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A. Settlement Statement U.S.Department of Housing <br /> and Urban Development air <br /> County Title Company <br /> OMB No.2502-0265 <br /> •B. Type of Loan <br /> SRI.Number 7.loan Number a Monpege Ineuranai Can.Numbs <br /> 1. ❑ FHA 2. ❑FmHA 3.® Cony.Unins. C-192949 <br /> 4. ❑VA 5. ❑Conv.Ins. <br /> C.Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are <br /> shown. Items marked '(p.o.c.)' were paid outside the closing; they are shown here for informational purposes and are not <br /> included in the totals. <br /> D.Name and Address of aormwe! E.Name and Address el Seller F.Name and Address of Lander <br /> SAM S. FISHER ROBERT J. GRIGGAS CASH <br /> JODI M. FISHER 158 Highway BB <br /> 832 Zander Lane Marshall, WI 53559 <br /> Deerfield, WI 53531 <br /> o Property Location N.SetrememAgent CAMBRIDGE STATE BANK <br /> 4017 STATE HIGHWAY 73 <br /> DEERFIELD, Wisconsin 53531 Place orSettlement I.Settlement Date <br /> Dane County, Wisconsin 221 West Main Street 3/12/09 <br /> SEC 16-7-12 E1/2 SE1/4 Cambridge, WI 53523 <br /> J.Summary of Borrower's Transaction K.Summary of Seller's Transaction <br /> 100.Gross Amount Due From Borrower 400.Gross Amount Due To Seller <br /> 101.Contract sales price 45,000.00 401.Contract sales price 45,000.00 <br /> 102.Personal property 402.Personal property <br /> 103.Settlement charges to borrower(line 1400) 705.75 403, 2008 real estate taxes paid <br /> 104. 404. Vacant land, no water reading <br /> 105. 405. <br /> Adjustments for items paid by seller In advance Adjustments for Item paid by seller In advance <br /> 106.City/town taxes to 406.Cfty/town taxes to <br /> 107.County taxes to 407.County taxes to <br /> 108.Assessments to 408.Assessments to <br /> 109. 409. <br /> 110. 410. <br /> 111. 411. <br /> 112. 412. <br /> 120.Gross Amount Due From Borrower 45,7 0 5.7 5 420.Gross Amount Due To Seller 45,000.00 <br /> 200.Amounts Paid By Or in Behalf Of Borrower 500.Reductions In Amount Due To Seller <br /> 201.Deposit or earnest money 501.Excess deposit(see instructions) <br /> 202.Principal amount of new loan(s) _502.Settlement charges to seller(line 1400) <br /> 203.Existing loan(s)taken subject to 503.Edging loan(s)taken subject to <br /> 204. 504.Payoff of first mortgage loan Cambridge Stat 43,609.46 <br /> 205. 606.Payoff of second mortgage loan <br /> 206. 606. <br /> 207. 507. <br /> 208. 508. <br /> 209. TAXPRO: $1,062.65/365x70 609. <br /> Adjustments for items unpaid by seller Adjustments for Items unpaid by seller <br /> 210.City/town taxes to 510.City/town taxes to <br /> 211.County taxes 01/01/09 to 3/12/09 203.80 511.County taxes 01/01/09 to 3/12/09 203.80 <br /> 212.Assessments to 512.Assessments to <br /> 213. 513. <br /> 214. 514. <br /> 215. 516. <br /> 216. 516. <br /> 217. 617. <br /> 218. 518. <br /> 219. 519. <br /> 220.Total Paid By/For Borrower 203.80 520.Total Reduction Amount Due Seiler 43,813.26 <br /> 300.Cash At Settlement From/To Borrower 600.Cash At Settlement To/From Seiler <br /> 301.Gross amount due from borrower(line 120) 4 5,7 0 5.75 601.Gross amount due to seller(line 420) 45,0 0 0.0 0 <br /> 302.Less amounts paid by/for borrower(line 220) ( 203.80 602.Less reductions in amt.due seller(line 620) ( 43,813.26', <br /> 303.Cash ®From To Borrower 45,501.95 1603. h OTo f From Seller <br /> 1,186.74 <br /> . - .� �- __ <br /> SAM�FI�/� -\=7`� RO=�r'T J. GRIGG•/' � / <br /> /fa'l/[l�+ •avid C Keleher <br /> JOpI . FISHER <br /> y hehr` im4 4'r- Notary Public <br /> r ifil.p 0001, State of Wisconsin <br /> Previous Edson is Obsdefe ►,/ FIRST DATA SYSTEMS,INC. RESPA,Ma a3c..2:HUD•1 R .Gres) <br /> 14 <br /> Dcuuaox FDS(Rev.12'92) 153574x04 <br />