NAME AND ADDRESS OF BORROWER Name Address City State Zip PROPERTY LOCATION Name Address City State Zip Settlement Agent SUMMARY OF BORROWER’S TRANSACTION 100. GROSS AMOUNT DUE FROM BORROWER: 101. Contract Sales Price 103. Settlement charges to borrower (line 1400) Adjustments for items paid by seller in advance 106. City/town taxes to 107. County taxes to 108. Assessments to 109. Condo Fees to 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 201. Deposit of earnest money 202. Principal amount of new loan(s) 203. Existing loan(s) taken subject to Adjustments for items unpaid by seller 210. City/town taxes to 211. County taxes to 212. Assessments to 213. Condo Fees to 215. 216. SETTLEMENT CHARGES ITEMS PAYABLE IN CONNECTION WITH LOAN 801.Loan Origination Fee Input Percent Decimal Range 0-6% 802. Loan Discount Input Percent Decimal Range 0-6% % 803. Appraisal Fee 804. Credit Report 805. Lender’s Inspection Fee 806. Underwriting Fee 807. Tax Service Fee 808. 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 902. Mortgage Insurance Premium 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard Insurance Input Hazard 2 months @ $ Hazard/12 per month 1002. Mortgage Insurance Input MI 2 months @ $ MI/12 per month 1003. City property taxes Input Total Taxes 4 months @ $ Total Taxes/12 per month 1004. County property taxes months Input Total Taxes @ $ Total Taxes/12 per month 1100. TITLE CHARGES 1101. Settlement or closing fee 1104. Title insurance binder 1113. Courier Fee 1300. ADDITIONAL SETTLEMENT CHARGES 1301. Survey 1303. HOA Management Transfer Fee