FORM T-19.1 OWNER POLICY ENDORSEMENT
COMBINED CHECKLIST
(Revised April, 2010)
GF NO.
This Endorsement may be issued with either the Form T-1 or Form T-1R Owner’s Policies and requires review of the following: 1) a current survey of the insured land (which can include prior survey evidence updated by acceptable affidavit); 2) all restrictive covenants affecting the insured land; and 3) all recorded mineral severances and leases occurring in the chain-of-title to the insured land. NOTE: Deletion of subparagraphs from the T-19.1 Endorsement must be done by x-ing or lining through the provision being deleted.
BUILDING SETBACK VIOLATIONS. UNLESS ONE OF THE FOLLOWING APPLIES, YOU MUST EXCEPT IN T-1 SCHEDULE “B” TO ANY SETBACK VIOLATION AND ALSO DELETE PARAGRAPH NO. 5 IN THE T-19.1 ENDORSEMENT:
Permanent structure of any age extends over a setback line (from plat or restrictions) by a distance of one foot (1.00’) or less, and the setback requirement conforms to the local municipal ordinance minimum, if any.
___ Permanent structure older than four (4) years extends over a setback (from plat or restrictions), but does not violate the local municipal ordinance minimum, if any.
Improvement extending into the setback width is not permanent (e.g. portable sign) OR is a nonstructural improvement (e.g., driveway, parking lot, fence, or landscaping element).
You obtain underwriter approval:
Describe apparent violation: Approved by: Date:
EASEMENT ENCROACHMENTS (including non-structural improvements). UNLESS ONE OF THE FOLLOWING APPLIES, YOU MUST 1) EXCEPT TO THE EASEMENT ENCROACHMENT IN T-1 SCHEDULE “B” AND 2) IN THE INSTANCE OF AN ENCROACHING BUILDING, YOU MUST ALSO DELETE PARAGRAPH NO. 2 IN THE T-19.1 ENDORSEMENT:
Encroaching building or other improvement occupies no more than 25% of the total easement width.
___ Encroached-upon easement is a generic utility easement dedicated by plat/restrictions along all lot lines, and survey shows evidence of underground or aerial utility lines located elsewhere on the land.
___ You obtain underwriter approval:
Describe apparent encroachment:
Approved by: Date:
BOUNDARY PROTRUSIONS OR ENCROACHMENTS (including nonstructural improvements): UNLESS YOU OBTAIN UNDERWRITER APPROVAL TO DO OTHERWISE, YOU MUST 1) SPECIFICALLY EXCEPT IN T-1 SCHEDULE “B” TO ANY PROTRUSION OR ENCROACHMENT OF AN IMPROVEMENT ONTO OR FROM ADJOINING PUBLIC OR PRIVATE LAND, AND 2) IN THE INSTANCE OF A BUILDING PROTRUDING ONTO ADJACENT LAND, YOU MUST ALSO DELETE PARAGRAPH NO. 4 IN THE T-19.1 ENDORSEMENT.
____ Underwriter approval given to omit exception and/or ____ omit deletion.
Describe protrusion/encroachment:
Approved by: Date:
RESTRICTIONS. UNLESS YOU OBTAIN UNDERWRITER APPROVAL TO DO OTHERWISE, YOU MUST SPECIFICALLY EXCEPT IN T-1 SCHEDULE “B” TO ANY OF THE FOLLOWING MATTERS ARISING UNDER/FROM RESTRICTIVE COVENANTS: 1) Easement right; 2) option to purchase; 3) right of first refusal or prior approval at sale or lease; 4) reversionary right or other potential loss of title as penalty for violation; and/or 5) significant existing violation disclosed by survey or other information known to you at or before closing:
____ Underwriter approval given to omit exception:
Describe omitted item:
Approved by: Date:
MINERALS: UNLESS ONE OF THE FOLLOWING APPLIES, YOU MUST DELETE PARAGRAPH NO. 3 FROM THE T-19.1 ENDORSEMENT:
____ Insured land is a lot/tract of 5.00 acres or less which is not contiguous to other land owned by the proposed owner-insured.
____ Part of the minerals remains intact with the surface, and the land is not the subject of any unexpired/producing mineral lease.
____ All of the minerals have been severed from the surface, but the land is not subject to any expired/producing lease and is occupied by permanent residential/commercial improvements.
____ All owners of outstanding, non-royalty mineral interest, including operating interest under any producing mineral lease, have relinquished surface rights by recorded waiver/non-disturbance agreement or drill-site designation of other land.
____ The insured land lies in the developed area of an incorporated municipality, but not in the immediate vicinity of any current mineral exploration/production.
____ The land is covered by mineral lease in a unit where production on other land in the unit has been ongoing for more than ten (10) years.
You obtain underwriter approval to retain Paragraph No. 3 in the T-19.1 Endorsement:
Approved by: Date: