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. 5123/13 7:42 AM OMB No.2502-0265
<br /> r.��NT„ A.U.S.Department of Housing B.Type of Loan
<br /> ,�Qw `% and Urban Development 1.[ )FHA 2.[]RHS 3.[X]Conv.Unins.
<br /> 9�� �'��I����} � 4.( ]VA 5. )Conv.Ins.
<br /> I � 6.File Number 7.Loan Number
<br /> o �
<br /> �'qe `��`� 402986 3106785
<br /> 5. �F�E
<br /> Settlement Statement 8.Mortgage Ins.Case No.
<br /> C.Note: This form is fumished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are
<br /> shown. Items marked("POC")were paid outside the closing: they are shown here for information purposes and are not
<br /> included in the totals.
<br /> D.Name of Borrower. Zdenko Grajcar,3220 Utah Avenue North,Crystal,MN 55427
<br /> Katarina Grajcarova
<br /> E Name of Seller. Kevin Talbot
<br /> Gayl Talbot -
<br /> F.Name of Lender: NoRh American Banking Company,4999 France Ave S#120,Minneapolis,MN
<br /> 55410
<br /> G.Property Location: Lot 8,Block 1,Painters Creek
<br /> 80 Luce Line Ridge,Orono,MN 55359
<br /> H.SetGement Agent: Land Title,Inc.(651)63&1900
<br /> Place of Settlement: �00 Caunry Road C#2205,Roseville,MN 55113
<br /> I.Settlement Date: 5/23/2013 Prorat(on Date: 5l23/2013
<br /> �.���:�.1°�Summ`ary+of�o'�""ainrer's;�a�s'!'actii3n�,���'., �`� ��-K?"$ur���°�Se11er'�'�r�insaction w''""
<br /> 700:�.�Gro s'iCnronhfoue rro'rii.�oirov er:��?�� � �' '�.,;�;� ;:',40o�.'�Gfo s Amounc;D3e"°td�sei�er , �."'." "
<br /> _,
<br /> '101. Contract saies price 662,500.00 401. Contract sales price 662,500.00
<br /> 102. Personal prope 402. Personal prope
<br /> 103. Settlement charges to borrower(line 1400) 10,520.02 403. Commission credit from listing agent from C86 449.00
<br /> 104. Escrow for septic 18,686.00 404.
<br /> 105. 405.
<br /> A�S�b�ehtsfoYK�6:ig�!?�I.eb�'s�tie�i�a v',�tiee- , ' ''° ,.,,: ` ;;Ad1'�s�rien.�4�it�ms:P,aidv�X�s�)�I��� . :=��:+��xy...�.�.
<br /> 106. CityRown taxes 406. Cityttown ta�ies
<br /> �07. Countytaxes SR3f2013 to 7l12013 829.35 407. Countytaxes 5/23/2013 to 7!1/2013 829.35
<br /> 108. Assessments 408. Assessments
<br /> 109. Association Dues 409. Association Dues
<br /> 1'10. 410.
<br /> 1'I1. 411.
<br /> 112. 412.
<br /> 120. Gross Amount Due from Borrower: 692,537.37 420. Gross Amount Due to Seller 663,778.35
<br /> �'00, r./irtioynts,Q,�id;6y or`�.BehalF�+o�rc4yw4C"',�' .^ . „�� ;, .._� :bOQ,<:,,t�edudion In�HliipGt�t�Dqd tii.Seligr„i;,�.��.�,,.> ,a,��,t�; ; � ,
<br /> 201. Deposk or eamest money 10,000.00 501. Excess deposit(see instrudions)
<br /> 202. Principai amount of new loan(s) 400,000.00 602. Settlement charges So seller(line 1400) 32,902.25
<br /> 203. Existin loan(s)taken subject to 503. Exis6ng loan(s)taken subjed to
<br /> 204• 504. Payoff of first mortgage loan Welis Far o Bank 377,898.02
<br /> 205. 505. Payoff of second mortgage loan BestSource CU 22,920.87
<br /> 206. 506. Deposit or eamest mone 10,000.00
<br /> 207. 507.
<br /> 208. 508.
<br /> 209. 509.
<br /> A�lustr`r'fi`en'tsis�r�fe.�?"s'uri id°:��l�e�_ _:�°;,, a;a::�?�. �.:'.,�'�.- .Aa�os�m" '�'foqit�i�'d'a�i ��;�e�e�y�.�;�. �..�:� �"-'r°
<br /> 210. City/town taxes 510. Ciry/town taxes
<br /> 211. Counry taxes 51�. County taxes
<br /> 212. Assessments 512. Assessments
<br /> 213. Association Dues 5'13. Association Dues
<br /> 214. 514.
<br /> 2'I5. 516.
<br /> 2�6. 516.
<br /> 217. 517.
<br /> 218. 518.
<br /> 219. 519.
<br /> 220. Total Paid bylfor Borrower 410,000.00 520. Total Reduction Amount Due Seller: 443,721.14
<br /> 300:�`�Cash,aF Sett(emenffrordlto`$o'rrowei;�5� Ydj� :" � " _ " �
<br /> .�,,;���t}b: :�r`;�,„�,�,,„, �a 500: Cash':atSattlement to/froFi�Selter.� �����<,�,�,� .��
<br /> 301. Gross amount due from borrower(line 120) 692,537.37 601. Gross amount due to seller(line 420) 663,778.35
<br /> 302. Less amount paid b lfor borrower line 220) 470,000.00 602. Less total reduction in amount due seller(line 520) 443,721.14
<br /> 303. CASH(X)FROM()TO BORROWER 282,537.37 603. CASH QFROM(X)TO SELLER 220,05721
<br /> SUBSTITUTE FORM 1099 SELLER STATEMENT-The infortnation contained In Blocks E,G,H and I and on line 401(or,if line 401 is asterisked,lines 403 and 404),408,407 antl
<br /> 408-412(applicable part of buyefs real estate ta�c reportable to the IRS)is important tax information and is being fumished to the Intemal Revenue Service.If you are required to file a
<br /> 2lum,a negiigence penalty or other sancdon will be imposetl on you if this item is required m be reported and the IRS detertnlnes that R has not been reported.
<br /> SELLER INSTRUCTION-If this real estate was your printlpal residence,file fortn 21�9,Sale or Exchange of Principal ResiEence,for arry gain,wilh your income tau retum;for other
<br /> transactions,completa ttie applicable parts ot form 4797,Form 6252 and/or Schadule D(Fortn 1040).
<br /> You arc rcquired by law M provide Land TNIe.Ina(651)63&1900 wMh your correct taxpayer identifica8on number.
<br /> If you do not provide Land TNe,Inc.(851)63&1900 wkh your cortect ta�ayer identiflcation number,you may be subjeG to civil or crlminal penalties.
<br /> The Public Reporting Burden for riiis collection of in�ormatlon is estimated at 35 minutes per responu for collec6ng,reviewing,and reporting The data.This agency may
<br /> not collect this infortnation,and you are not requirad to complete this fortn,unless k displays a curtently valid OMB control number.No confidentiaiity is assured:this
<br /> disdosura is mandaWry.This is designed to provida the parties to a RESPA covered transaction w(th informatian during the settlement pracess.
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