Settlement StatementA. Settlement Statement U.S. Department of Housing
and Urban Development ir
Citizen's Title & Escrow Co.
OMB No. 2502-0265
B. Type of Loan
1. ❑ FHA 2. ❑ FmHA 3. ❑ " onv. Unins.
4. ❑ VA 5. ❑ Conv. Ins.
6. File Number
CT - 5 0 09 0
7. Loan Number
8. Mortgage Insurance Case Number
JF
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
Richard A. Dasen, Sr.
E. Name and Address of Seller
The City of Kalispell
F. Name and Address of Lender
G. Property Location
Kalispell, Montana 59901
Flathead County, Montana
20-28-21 NW NE 8A
H.SettlementAgent Citizen's Title & Escrow Co, Inc
TIN-81-0380003
Place of Settlement
Box 1310 704 South Main
Kalispell, Montana 59901
I. Settlement Date
7/15/97
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
7 3 8, 7 0 0. 0 0
401. Contract sales price
738,700.00
102. Personal property
402. Personal property
103. Settlement charges to borrower (line 1400)
12.00
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. Cit /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
7 3 8 , 712 . 0 0
420. Gross Amount Due To Seller
738,700.00
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 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/sown taxes to
510. City/town taxes to
211. County taxes to
511, County taxes to
212. Assessments to
512. Assessments to
213. 41513.
214.
514.
215.
515.
216.
516.
217.
517.
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. Gross amount due to seller (line 420)
738,700.00
302. Less amounts paid by/for borrower (line 220)
3 7 , 0 0 0. 0 0
602. Less reductions in amt. due seller (line 520)
( 38,971.00)
303. Cash ❑ From ❑ To Borrower
7 01, 712 . 0 0
603. Cash ❑To ❑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. If you are required to file a return, a negligence
alty or other sanction will be imposed on you if this item is required to be reported
t P, r,; t, s t- t it has not been reported.
_ The Cit Ill" p 1
;Rnc and � .Dasen, Sr. BY'
G IER,'CITY ATTORNEY
Previous Edition is Uosoiete rI . .
DCM0005 Initial(s) FDS (Rev. 12/92) 1-615-361-8404
OMB No. 2502-0265
L Settlemtryt 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. ftems 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 to
806. Mortgage Insurance Application Fee to
807. Assumption Fee to
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. Flood Insurance Premium for 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. Flood Insurance months @ $ per month
1007. months @ $ per month
1008. months @ $ per month
1009. months @ $ per month
1010. months @ $ per month
1100. Title Charges
1101. Settlement or closing fee to Citizen's Title & Escrow Co, Inc 100.00P.O.C. (b)
100.00
1102. Abstract or title search to
1103. Title examination to
1104. Title insurance binder to
1105. Document preparation to
1106. Notary fees to
1107. Attorne 's fees to
(includes above item numbers: j
1108. Title insurance to Citizen's Title & Escrow Co, Inc
1,871.00
(includes above item numbers:
1109. Lender's coverage $
1110. Owner's coverage $ 1,871.00 for $738,700.00
1111.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Recording fees: Deed $ 12. 00 ; Mortgage $ ; Releases $
12.00
1202. City/county tax/stamps: Deed $ ; Mortgage $
1203, State tax/stamps: Deed $ ; Mortgage $
1204. Miscellaneous Recording Fees
1205. Miscellaneous Recording Fees
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)
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
asen, r. The Cilt4 a s ell
By:
GL ,EY
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 can include a fine or imprisonment. For details
see: Title 18 U.S. Code Section 1001 and Section 1010.
Initial(s)� C- 5 0 0 9 0 FIRST DATA SYSTEMS, INC. HUD-1, REV. (3/86)
DCM0006 FDS (Rev. IM21 1.615-361-8404