The printed portions of this form, except differentiated additions, have been approved by the Colorado Real Estate Commission. (SS61-9-08) WORKSHEET FOR CLOSING STATEMENT SELLER_____________________________BUYER______________________________ PROPERTY ADDRESS _____________________________________________________ SETTLEMENT DATE ________________DATE OF PRORATION________________ LEGAL DESCRIPTION: Debit SELLER Credit Debit BUYER Credit Debit BROKER Credit 1. Purchase Price 2. Deposit (Earnest Money) Paid to 3. Principal amount of new 1st Loan Payable to 4. Principal amount of new 2nd Loan Payable to 5. 1st Loan Payoff to 6. 2nd Loan Payoff to 7. Taxes for Preceding Year(s) 8. Taxes for Current Year 9. Personal Property Taxes 10. Transaction Fee 11. Loan Origination Fee 12. Loan Discount Fee 13. Appraisal Fee 14. Appraisal Fee 15. Loan Processing Fee 16. Tax Service Fee 17. Flood Certification 18. Loan Document Preparation Fee 19. Loan Underwriting Fee 20. Interest on New Loan SS61-9-08. WORKSHEET FOR CLOSING STATEMENT Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com 21. Mortgage Insurance Premium/PMI 22. Premium for new Hazard Insurance 23. Reserves Deposited With Lender 23 a. Hazard Insurance Reserve 23 b. Mortgage Insurance Reserve 23 c. County Property Tax Reserve 24. Aggregate Adjustment 25. Real Estate Closing Fee 26. Loan Closing Fee 27. Title Insurance Premium – Owner’s 28. Owner’s Extended Coverage 29. Title Insurance Premium – Lender’s Policy 30. Endorsements: 31. Certificate of Taxes Due 32. Overnight Delivery Fee 33. E-Doc Fee (Loan) 34. Release Facilitation Fee 35. Cashier’s Check/Wire Fee 36. Recording: 36 a. Warranty Deed 36 b. Deed of Trust 36 c. Release 36 d. Other 37. Survey 38. Documentary Fee 39. Transfer Fee 40. Sales and Use Tax 41. HOA – CIC Document Procurement Fee 42. HOA Transfer/Status Letter Fee 43. HOA Dues 44. HOA Working Capital 45. Water and/or Sewer Escrow 46. Homeowner Warranty 47. 2% Colorado Withholding 48. Foreign Investment in Real SS61-9-08. WORKSHEET FOR CLOSING STATEMENT Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com Property Tax Act (FIRPTA) – 10% 49. Propane/Fuel Oil Proration 50. Rents/Rent Proration 51. Security Deposits 52. Seller Concessions: 53. Broker’s Fee 54. Other: Subtotals Balance due to/from Seller Balance due to/from Buyer TOTALS SS61-9-08. WORKSHEET FOR CLOSING STATEMENT Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com