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<br />HUD-1
<br />A. Seitlement Statement
<br />
<br />B, Type of Loan
<br />
<br />U.S. Department of Housing
<br />and Urban Development
<br />
<br />OMB No. 2502-0265
<br />
<br />() 1. FHA
<br />() 4. VA
<br />
<br />7. Loan Number
<br />609444-40
<br />
<br />() 2. FmHA () 3, Conv, Unins.
<br />. 5. Conv, Ins.
<br />
<br />6. FiJe Number
<br />03-12-46
<br />
<br />8, Mortg, Ins. Case Num.
<br />
<br />C, NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the selt/ement agent are shown, Items
<br />marked "(p,o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
<br />
<br />10:
<br />
<br />D. NAME OF BORROWER:
<br />Address of Borrower:
<br />
<br />E, NAME OF SELLER:
<br />Address of Seller:
<br />
<br />F, NAME OF LENDER:
<br />Address of Lender:
<br />
<br />G. PROPERTY LOCATION:
<br />
<br />H, SETTLEMENT AGENT:
<br />Place of Settlement:
<br />
<br />I. SETTLEMENT DATE:
<br />
<br />Jason R. Petty and Kathryn Petty, his wife
<br />6504 Huntington Drive, Zephyrhills, Florida 33541
<br />
<br />Stephanie L. Nelson f/kJa Stephanie L. Brown, a married woman, joined by her husband, David Nelson
<br />38847 Alston Avenue, Zephyrhills, Florida 33542 TIN: 226-96-3822
<br />
<br />GTE Federal Credit Union
<br />711 S. Dale Mabry Highway, Tampa, Florida 33609
<br />
<br />39013 1 st Ave, Zephyrhills, Florida 33542
<br />
<br />Meridian Title Company, Inc.
<br />37837 Meridian Avenue, Suite 311, Dade City, Florida 33525
<br />
<br />1/9/04 DISBURSEMENT DATE: 1/9/04
<br />
<br />TIN: 59-3597293
<br />
<br />Phone:
<br />
<br /> . , . . . . .
<br />II . . . . , . . . . ,. . . . , . . .
<br />101. Contract sales price 56,100,00 401. Contract sales price 56,100,00
<br />102. Personal property 402. Personal property
<br />103, Settlement charges to borrower (Line 1400) 2,189,18 403.
<br />104. 404.
<br />105. 405,
<br />. , . , I. . . . , . . , , . too. . ,.
<br />106, City/town taxes 406. City/town taxes
<br />107. County taxes 407. County taxes
<br />108. Assessments 408. Assessments
<br />109. , 409.
<br />110, 410.
<br />111. 411.
<br />112. 412.
<br />120. Gross amount due from borrower: 58,289.18 420. Gross amount due to seller: 56,100.00
<br />.. . . I. . . , . . I . . .. . , I I . . . .
<br />201. Deposit or earnest money 300,00 501. Excess deposit (see instructions)
<br />202. Principal amount of new loan(s) 50,490,00 502. Settlement charges to seller (line 1400) 7,267.28
<br />203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
<br />204, Principal amount of second mortgage 504. 091 0214018/Payoff Chase 32,779.42
<br />205. 505. Payoff of second mortgage loan
<br />206. 506. Deposits held by seller
<br />207. Principal am! of mortgage held by seller 507, Principal amt of mortgage held by seller
<br />208. 508.
<br />209. I 509.
<br />. , . ... . . . . . t.. . .
<br />210, City/town taxes 510. City/town taxes
<br />211. County taxes from 01/01/04 to 01/09/04 8.04 511. County taxes from 01/01/04 to 01/09/04 8,04
<br />212. Assessments 512. Assessments
<br />213, 513.
<br />214. 514.
<br />215. 515.
<br />216. 516,
<br />217. 517.
<br />218, 518, .
<br />219. 519.
<br />220, Total paid by/for borrower: 50,798,04 520. Total reductions in amount due seller: 40,054,74
<br />.. , . , . .. , ,.. . .
<br />301, Gross amount due from borrower 58,289.18 601, Gross amount due to seller 56,100.00
<br /> (line 120) (line 420)
<br />302. Less amount paid by/for the borrower (50,798.04 ) 602, Less total reductions in amount due seller (40,054.74)
<br /> (line 220) (line 520)
<br />303. Cash ( ~ From o To ) Borrower: 7,491.14 603. Cash ( ~ To o From ) Seller: 16,045.26
<br />
<br />;ubstltute Form 1099 Seller Statement: The information contained in blocks E, G, H, and I and on line 401 is important tax information and is being
<br />urnished to the IRS, If you are required to tile a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and
<br />he IRS determines that it has not been reported,
<br />
<br />leller Instructions: If this real estate was your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your tax
<br />eturn; for other transactions, complete the applicable parts of Form 4797, Form 6262 and/or Schedule 0 (Form 1040).
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