American Land Title Association	ALTA Settlement Statement - Borrower/Buyer
Adopted 05-01-2015

File No./Escrow No.:	
Title Company Name	
Title Company	
Print Date & Time:	ALTA Universal ID	Logo	
Officer/Escrow Officer:	Title Company Address		
Settlement Location:			

Property Address: Buyer:
Seller: Lender:

Settlement Date: Disbursement Date:
Additional dates per state requirements:

	
Description	Borrower/Buyer	
	Debit	Credit	
Financial			
Sales Price of Property			
Personal Property			
Deposit including earnest money			
Loan Amount			
Existing Loan(s) Assumed or Taken Subject to  				
Seller Credit			
Excess Deposit			
			
Prorations/Adjustments			
School Taxes from (date) to (date)			
County Taxes from (date) to (date)			
HOA dues from (date) to (date)			
Seller Credit			
			
Loan Charges to (lender co.)			
Points			
Application Fee			
Origination Fee			
Underwriting Fee			
Mortgage Insurance Premium			
Prepaid Interest			

Other Loan Charges			
Appraisal Fee to  				
Credit Report Fee to  				
Flood Determination Fee to  				
Flood Monitoring Fee to  				
Tax Monitoring Fee to  				
Tax Status Research Fee to  				
			
Impounds			
Homeowner's Insurance   	mo @ $  	/mo			
Mortgage Insurance   	mo @ $  	/mo			
City/town taxes   	mo @ $  	/mo			
County Taxes  	mo @ $  	/mo			
School Taxes  	mo @ $  	/mo			
Aggregate Adjustment			
			
Title Charges & Escrow / Settlement Charges			
Owner's Title Insurance ($ amount) to  				
Owner's Policy Endorsement(s)  				
Loan Policy of Title Insurance ($ amount) to  				
Loan Policy Endorsement(s)  				
Title Search to  				
Insurance Binder to  				
			
Escrow / Settlement Fee to  				
Notary Fee to  				
Signing Fee to  				
			
Commission			
Real Estate Commission to  				
Real Estate Commission to  				
Other			
			
Government Recording and Transfer Charges			
Recording Fees (Deed) to  				
Recording Fees (Mortgage/Deed of Trust) to  				
Recording Fees (Other) to  				
Transfer Tax to  				
Transfer Tax to  				
			
Payoff(s)			
Lender: Payoff Lender Co.			
Principal Balance ($ amount)			
Interest on Payoff Loan ($ amount/day)			
Additional Payoff fees/Reconveyance Fee/Recording
Fee/Wire Fee			
			
Lender: Payoff Lender Co.			
Principal Balance ($ amount)			

Interest on Payoff Loan ($ amount/day)			
Additional Payoff fees/Reconveyance Fee/Recording
Fee/Wire Fee			
			
Miscellaneous			
Pest Inspection Fee to  				
Survey Fee to  				
Homeowner's insurance premium to  				
Home Inspection Fee to  				
Home Warranty Fee to  				
HOA dues to  				
Transfer fee to Management Co.			
Special Hazard Disclosure			
[Utility] Payment to  				
Assessments			
School Taxes			
City/town taxes			
County Taxes/County Property taxes			
Buyer Attorney fees to  				
Seller Attorney fees to  				
			
	Debit	Credit	
Subtotals			
Due From/To Borrower			
Due From/To Seller			
Totals			

Acknowledgement

We/I have carefully reviewed the ALTA Settlement Statement and find it to be a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction and further certify that I have received a copy of the ALTA Settlement Statement.  We/I authorize  	title company name 	 to cause the funds to be disbursed in accordance with this statement.

Borrower

Borrower

Escrow Officer