B. Type of Loan
U.S. Department of Housing
and Urban Development
|OMB No. 2502-0265|
3. Conv. Unins.
5. Conv. Ins.
|6. File Number
|7. Loan Number||8. Mortgage Insurance Case Number|
|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 information purposes and are not included in the totals.
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 and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010.
|D. NAME OF
BORROWER: John T. Readybuy and Mary A. Readybuy
E. NAME OF
Thomas T. Moneysell and Betty E. Moneysell
F. NAME OF
Cash Flow Mortgage Co.
ADDRESS: 123 ABC Street, Frederick, Maryland
Lot 1, "NEW HOME SUBDIVISION"
Principal Residence Other Real Estate
AGENT: KEYSTONE TITLE SETTLEMENT SERVICES, INC.
PLACE OF SETTLEMENT: 60 A Thomas Johnson Drive, Frederick, MD 21702
|I. SETTLEMENT DATE: 12/31/2006|
|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||100,000.00||401 Contract sales rice||100,000.00|
|102 Personal Property||402. Personal Property|
|103. Settlement charges to borrower (Line 1400)||6.004.24||403|
|Adjustments for items paid by seller in advance||Adjustments for items paid by seller in advance|
|106 City/Town taxes||406. City/Town taxes|
|107. County taxes 12/31/2005 to 06/30/2006||941.90||407 County taxes 12/31/2005 to 06/30/2006||941.90|
|108 H0A Dues/Condo Dues 12/31/2005 to 06/30/2006||124.65||408. HOA Dues/Condo Dues 12/31/2005 to 06/30/2006||124.65|
|120. GROSS AMOUNT DUE FROM BORROWER||107, 070.79||420. GROSS AMOUNT DUE TO SELLER:||101, 066.55|
|200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER||500. REDUCTIONS IN AMOUNT DUE TO SELLER|
|201. Deposit or earnest money||2,000.00||501 Excess Deposit see Instructions|
|202 Principal amount of new loan(s)||99,500.00||502. Settlement charges to seller (Line 1400)||7,208.00|
|203 Existing loan(s) taken subject to||503. Existing loans taken subject to|
|204.||504. Payoff of First Mortgage Loan||98,052.20|
|205.||505. Payoff of Second Mortgage Loan|
|206||506. Final Water Bill||98.25|
|207.||507. SECURE RELEASE||100.00|
|Adjustments for items unpaid by seller||Adjustments for items unpaid by seller|
|210 City/Town taxes||510. City/town taxes|
|211. County taxes||511 County taxes|
|212 HOA Dues/Condo Dues||512. HOA Dues/Condo Dues|
|220. TOTAL PAID BY/FOR BORROWER||101, 500.00||520. TOTAL REDUCTION AMOUNT DUE SELLER||105, 458.45|
|300. CASH AT SETTLEMENT FROM OR TO BORROWER||600. CASH AT SETTLEMENT TO OR FROM SELLER|
|301. Gross amount due from borrower (line 120)||107,070.79||601. Gross amount due to seller (line 420)||101,066.55|
|302 Less amounts paid by/for borrower (line 220)||101,500.00||
602 Less reduction amount due seller (line 520)
|303. CASH FROM BORROWER||5, 570. 79||603. CASH FROM SELLER||4,391.90|
SUBSTITUTE FORM 1099 SELLER STATEMENT: The information contained herein 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 the IRS determines that it has not been reported. The Contract Sales Price described on line 401 above constitutes the Gross Proceeds of this transaction.
SELLER INSTRUCTIONS: If this real estate was your principal residence, file Form 2199, Sale or Exchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form 4797, Form 6252 and/or Schedule D (Form 1040).
You are required by law to provide KEYSTONE TITLE SETTLEMENT SERVICES, INC. with your correct taxpayer identification number. If you do not provide your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law, and Under penalties of perjury. I certify that the number shown on this statement is my correct taxpayer identification number.
TIN:_________________ / ___________________
SELLER 1 SELLER 2
SELLER(S) SIGNATURE(S): _______________________ / ________________________
SELLER 1 SELLER 2
Go to Sample Settlement Statement (Page 2)
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