Settlement Statement�iifi 6r ! 'N
A. ;�ttlement Statement U.S. Deparhnent of Housing
and Urban Development
Citizen's Title & Escrow Co.
OMB No. 2502-0265
B. T e of Loan
t. () FHA 2. ❑ FmHA 3. ❑ " onv. Unins.
4. ❑ VA 5. ❑ Conv. ins.
e. Fie Number
CT - 50 09 0
7. Loan Number
87Fps kasa d aumnoe CNurrtw
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. tame end Address or aormo
Richard A. Dasen, Sr.
E. Name and Address of Safer
The City of Kalispell
F. Nmu and Address d Lw1dw
G. P,op.dy Location
Kalispell, Montana 59901
Flathead County, Montana
20-28-21 NW NE 8A
H. Setd-d Agem Citizen's Title & Escrow Co, Inc
TIN-81-0380003
Mace of 3eteamerrt
Box 1310 704 South Main
Kalispell, Montana 59901
117seftl-WW.
7/15/97
J. Summary of Borrowers Transaction
K. Summary of Sellses Transaction
100. Gross Amount Due From Borrower
400. Gross Amount Due To Seller
101. Contract sales price
738,700.00
401. Contract sales price
738,700.0O
102- Personal property
402. Personal properly
103- Settlement charges to borrower line 1400)
12.0 0
403.
104.
404.
105.
405.
Adjustments for items paid by seller in advance
Adjustments for Items paid by seller In advance
106. Cif Mown 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.
ill.
411.
112.
412,
120. Gross Amount Due From Borrower
7 3 8 , 712 . 0 0
420. Gross Amount Due To Seller
73 8 , 70 0. 0 0
200. Amounts Paid By Or In Behalf Of Borrower
500. Reductions In Amount Due To Seller
201. Deposit or earnest money
37, 000. 00
501. Excess deposit see instructions)
37, 000. 00
202. Principal amount of new loan(s)
502. Settlement charges to seller (line 1400)
1,971.00
203. Existing loans taken subject to
503. Existing loans taken su 'ect 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, Cif/town taxes to
610. Cif/town taxes to
'211. County taxes to
511. County taxes to
212. Assessments to
512. Assessments to
213.
513.
214.
614,
215.
515.
216.
516.
217,
W.
218.
518.
219.
519,
220. Total Paid By/For Borrower
37,000.00
520. Total Reduction Amount Due Seller
38,971.00
300. Cash At Settlement From/To Borrower
600. Cash At Settlement To/From Seller
301. Gross amount due from borrower (line 120)
7 3 8 , 712 . 0 0
601. Grass amount due to seller (line 420)
738,700.00
302. Less amounts paid by/for borrower line 220)
37,000.00
602. Less reductions in arm. due seller line 520
38,971.00
303. Cash E) From 0 To Borrower
701,712.00
603. Cash EITo ❑From Seller
699,729.00
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained in Blocks E, G, H and I, lines
401 (or, if line 401 is asterisked, lines 403 and 404), 406, 407 and 408-412 (applicable part of
buyer's real estate tax reportable to the IRS) is important tax information and is being
furnished to the Internal Revenue Service. I£ you are reuired to file a return, a negligence
penalty or other sanction will
nreportedthis item is required to be reported
be imposed not on
The Cit K.
R c and Dasen, sr. BY
G IER, C,3TY ATTORNEY
1,-ious Edlucn¢ OosN.te VIMbi UA:A bTbILMJ. nU. HabHA. Hd QU54 HUU-1 HLV. i -b)
]CM0005 im; a;si _. , FDS ,Rev. 1252) 1-615.3614404
14
L,,, 8�tnao.ec Ca1a
700.To1elSsMsrBrokersCommtsafonbesedon i
PaidFram
Borrower's
Fund: ai
Sotdemert
PidFran
SWIVS
Funds at
S"Went
Diviciat of Carinision Ana 700 as foAowa:
701. i to
701S to
703. Commission paid at Settlement
704.
NO. Ilan s; "ble In Connection With Loan
801.1oen Originationi Few %
a 2 Loan Disowrd %
803 AWaisal Fee to
ON. Credit Report to
85. Lsnder'a Fee to
11011, Mortgage Insurance Application Fee to
l07. AssuriVeon Fee to
am
809.
alm
aBl l _
WM items By Lender To Be Paid In Advance
901. Interest from to @ $ /da
902 fillortgagio Insurance Premium for months to
9D3. Hazard Insurance Premium for years to
904. Flood Insurance Premium for years to
90&
1000. Reserves Deposited With Lender
1001. Hazard irsurance months @ $ per month
1002. Mortgage insurance months @ $ per month
1003. City property taxes months @ $ per month
1004. Cam taxes months @ $ per month
1005. Annual Assessments months @ $ per month
1006. Flood Insurance months @ $ per month
1007- months @ $ per month
1008. months @ $ per month
1009. months @ $per month
1010. months Per month
1100. This Char
1101.Sealemer;orclosing lee to Cl-'_Z2 'S = le & c9cro _'7nC
1102. Abstracl or title search to
1103. Title examinailon to
1104. Tide insurance bender to
1105. Document preparation to
1106. Notary fees to
1107. Atiorne 's tees to
(includes above item numbers: j
1108. Title insurance to Citizen's Title Escrow Co, Inc
1,871.00
(includes above item numbers:
1109-Lendoescoverage $
1110.Owner's cov e $ 1,871.00 for $738,700.00
1111.
1112
1113-
1200. Govermnent Recording and Transfer Charges
12ot. Recordi tees: Deed $ 12.00 ; Mors age $ ; Releases $
12.00
12OZ City/countyCity/county lax/stamps: Deed $ ; Mortgage $
1203. State laxti : Deed $ ; Mortgage $
1204. Miscellaneous Recording Fees
1205- Miscellaneous Recording Fees
1300. Additional Settlement Char es
1301. Stxvey to
1302. Pest Irmpect1cm to
1303.
1304.
1305-
1400-Total Settlement Charges (enter on Imes 103, Section J and 502, Section K)
12.00
1,971.00
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and
belief, it is a true and accurate statement of all receipts and disbursements made on my account
or by me in this t tion I further certify that I have received a copy of HUD-1 Settlement
S
A asen, r. The Cit a s e11
GL ,
To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and
accurate account of the funds which were received and have been or will be disbursed by the
undersigned as part of the settlement of this transaction.
Settlement Agent Date july 15. 1997
WARNING: it is a crime to knowingly make false statements to the United States on this or any
other similar form. Penalties upon conviction car, include a fine or imprisonment. For detai';s
see: _it= 18 U.S. code Ser.tio;: i001 and Section 1020.