American Land Title Association	ALTA Settlement Statement - Combined
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:

	
Seller	Description	Borrower/Buyer	
Debit	Credit		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  				
					
Seller		Borrower/Buyer	
Debit	Credit		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.

_________________________
Buyer

_________________________
Buyer

_________________________
Seller

Escrow Officer