A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT

B. TYPE OF LOAN

6. File Number

7. Loan Number

1. o FHA

2. o FmHA

3. o CONV. UNINS.

4. o VA

5. o CONV. INS.

8. Mortgage Insurance Case Number

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

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)