HomeMy WebLinkAbout10-11249 CITY OF ZEPHYRHILLS
5335 - 8T1-1 STREET
(813)780 -0020 11249
BUILDING PERMIT
P ermi t Number: 11249 Address: 5453 12TH ST
Permit Type: DEMOLITION ZEPHYRHILLS, FL.
Class of Work: 636- DEMOLITION Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11- 26 -21- 0010 - 13800 -0050
Improv. Cost: 500.00
Date Issued: 12/02/2010 Name: POTWIN, ANTHONY W.
Total Fees: 75.00 Address: 5453 12TH ST
Amount Paid: 75.00 ZEPHYRHILLS, FL. 33542
Date Paid: 12/02/2010 Phone: (813)788 -1896
Work Desc: DEMOLITION OF SINGLE FAMILY DWELLING
1 To 1 I.' 75.s.
h .---;-- il 0
'
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
z _."-- -,,-,- -- • 66g.- 2 , /., ,
- i 4 -- G • / - -,: / ,
CONT- • CTOR SIGNATURE PERMIT OFFI 'R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
813- 780 -0020 City of Zephyrhills Permit Application Fax- 813- 780 -0021
Building Department
Date Received
Phone Contact for Permittin
Owner's Name ' � v -
/? �pi ! /� Gv Owner Ph a Number. r /
Owner's Address Owner Phone Number I 5'/.-e— 7 7 k
Fee Simple Titleholder Name . I./172 J G j �i> / 7 J jai - j) Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS / q 5 3 5t }
L LOT #
1
SUBDIVISION PARCEL ID# — 2 7 _ / — O J / C3 / _- Jb 5 v
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN pi [V DEMOLISH
INSTALL REPAIR
PROPOSED USE I SFR n COMM I I OTHER I
TYPE OF CONSTRUCTION fiSn BLOCK rszi FRAME L STEEL I] 1
DESCRIPTION OF WORK = . J 07,i)e. ,
BUILDING SIZE SQ FOOTAGE ) (J C/ HEIGHT I
14BUILDING $:. VALUATION OF TOTAL CONSTRUCTION
I1ELECTRICAL $ AMP SERVICE I I PROGRESS ENERGY I W.R.E.C.
I IPLUMBING
1 (MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION .mil J /
I IGAS h ROOFING [1 SPECIALTY I 1 OTHER /
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA I YES
BUILDER : _
COMPANY Gam.' L�
SIGNATURE 4:-. i. '"Z ` �i C �� -t REGISTERED 1 Y / N I FEE C tREI I ¥/N I
Address License # 1
ELECTRICIAN COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREI I Y/ N I
Address I License # I
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREI I Y/ N I
Address License # I
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N J FEE CURREN 1 Y/ N I
Address I License # I
OTHER COMPANY
SIGNATURE REGISTERED I Y/ N I FEE CURREI I Y/ N I
Address License # I
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R -O -W Permit for new construction,
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions /large projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms. R -O -W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance
SIGN PERMIT Attach (2) sets of Engineered Plans.
* ** *PROPERTY SURVEY required for all NEW construction.
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (A/C upgrades over $7500)
** Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades NC Fences (Plot/Survey /Footage)
Driveways -Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division — Licensing Section at 727 -847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT /UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89 -07 and
90 -07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water /Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law — Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner ", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the "owner" prior to commencement.
CONTRACTOR'S /OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions 1 must take to be in compliance. Such agencies include but are not limited to:
Department of Environmental Protection - Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District - Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers - Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services /Environmental Health Unit - Wells, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency- Asbestos abatement.
- Federal Aviation Authority- Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone "V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A ", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03) ' J
C_ OWNE AGENT] J 4i J 7 sf vac :! C ONTRACTOR-
scribed and sworn t. (or a " ed) bdore - s Subscribed and sworn to (or affirmeHH) before
/
- -2 - /12 by 1. AI. , s
' r �{, y
Who is /are.pgrsonaIl known o me or has/have produced Who is /are personally known to me or has /have produced
)` < r /,_./ as identification. as identification.
�- � �� a t. ,. 61 "`C� Notary Public
Commission No. Commission No.
BOBBIE S. SWETLAND
ed Name of Notary typed, printed or stamped
AO
` ` Bonded Thai Troy Fain Insurance 800-385-7019
Map - Pasco County Property Appraiser Page 1 of 1
Pasco County, Florida Section 11, Township 26, Range 21, 0.4 miles NE of Zephyrhills
Mike Wells r A. 1
y
Mil .., , MB
AIIMMIIMIII. 10
lik lot
When I click on the map: "\
;_j Quick Info
, 030
, Full Info*
!(? Zoom In 1.5x s,
Choose Layers: o
-- Parcel Lines (Default)
■
-- Parcel Labels (Automatic) .
Street Names (Automatic) 321) 2009 1 ft - Color ] � r y' "
-- Select Additional Layer t .
-- Select Grouping
•
D. raw i Help Print] f i
Image Size / Quality: ....
00000
. x y 1 01 0
(Quality applies if !nagery is selected)
Low Quality (Fast / JPEG)
Links of Interest:
■ ■ 4
Recent Sales in this area
Search for property in Pasco M N
Map Search 495 Feet
MapIDO 11028659/4423
Street name information is maintained by the Pasco County BOCC GIS
Department.
http: / /maps.pascogov.com /maps /showmap. asp? Name= PascoMap_New &mdi= 11028659 &... 12/2/2010
Pasco County Parcel: 11- 26 -21- 0010 - 13800 -0050 001 Page 1 of 2
Data Current as Of: II Weekly Archive - Saturday, November 27, 2010
I Parcel ID ,
I Classification 11 01 - Single Family
Mailing Address Property Value
POTWIN ANTHONY W & CHARLENE Ag Land $0
5449 12TH ST Land $25,326
ZEPHYRHILLS FL 33542 -4317 Building $36,124
Physical Address Extra Features $738
5453 12TH ST
ZEPHYRHILLS FL 33542 -4317 Market Value $62,188
Legal Description (First 4 Lines) Assessed (Non - School Amendment 1) $62,188
See Plat for this Subdivision .1' Taxable Value $62,188
ZH PB 1 PG 54 LOTS 5 6 & 7
INCL BLK 138
OR 8454 PB 1603
Land Detail (Card: 001 of 001)
Line it Use I°Descriptionll Zoning (i Units II Type (I Price I° Condition II Value
1 II 0100 II SFR I 00R4I 8,400.00 (l SF II $2.84 II 1.00 II $23,856
2 II 0100 a SFR 0 00R4 II 4,200.00 11 SF 0 $0.35 0 1.00 II $1,470
Additional Land Information
Acres II 0.29 0 Tax Area 0 30ZH II FEMA Code II X °Residential Codel) ZHLHLP2
Building Information - Use 01 - Single Family Residential (Card: 001 of 001) I
Year Built 1945 Stories 1.0
Exterior Wall 1 Average Exterior Wall 2 Concrete or Cinder Block
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Pine or Soft Wood Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 1.0
Line Description ( Sq. Feet Repl. Cost New
1 UOP ] 42 $262
2 FEP 279 $8,522
3 USP 63 $830
4 FOP 72 $787
5 UCP 264 $1,748
6 BAS 480 $20,976
7 U DG 1,008
$13,197
8 UDU 460 $6,031
Extra Features (Card: 001 of 001)
Line ii Description i 1986 II 320 I Value
1 DWA ° $233
2 11 UDU -M ( 1977 II 1 ° $505
Sales History
Previous Owner YOUNG MARY L
Year II Month I Book /Page II Type II Amount
2010 10 ( 8454 / 1603 0 WD II $34,000
l 2010 1 II 2 0 8454 / 1601 $0
I 2009 l 12 I 8238 / 1639 lI 2 (I $0
http: / /www. appraiser. pascogov .com /search/parcel.aspx ?sec =11 &twn= 26 &rng =21 &sbb =0... 12/2/2010
A. U. S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT B TYPE OF LOAN
Sunstate Title Agency, Inc.
I • I I FHA 2. I J FMHA 3. CONV. UNINS.
13937 7th Street
Dade City, Florida 33525 a. ❑ VA s. I CONV. INS.
352 - 567 -1141 fax: 3 52-567-3830
6, File Number:
7. Loan Number:
S -28461
8. Mortgage Ins. Case No.:
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
.oc were .aid outside the closin •. The are shown here or in ormational .ur.oses and are not included in the totals.
D. Bu er: ANTHONY W. POTWIN and C
E. Seller: MARY L. YOUNG, a married woman
POTWIN, his wife
F. Lender:
5453 12th Street
G. Property: Zephyrhills, Pasco County, Florida 33542
Section 11, Township 26, Range 21, Lot 5, 6 & 7, Block 138, CITY OF ZEPHYRHILLS (formerly To of
Ze•hyrhills), Book 1, Page 54, Pasco County, Florida
H. Settlement Agent: Sunstate Title Agency, Inc.
Place of Settlement: 13937 7th Street, Dade City, Florida 33525 Pasco County
I. Settlement Date: October 26, 2010
J. Summary of Buyer's Transaction
K. Summary of Seller's Transaction
100. Gross Amount Due From Bu er:
101. Contract Sales Price 400. Gross Amount Due To Seller:
102. Personal Property 34,000.00 401. Contract Sales Price
103. Settlement Char: es to Bu er (line 1400 402. Personal Pro •erty 34,000.00
104. _ 168.50 403.
105. 404.
Ad'ustments for Items Paid b Seller in Advance: 405.
Ad'ustments for Items Paid b Seller in Advance:
106. Ci / Town Taxes
107.
250.56 407.
County /Parish Taxes ($1,365 406. Ci / Town Taxes
2010 thru Dec 31, 2010 e) Oct 26,
County nty Parish Taxes ($1,365
yr e) Oct 26,
108. Assessments 2010 thru Dec 31, 2010 250.56
109. 408. Assessments
110. 409.
120. Gross Amount Due from Bu er: 410.
34,419.06 420. Gross Amount Due to Seller:
200. Amounts Paid b or in Behalf of Bu er: 34 250.56
500. Reductions in Amount Due to Seller:
201. De aosit / Earnest Mone
202. Princi al Amount of New Loan 500.00 501. Excess De a osit see instructions)
203. Existing Loan(s) 502. Settlement Char:es to Seller (Line 1400
204. 503. Existin: Loan s 3,892.57
205. 504. Payoff of First Mort • a • e
206. 505. Payoff of Second Mortga. e
Ad'ustments for Items Un I aid b Seller: 506. Purchase Money Mort:a:e
210. City /Town Taxes Ad'ustments for Items Un • aid b Seller:
211. County / Parish Taxes 510. City / Town Taxes
212. Assessments 511. County / Parish Taxes
213. 512. Assessments
214. 513.
220. Total Paid b / for Bu er: 514.
500.00 520. Total Reductions in Amount Due Seller:
300. Cash at Settlement from / to Bu er: 3,892.57
301. Gross Amount due from Buyer line 120) 600. Cash at Settlement to / from Seller:
34,419.06 601. Gross Amount due to Seller ine 420
302. Less Amount Paid by /for Buyer (line 220) 34,250.56
500.00 602.
Less Amount due Seller (line
3,892.57
303. Cash From Buyer:
$33,919.06 603. Cash To Seller:
$30,357.99
Settlement Date:October 26, 2010 File Number: S -28461
L. Settlement Charges
700. Total Sales / Broker's Commission: Paid from Paid from
Based on Price $34,000.00 @ 6.00% = $2,040.00 Buyer's Seller's
Division of Commission as follows Funds at Funds at
701. 2,040.00 to COLDWELL BANKER/PENCY OWENS REALTY Settlement Settlement
702.
703. Commission Paid at Settlement 2,040.00
800. Items Payable in Connection with Loan:
801. Loan Origination Fee
802. Loan Discount
803. Appraisal Fee
804. Credit Report
805. Lender's Inspection Fee
806. Mortgage Insurance Application Fee
807. Assumption Fee
900. Items Required by Lender to be Paid in Advance:
901. Daily interest charge from Oct 26, 2010
902. Mortgage Insurance Premium
903. Hazard Insurance Premium
904. Flood Insurance Premium
905. Winstorm Insurance
1000. Reserves Deposited with Lender:
1001. Hazard Insurance
1002. Mortgage Insurance
1003. City Property Taxes
1004. County Property Taxes
1005. Annual Assessments
1006. Flood Insurance
1007. Windstorm Insurance
1100. Title Charges:
1101. Settlement or Closing Fee to Sunstate Title Agency, Inc. 150.00 150.00
1102. Abstract or Title Search to Sunstate Title Agency, Inc. 150.50
1103. Title Examination
1104. Title Insurance Binder
1105. Document Preparation
1106. Notary Fees
1107. Attorney Fees
(includes above item numbers:
1108. Title Insurance to Sunstate Title Agency, Inc.
(includes above item numbers: 195.50
1109. Lender's 0.00
Coverage
1110. Owner's 34,000.00 Risk Rate Premium: 195.50
Coverage
1200. Government Recording and Transfer Charges:
1201. Recording Fees: Deed 18.50 Mortgage 0.00 Releases 0.00 18.50
1202. City /County Tax/Stamps: Deed 0.00 Mortgage 0.00
1203. State Tax/Stamps: Deed 238.00 Mortgage 0.00 238.00
1204. Intangible Tax to Clerk of the Circuit Court
1205. Record death certificate and corrective QCD to Clerk of the Circuit Court 28.50
1300. Additional Settlement Charges:
1301. Survey
1302. Pest Inspection
1303. Real Estate Taxes 2010 (est. -hold in escrow until 11/1/10) ($1400 est - $309.93 partial
payment) to Mike Olson Tax Collector 1,090.07
1304.
1305.
1306. UPS/Handling/Mortgage Payoff
1307.
1400. Total Settlement Charges (Enter on line 103, Section J and line 502, Section K) $168.50 $3,892.57
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 transaction. I further certify that I have received a copy of HUD -1 Settlement Statement.
901. Daily interest charge from Oct 26, 2010
902. Mortgage Insurance Premium
903. Hazard. Insurance Premium
904. Flood Insurance Premium
905. Winstorm Insurance
1000. Reserves Deposited with Lender:
1001. Hazard Insurance
1002. Mortgage Insurance
1003. City Property Taxes
1004. County Property Taxes
1005. Annual Assessments
1006. Flood Insurance
1007. Windstorm Insurance
1100. Title Charges:
1101. Settlement or Closing Fee to Sunstate Title Agency, Inc.
1102. Abstract or Title Search to Sunstate Title Agency, Inc. 150.00 150.00
1103. Title Examination 150.50
1104. Title Insurance Binder
1105. Document Preparation
1106. Notary Fees
1107. Attorney Fees
(includes above item numbers:
1108. Title Insurance to Sunstate Title Agency, Inc.
(includes above item numbers: 195.50
1109. Lender's
Coverage 0.00
1110. Owner's
Coverage 34,000.00 Risk Rate Premium: 195.50
1200. Government Recording and Transfer Charges:
1201. Recording Fees: Deed 18.50 Mortgage 0.00 Releases 0.00 18.50
1202. City/County Tax/Stamps: Deed 0.00 Mortgage
1203. State Tax/Stamps: 0.00
P Deed 238.00 Mortgage 0.00 238.00
1204. Intangible Tax to Clerk of the Circuit Court
1205. Record death certificate and corrective QCD to Clerk of the Circuit Court
1300. Additional Settlement Charges: 28.50
1301. Survey
1302. Pest Inspection
1303. Real Estate Taxes 2010 (est. -hold in escrow until 11/1/10) ($1400 est - $309.93 partial
payment) to Mike Olson Tax Collector 1,090.07
1304.
1305.
1306. UPS/Handling/Mortgage Payoff
1307.
1400. Total Settlement Charges (Enter on line 103, Section J and line 502, Section K) $168.50
$3,892.57
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 transaction. I further certify that I have received a copy of HUD -1 Settlement Statement.
Buyer: / /iG �� Cv' r� 1� ��ut�► �_ v
ANTHONY W. P c WIN Seller:
MARY L. YO01■115.
Buyer: a."..1
ENE
�
A POTWIN
The HUD -1 Settlement Statement which I ha e prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in
accordance with this statement. //
Settlement Agent: Date: October 26, 2010
SUNSTATE TITLE
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.
HUD - 1 May 2007
October 25, 2010 6:32 PM OMB No. 2502 - 0265
RESPA handbook 4305.2