Homeowner Application – Safety Deed

Your Home - Step 1 of 7

Is someone helping you fill out this form?

Name of the person helping you

Their relationship to you

Property Address

Address Line 1

Address Line 2

City

State

Zip Code

Please enter the full address of the property you want to protect.

Is your home in a trust?

Is it a REVOCABLE trust?

Are you a trustee?

If your home is in an irrevocable trust, only your trustee can sign a SHERPA Agreement to protect it. Please ask the trustee to visit our website to learn more about protecting this home

Name of the trust

Please enter the full legal name of the trust

How many trustees are there in total?

We will only collect information about the first two trustees right now.

Is your name on the title?

Your name must be on the title to sign a SHERPA Agreement. Please ask the owner of the home to visit our website to learn more about protecting this home.

How many people are on the title in total?

For married couples, this is usually 2.

We will only collect information about the first two homeowners right now.

HOMEOWNER(S) or TRUSTEE(S)

First Homeowner or Trustee

Name (Required)

First

Middle

Last

Please enter your name as it appears on your title.

Suffix

Is your home address the best place to write to you?

Preferred Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Best phone number to reach you?

Can we send you text messages?

Alternate phone number

Can we send text messages to this number?

What is the best email address to reach you?

Second Homeowner or Trustee

Relationship to First Homeowner/Trustee

Spouse or Partner
Child or Sibling
Former Spouse or Partner
Other

Second homeowner/trustee name

First

Middle

Last

Please enter the name as it appears on the title.

Second homeowner/trustee Suffix

Second homeowner/trustee preferred phone number

Second homeowner/trustee alternate phone

Second homeowner/trustee Email

What is the second homeowner/trustee's or trustee's preferred address?

Same as the property
Same as the first homeowner
At another address

Second homeowner/trustee's preferred mailing address

Address Line 1

Address Line 2

City

State

Zip Code

YOUR LAWYER

Your SHERPA Agreement will require you to have legal representation in future transactions involving the title to your home if any of your Reviewers believes it would be beneficial for you to have a lawyer OR if fewer than two Reviewers are available to discuss a transaction with you. However, you may choose to ALWAYS have legal counsel in addition to or instead of having Reviewers.

Don't worry if you don't have all this information right now, you can update it later.

Do you want to always be represented by an attorney in future transactions involving your home?

I would like this requirement to take effect:

On the day the SHERPA Agreement is signed and recorded
Once the homeowner turns this age

We would like this requirement to take effect:

On the day the SHERPA Agreement is signed and recorded

Multiple Owners passing legal representation

When either homeowner dies
If the first homeowner dies before the second homeowner
If the second homeowner dies before the first homeowner

Multiple Owners aging legal representation

Once the first homeowner turns this age
Once the second homeowner turns this age

SHEPRA enforced when first homeowner turns this age

SHEPRA enforced when second homeowner turns this age

Current Lawyer

I have a lawyer
I do not have a lawyer

Our Current Lawyer

We have a lawyer
We do not have a lawyer

Lawyer's name

Lawyer's firm

YOUR REVIEWERS

You may nominate up to three (3) Reviewers to be informed in advance about transactions involving your home. If fewer than two Reviewers are available to review a transaction and discuss it with you, you will have to retain a lawyer (at your cost) to represent you in the transaction.

Don't worry if you don't have all this information right now, you can update it later.

First reviewer

Name first reviewer

First

Middle

Last

Suffix first reviewer

Suffix

Is the first reviewer a legal heir to your estate?

How do you know the first reviewer?

How long have you known the first reviewer?

Address first reviewer

Address Line 1

Address Line 2

City

State

Zip Code

Home phone first reviewer

Mobile phone first reviewer

Business phone first reviewer

Email first reviewer

Your legal reviewers

Don't worry if you don't have all this information right now, you can update it later.

Second reviewer

Name second reviewer

First

Middle

Last

Suffix second reviewer

Suffix

Is the second reviewer a legal heir to your estate?

How do you know the second reviewer?

How long have you known the second reviewer?

Address second reviewer

Address Line 1

Address Line 2

City

State

Zip Code

Home phone second reviewer

Mobile phone second reviewer

Business phone second reviewer

Email second reviewer

Your legal reviewers

Don't worry if you don't have all this information right now, you can update it later.

Third reviewer

Name third reviewer

First

Middle

Last

Suffix third reviewer

Suffix

Is the third reviewer a legal heir to your estate?

How do you know the third reviewer?

How long have you known the third reviewer?

Address third reviewer

Address Line 1

Address Line 2

City

State

Zip Code

Home phone third reviewer

Mobile phone third reviewer

Business phone third reviewer

Email third reviewer

Please let us know when it would be OK to call you about your application.

Mornings (9am to 12pm)
Afternoons (12pm to 5pm)
Evenings (5pm to 9pm)

Is there anything else you want to tell us?

Please do not include any additional personally identifiable information like social security numbers or birthdates.

I have read and agree to the Terms of Use