C.
NOTE: This form s
furnished to give you a statement of actual settlement costs.Amounts paid to and by the
settlement agent are shown.Item
marked “(p.o.c.)” were paid outside the closing, they are shown
here for informational purposes and are not included in the totals.
D.
NAME AND ADDRESS OF BORROWER:
E.
NAME AND ADDRESS OF SELLER:
TIN:
F.
NAME AND ADDRESS OF LENDER:
G.
PROPERTY
LOCATION:
H.
SETTLEMENT AGENT: Beltway
Title & Abstract, Inc.
PLACE OF
SETTLEMENT:
PHONE:
TIN:
I.
SETTLEMENT DATE:
J.SUMMARY OF
BORROWER'S TRANSACTION
K.SUMMARY
OF SELLER'S TRANSACTION
100.
GROSS AMOUNT DUE FROM BORROWER:
400.
GROSS AMOUNT DUE TO SELLER::
101.
Contract Sales Price
401.
Contract Sales
Price
102.
Personal Property
402.
Personal Property
103.
Settlement charges to
Borrower (line 1400)
403.
104.
404.
105.
405.
ADJUSTMENTS
FOR ITEMS PAID BY SELLER IN ADVANCE:
ADJUSTMENTS
FOR ITEMS PAID BY SELLER IN ADVANCE:
106.
City/town taxes……to…….
406.
City/town
taxes……to…….
107.
County taxes…….to…….
407.
County
taxes…….to…….
108.
Assessments…….to…….
408.
Assessments…….to…….
109.
409.
10.
410.
111.
411.
112.
412.
120.
GROSS AMOUNT DUE
FROM BORROWER:
420.
GROSS AMOUNT DUE
TO SELLER:
200.
AMOUNTS PAID BY OR IN BEHALF OF BORROWER:
500.
REDUCTIONS IN AMOUNT DUE TO SELLER:
201.
Deposit or earnest money
501.
Excess deposit (see instructions)
202.
Principal amount of new loan(s)
502.
Settlement charges to Seller (line
1400)
203.
Existing loan(s) taken subject to
503.
Existing loan(s) taken subject to
204.
504.
Payoff of first mortgage loan
205.
505.
Payoff of second mortgage loan
206.
506.
207.
507.
208.
508.
209.
509.
ADJUSTMENTS
FOR ITEMS UNPAID BY SELLER:
ADJUSTMENTS
FOR ITEMS UNPAID BY SELLER:
210.
City/town taxes……to…….
510.
City/town taxes……to…….
211.
County taxes…….to…….
511.
County taxes…….to…….
212.
Assessments…….to…….
512.
Assessments…….to…….
213.
513.
214.
514.
215.
515.
216.
516.
217.
517.
218.
518.
219.
519.
220.
TOTAL PAID BY/FOR
BORROWER:
520.
TOTAL REDUCTIONS
IN AMOUNT DUE SELLER:
300.
CASH AT SETTLEMENT FROM/TO BORROWER:
600.
CASH AT SETTLEMENT TO/FROM SELLER:
301.
Gross Amount due from Borrower (line
120)
601.
Gross amount due to Seller (line
420)
302.
Less amounts paid by/for Borrower (line 220)
(.................)
602.
Less reductions in amt. due
Seller (line 520)
