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TAX SALE REGISTRATION AND AFFIDAVIT OF PURCHASER

Name of Representative *

First

Last

Representative's Business Name *

Purchaser’s Name *

First

Last

Purchaser’s Physical Address *

Address Line 1

Address Line 2

City

State

Zip Code

(As it will appear on the certificate)

Purchaser’s Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

(As it will appear on the certificate)

Purchaser’s Telephone Number *

Purchaser’s email address *

Purchaser’s Telephone Number for payoffs *

Do you want to set a purchase cap?

Yes
No

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