INFORMATION
REQUEST FORM
FULL NAME OF RESPONSIBLE PARTY:
MAILING ADDRESS:
PRIMARY PHONE:
 ALT. PHONE:
EMAIL ADDRESS:
I AM REQUESTING A:
?
PART OF          OF THE:
THE:
?
SEC.                       TWN.                                RNG.
?
(eg., SEC. 6,          TWN. 7N,                      RNG. 16E
OR ENTER THE
NAME OF SUBDIVISION
?
BLOCK            LOT NO.
?
?
IN THE COUNTY OF:
BY CHECKING THIS BOX, I
UNDERSTAND THAT CULPEPPER
AND PURVIS WILL NOT CONTACT
ME OR CONSIDER PERFORMING A
SURVEY FOR ME UNTIL I HAVE
PAID A RESEARCH FEE OF $25.00
(NON-REFUNDABLE) . IF YOU DO
NOT AGREE PLEASE UNCHECK.
USE THIS SPACE FOR ANY
ADDITIONAL COMMENTS OR
INSTRUCTIONS.
Henry "Dee" Purvis, III
Professional Surveyor
email:
DeePurvis@LandSurvey101.com
Mississippi Counties
AFTER SUBMITTING REQUEST
FORM
USE PAYPAL/VISA/
MASTERCARD




$25.00 (non-refundable) Research Fee
is required for information inquiries.
(You must submit a new Research Fee
for each information inquiries.
This service is provided to help locate survey
information that is available from Henry D.
Purvis. The survey information is historical
information. There is NO guarantee that the
information is correct or accurate. The survey
information does NOT contain the seal or
signature of Henry D. Purvis.
Henry D. Purvis retains the right to return any fees and deny any request.
Work In Progress.  
Please be patient.