Exhibit H - Closing DocumentsA. Settlement Statement U.S.DUrban epar>rrgilofHousi
Citizen's Title & Escrow Co. and ir
0W W. 2502-0265
S. Type of Loan
1. ❑ FHA 2. ❑ FmHA 3. [ " •xtv. Units.
4. ❑ vA 5. ❑ Conv. Its.
0. Fie Number
CT - 5 0 0 9 0
7. Loan Nwnber
I. Mort w Murano Cam Nund w
JF
C. We: This form is finished to give you a statement of actual settlement costs. Amounts paid to and by the ssloment agam we
shown. items marked '(p.o.c.)' were paid outside the dosirtg; they are shown here for infonnattoonal purposes wW we riot
Included in the totals.
D. Nwrr and Addn m d Somvvw
Richard A. Dasen, Sr.
E. Nsmf and Address of War
The City of Kalispell
F. Nwn and Addrms of Lwdw
a-Pwp'"yLOcamn
Kalispell, Montana 59901
Flathead County, Montana
20-28-21 NW NE 8A
Rsetsam"'Aqwd Citizen's Title & Escrow Co, Inc
TIN-81-0380003
plow ofsawwwo
Box 1310 704 South Main
Kalispell, Montana 59901
LsemwnwdDo*
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 Erice
7 3 8, 7 0 0. 0 0
401. Contract sales price
7 3 8, 7 0 0. 0 0
102- Personal properly
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_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.
11i.
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 ban(s)
502. Settlement charges to seller (line 1400)
1,971.00
203. Existing loan(s) taken subject to
503. EAstin 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 un aid by seller
Adjustments for Items unpaid by seller
210. Cat/town taxes to
510. Cat/town taxes to
211. County taxes to
511. County taxes to
212. Assessments to
512. Assessments to
213.
513.
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 Seiler
301. Gross amount due from borrower (line 120)
738,712.00
601. Gross 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 amt. due seller (line 520)
3 8 , 9 71.0 0
303. Cash El From ❑ To Borrower
7 01, 712 . 0 0
603. Cash EITo ❑From Seller
699,729.00
SUBSTIT'JTE 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
penalty or other sanction will be imposed on you if this item is required to be reported
and s t it has not been reported.
The Cit 1
_. c and Dasen, Sr. By•
G IER,ITY ATTORNEY
Prew;,„s E 5 O.,_r'e:F� r.Hb, UA A SYS --VS.'..,. Pc.SPA,H@ 4'1,;5.2 HJCI RE, .
DCMJC�_ ., _ PCS e, 7-S2 :-
L SettiemM Chares
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 to Connection With Loan
SDI. Loan Or' "nation Fee %
OO2. 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 @ $ /da
902 Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for yearslo
904. Flood Insurance Premium for yearsto
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 Co-) $ per month
1100. Title Charges
1101. Settlement or closing fee to Citizen's Title & Escrow Co, Inc 100.00P.C.C. (b)
100.00
1102. Abstract or title search to
1103. Title examination to
1104_ Title insurance binder to
11055. 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
t11t_ '
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 taxist : 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 the in this t etion I further certify that I have received a copy of HUD-1 Settlement
��asen, r. The Cit a s ell
By:
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 can include a fine or imprisonment. For details
see: Title 18 U.S. Code Section 1001 and Section 1010.
Inha!(s) _ CT 50090 FIRST DATA SYSTEMS, INC. _=n.�, REV. ;3 86,
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