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 A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT    | 
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 B. TYPE OF LOAN   | 
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 6. File Number   | 
 7. Loan Number  | 
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 1. o FHA   | 
 2. o FmHA   | 
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 3. o CONV. UNINS.   | 
 4. o VA   | 
 5. o CONV. INS.   | 
 8. Mortgage Insurance Case Number     | 
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 C. NOTE: This form is furnished to give you a
statement of actual settlement costs. Amounts paid to and by the
settlement agent are shown. Items marked "(p.o.c.)" were
paid outside the closing; they are shown here for informational
purposes and are not included in the totals.   | 
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 D. NAME AND ADDRESS OF BORROWER:   | 
 E. NAME AND ADDRESS OF SELLER:   | 
 F. NAME AND ADDRESS OF LENDER:   | 
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 G. PROPERTY LOCATION:   | 
 H. SETTLEMENT AGENT: NAME, AND ADDRESS   | 
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 PLACE OF SETTLEMENT:   | 
 I. SETTLEMENT DATE:   | 
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 J. SUMMARY OF BORROWERS TRANSACTION   | 
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 K. SUMMARY OF SELLERS TRANSACTION   | 
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 100. GROSS AMOUNT DUE FROM BORROWER:   | 
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 400. GROSS AMOUNT DUE TO SELLER:   | 
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 101. Contract sales price   | 
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 401. Contract sales price   | 
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 102. Personal property   | 
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 402. Personal property   | 
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 103. Settlement charges to borrower(line 1400)   | 
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 403.   | 
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 104.   | 
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 404.   | 
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 105.   | 
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 405.   | 
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 Adjustments for items paid by seller in advance   | 
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 Adjustments for items paid by seller in advance   | 
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 106. City/town taxes to   | 
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 406. City/town taxes to   | 
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 107. County taxes to   | 
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 407. County taxes to   | 
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 108. Assessments to   | 
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 408. Assessments to   | 
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 109.   | 
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 409.   | 
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 110.   | 
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 410.   | 
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 111.   | 
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 411.   | 
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 112.   | 
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 412.   | 
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 120. GROSS AMOUNT DUE FROM BORROWER   | 
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 420. GROSS AMOUNT DUE TO SELLER   | 
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 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER:   | 
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 500. REDUCTIONS IN AMOUNT DUE TO SELLER:   | 
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 201. Deposit of earnest money   | 
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 501. Excess deposit (see instructions)   | 
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 202. Principal amount of new loan(s)   | 
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 502. Settlement charges to seller (line 1400)   | 
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 203. Existing loan(s) taken subject to   | 
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 503. Existing loan(s) taken subject to   | 
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 204.   | 
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 504. Payoff of first mortgage loan   | 
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 205.   | 
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 505. Payoff of second mortgage loan   | 
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 206.   | 
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 506.   | 
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 207.   | 
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 507.   | 
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 208.   | 
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 508.   | 
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 209.   | 
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 509.   | 
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 Adjustments for items unpaid by seller   | 
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 Adjustments for items unpaid by seller   | 
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 210. City/town taxes to   | 
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 510. City/town taxes to   | 
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 211. County taxes to   | 
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 511. County taxes to   | 
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 212. Assessments to   | 
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 512. Assessments to   | 
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 213.   | 
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 513.   | 
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 214.   | 
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 514.   | 
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 215.   | 
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 515.   | 
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 216.   | 
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 516.   | 
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 217.   | 
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 517.   | 
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 218.   | 
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 518.   | 
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 219.   | 
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 519.   | 
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 220. TOTAL PAID BY/FOR BORROWER   | 
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 520. TOTAL REDUCTION AMOUNT DUE SELLER    | 
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 L. SETTLEMENT CHARGES   | 
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700. TOTAL SALES/BROKERS COMMISSION based on price $ @ %=   | 
 
        
 PAID FROM BORROWERS FUNDS AT SETTLEMENT   | 
  PAID FROM SELLERS FUNDS AT SETTLEMENT  | 
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 Division of Commission (line 700) as follows:  
        
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 701. $ to   | 
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 702. $ to   | 
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 703. Commission paid at Settlement   | 
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 704.   | 
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 800. ITEMS PAYABLE IN CONNECTION WITH LOAN   | 
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 801. Loan Origination Fee %   | 
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 802. Loan Discount %   | 
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 803. Appraisal Fee to   | 
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 804. Credit Report to   | 
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 805. Lenders Inspection Fee   | 
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 806. Mortgage Insurance Application Fee to   | 
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 807. Assumption Fee   | 
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 808.   | 
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 809.   | 
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 810.   | 
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 811.   | 
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 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE   | 
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 901. Interest from to @$ /day   | 
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 902. Mortgage Insurance Premium for months to   | 
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 903. Hazard Insurance Premium for years to   | 
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 904. years to   | 
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 905.   | 
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 1000. RESERVES DEPOSITED WITH LENDER   | 
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 1001. Hazard Insurance months @ $ per month   | 
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 1002. Mortgage insurance months @ $ per month   | 
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 1003. City property taxes months @ $ per month   | 
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 1004. County property taxes months @ $ per month   | 
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 1005. Annual assessments months @ $ per month   | 
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 1006. months @ $ per month   | 
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 1007. months @ $ per month   | 
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 1008. Aggregate Adjustment months @ $ per month   | 
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 1100. TITLE CHARGES   | 
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 1101. Settlement or closing fee to   | 
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 1102. Abstract or title search to   | 
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 1103. Title examination to   | 
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 1104. Title insurance binder to   | 
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 1105. Document preparation to   | 
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 1106. Notary fees to   | 
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 1107. Attorneys fees to   | 
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  (includes above items numbers; )   | 
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 1108. Title Insurance to   | 
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  (includes above items numbers; )   | 
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 1109. Lenders coverage $   | 
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 1110. Owners coverage $   | 
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 1111.   | 
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 1112.   | 
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 1113.   | 
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 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES   | 
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 1201. Recording fees: Deed $ ; Mortgage $ ; Releases $   | 
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 1202. City/county tax/stamps: Deed $ ; Mortgage $   | 
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 1203. State tax/stamps: Deed $ ; Mortgage $   | 
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 1204.   | 
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 1205.   | 
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 1300. ADDITIONAL SETTLEMENT CHARGES   | 
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 1301. Survey to   | 
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 1302. Pest inspection to   | 
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 1303.   | 
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 1304.   | 
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 1305.   | 
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 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103,
Section J and 502, Section K)   | 
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