OMB Approval No. 2502-0265 A. Settlement Statement (HUD-1) B. Type of Loan 1. 4. C. Note: FHA VA 2. 5. RHS Conv. Ins. 3. Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 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. E. Name & Address of Seller: F. Name & Address of Lender: D. Name & Address of Borrower: G. Property Location: H. Settlement Agent: I. Settlement Date: Place of Settlement: J. Summary of Borrower's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due from Borrower 101. Contract sales price 102. Personal property 103. Settlement charges to borrower (line 1400) 104. 105. Adjustment for items paid by seller in advance 106. City/town taxes 107. County taxes 108. Assessments 109. 110. 111. 112. 120. Gross Amount Due from Borrower 200. Amount Paid by or in Behalf of Borrower 201. Deposit or earnest money 202. Principal amount of new loan(s) 203. Existing loan(s) taken subject to 204. 205. 206. 207. 208. 209. Adjustments for items unpaid by seller 210. City/town taxes 211. County taxes 212. Assessments 213. 214. 215. 216. 217. 218. 219. 220. Total Paid by/for Borrower 300. Cash at Settlement from/to Borrower 301. Gross amount due from borrower (line 120) 302. Less amounts paid by/for borrower (line 220) 303. Cash From To Borrower ( ) to to to to to to 400. Gross Amount Due to Seller 401. Contract sales price 402. Personal property 403. 404. 405. Adjustment for items paid by seller in advance 406. City/town taxes 407. County taxes 408. Assessments 409. 410. 411. 412. 420. Gross Amount Due to Seller 500. Reductions In Amount Due to seller 501. Excess deposit (see instructions) 502. Settlement charges to seller (line 1400) 503. Existing loan(s) taken subject to 3D\RII RI ¿UVW PRUWJDJH ORDQ 505. Payoff of second mortgage loan 506. 507. 508. 509. Adjustments for items unpaid by seller 510. City/town taxes 511. County taxes 512. Assessments 513. 514. 515. 516. 517. 518. 519. 520. Total Reduction Amount Due Seller 600. Cash at Settlement to/from Seller 601. Gross amount due to seller (line 420) 602. Less reductions in amounts due seller (line 520) 603. Cash To From Seller ( ) to to to to to to The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not FROOHFW WKLV LQIRUPDWLRQ DQG \RX DUH QRW UHTXLUHG WR FRPSOHWH WKLV IRUP XQOHVV LW GLVSOD\V D FXUUHQWO\ YDOLG 20% FRQWURO QXPEHU 1R FRQ¿GHQWLDOLW\ LV DVVXUHG WKLV GLVFORVXUH is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. Previous edition are obsolete Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com HUD-1 L. Settlement Charges 700. Total Real Estate Broker Fees Division of commission (line 700) as follows : 701. $ 702. $ 704. 800. Items Payable in Connection with Loan 801. Our origination charge