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Florida Insurance Premium Disclosure&Settleinent Agent Certification Agency File#16-4747 Closing Date: 8/30/2016 i � You are being given this form and certification to explain differences between Federal and Florida law.Federal law requires the costs oFthe policies to be calculated using the full premium for the lender policy.Florida law allows the premium'for the lender's policy to be calculated using a lower rate when purchased along with an owner's policy IFbo[h an owners policy and a lenders policy are being purchased,the ritle insurance premiums on this form might differ from the premiums on the Closing Disclosure.The owner's policy premium listed on the Closing Disclosure will probably be lower than on this form,and the lender's policy premium will probably be highcr. The chart below lists[he amount disdosed by the lender and the premium For the policies being purchased.These amounts include the charges for endorsemen[s to the policies: Closing Dlsclosure Amaunt Florida Premium Bu er + Scller Bu er � Seller (a) Lender s olic : I 35.00 25•00 (bJ Lender's Endorsemen[s 93.75 92.75 (c) Lender's Policy Total: j 117.75 j 117.75 (d) Owner's Policy i G52.50 652.50 (e) �wner's Endorsements: � (� Owrier's Policy Total: 652.50 652.50 Total All Policies c+ : __ 770.25 __ _ .^ 770.25 The total dollar amount for the policies as disclosed on this form should be equal to the total premium calculated using the Florida Insurance Code. The Florida Premium amounts listed above will be used to disburse the funds from the title agency's escrow account to(Name of Insurer)and(Name of Title Agency). The undersigned hereby cer[ify that they have carefully reviewed the Closing Disclosure or other settlement statement form,and tliey approve and agree to the payment of all fees,costs,expenses and disbursement as reflected on the Closing Disclosure or other settlement statement form to be paid on their behalf.We further certify that we have received a copy ofthe Closing Disclosure or other settlement statement. � , ' Zb1 � _— Bfli b�!��e1�4a�'�"g'w�f+Jo:�l�f Buyer�QaT4l��Iff�. [3uycr/I�orrower n ��rc Date Signed as A�+:��n';?-�r�-►-��Gr Federal National Mnrt�i�na at�;t�rl��lon alkla Fannie Mae l�R�►�Ki�6CR'� �e�er Printed Name BuyedBorrower Printed Name ;� � �'�i a� / Seller Signature Date Signed uyerBorrower Si na Gr Date Signed � y %' Seller Printed Name uyerBorrower Pri te ume Settlement Agent Certification 1 have revlewed the Closing Disclosure,�he settlement statement,the lender's closing instructions and any and all other forms relative to[he escrow fund,including any disclosure of the Florida Title lnsurance premiums heing paid,an 1 agree to disburse the escrow Fund in accordance with the terms of this transaction and Florida]aw Settlement Agent Stgnature Da�e Signed t Liz Miranda Settlement Agent Name Florida License Number BuVer's Title,Inc. D005069 Title Agency Holding Funds Florida License Number Form DFS-H1-2146(Effective 10/3/2015 69B-186.008,F.A.C. � - - -