6(d) Certificate Request Form

Please fill out and submit the following form. The charge for the 6(d) is $75; this covers the 6(d) certificate, notarization and mailing. The 6(d) certificate will be mailed as noted below; it will not be faxed as the original notarized certificate is needed for your closing. The 6(d) will be processed and release two (2) weeks before the closing. If there is an issue with the release, we will contact you accordingly. Thank you for submitting your request.

YOUR INFORMATION Owner’s Name: ___________________________________________________ Email: ___________________________________________________ Phone Number: ___________________________________________________

OWNER INFORMATION Property: ___________________________________________________ Unit Street Address: ___________________________________________________

Unit Number: ___________________________________________________ Closing Date: ___________________________________________________ Month Requested Through: ________________________________________ 6(d) For (Circle One): Sale of a Unit Refinance of a Unit

SEND 6(d) TO: Name: ___________________________________________________ Company: ___________________________________________________ Street Address: ___________________________________________________ City, State and Zip: ___________________________________________________ Special Instructions: ___________________________________________________ ___________________________________________________

___________________________________________________ ___________________________________________________

Premier Property Solutions, LLC 311 Summer Street, Suite 200 Boston, Massachusetts 02210

617/345-0045 Phone 617/345-0411 Fax

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