A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. TYPE OF LOAN 6. File Number 7. Loan Number 8. Mortgage Insurance Case Number 1. o FHA  2. o FmHA   3. o CONV. UNINS. 4. o VA 5. o CONV. INS. 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. D. NAME AND ADDRESS OF BORROWER:   E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: G. PROPERTY LOCATION: H. SETTLEMENT AGENT: NAME, AND ADDRESS   PLACE OF SETTLEMENT: 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. 110. 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 of 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 REDUCTION 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 amount due seller (line 520) 303. CASH (_ FROM) (_ TO) BORROWER 603. CASH (o TO) (o FROM) SELLER L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION based on price $ @ %= PAID FROM BORROWER'S FUNDS AT SETTLEMENT PAID FROM SELLER'S FUNDS AT SETTLEMENT Division of Commission (line 700) as follows: 701. $ to 702. $ to 703. Commission paid at Settlement 704. 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee % 802. Loan Discount % 803. Appraisal Fee to 804. Credit Report to 805. Lender's Inspection Fee 806. Mortgage Insurance Application Fee to 807. Assumption Fee 808. 809. 810. 811. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest from to @$ /day 902. Mortgage Insurance Premium for months to 903. Hazard Insurance Premium for years to 904. years to 905. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance months @ $ per month 1002. Mortgage insurance months @ $ per month 1003. City property taxes months @ $ per month 1004. County property taxes months @ $ per month 1005. Annual assessments months @ $ per month 1006. months @ $ per month 1007. months @ $ per month 1008. Aggregate Adjustment months @ $ per month 1100. TITLE CHARGES 1101. Settlement or closing fee to 1102. Abstract or title search to 1103. Title examination to 1104. Title insurance binder to 1105. Document preparation to 1106. Notary fees to 1107. Attorney's fees to (includes above items numbers; ) 1108. Title Insurance to (includes above items numbers; ) 1109. Lender's coverage $ 1110. Owner's coverage $ 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recording fees: Deed $ ; Mortgage $ ; Releases $ 1202. City/county tax/stamps: Deed $ ; Mortgage $ 1203. State tax/stamps: Deed $ ; Mortgage $ 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey to 1302. Pest inspection to 1303. 1304. 1305. 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K)