No special characters. Name: Name: Name: Name: Name: Name: Name: Name: ---PAGE BREAK--- 2 of 2 ID Verification: Name: State of: County of: This record was acknowledged before me on by: Notary’s Official Signature Title of Office: My Commission Expires: (Seal) County Clerk and Recorder Use Only Processed By: Date: SIGN