| 
  
 Settlement sheet.  
ESCROW TRUST DEPARTMENT 
SETTLEMENT SHEET 
  
    | Dated: _________  | 
    
     Escrow Trust No. _________   | 
   
 
  
DUE SELLER  
  
    | 1.  | 
    Purchase price  | 
    
     $   | 
   
  
    | 2.  | 
    Unearned insurance premiums  | 
    
     | 
   
  
    | 3.  | 
    Water tax paid in advance  | 
    
     | 
   
  
    | 4.  | 
    Coal and supplies on hand  | 
    
     | 
   
  
    | 5.  | 
    Miscellaneous  | 
    
     | 
   
  
     | 
     | 
    
     | 
   
  
     | 
     | 
    
     _________   | 
   
  
     | 
    
     TOTAL   | 
    
     $   | 
   
 
  
CREDITS TO PURCHASER  
  
    | 1.  | 
    General taxes as pro-rated: Tax for year 
    _________ $_____ January 1 to date  | 
    
     $   | 
   
  
    | 2.  | 
    Rents unearned as pro-rated  | 
    
     | 
   
  
    | 3.  | 
    Water tax due on meter reading of _________[date]
     | 
    
     | 
   
  
    | 4.  | 
    Gas bill due on meter reading of _________[date]
     | 
    
     | 
   
  
    | 5.  | 
    Electricity bill due on meter reading of 
    _________[date]  | 
    
     | 
   
  
    | 6.  | 
    Existing first mortgage  | 
    
     | 
   
  
     | 
    Accrued Interest $_____ @ % from _________ to 
    date  | 
    
     | 
   
  
    | 7.  | 
    Existing second mortgage  | 
    
     | 
   
  
     | 
    Accrued Interest $_____ @ % from _________ to 
    date  | 
    
     | 
   
  
    | 8.  | 
    Wages accrued and unpaid  | 
    
     | 
   
  
    | 9.  | 
    Purchase money notes  | 
      | 
   
  
    | 10.  | 
    Miscellaneous  | 
    
     | 
   
  
     | 
     | 
    
     | 
   
  
    | 11.  | 
    Earnest money  | 
    
     | 
   
  
    | 12.  | 
    Cash to balance  | 
    
     _________   | 
   
  
     | 
    
     TOTAL   | 
    
     $   | 
   
 
  
The settlement above set forth is hereby approved:  
  
NOTE: This statement should be preserved for use in the 
preparation of income tax returns. Additional figures may well be inserted by 
each party, as indicated below:  
  
    | 
     | 
    
     | 
    
     EXPENSE OF SELLER   | 
    
     EXPENSE OF PURCHASER   | 
   
 
  
    | 1.  | 
    Title Policy  | 
    
     $   | 
    
     $   | 
   
  
    | 2.  | 
    Escrow Trust Fee  | 
      | 
      | 
   
  
    | 3.  | 
    Commission to Broker  | 
    
     | 
    
     | 
   
  
    | 4.  | 
    Recording  | 
    
     | 
    
     | 
   
  
    | 5.  | 
    Revenue Stamps on Deed or Notes  | 
    
     | 
    
     | 
   
  
    | 6.  | 
    Miscellaneous  | 
    
     | 
    
     | 
   
  
    | 
     | 
     | 
    
     | 
    
     | 
   
  
    | 
     | 
     | 
    
     | 
    
     | 
   
  
    | 
     | 
    
     TOTAL   | 
    
     $   | 
    
     $   | 
   
  
    | Principal and Interest payments 
    on Mortgages are to be made as follows:  | 
      | 
      | 
   
  
    | 
     | 
    
     | 
    Net Proceeds  | 
    Total Cost  | 
   
  
    | First Mortgage to  | 
      | 
      | 
   
  
    | 
     | 
    
     | 
    
     $   | 
    
     $   | 
   
  
    | 
     | 
    
     | 
    Profit or loss  | 
      | 
   
  
    | Second Mortgage to  | 
      | 
      | 
   
  
    | 
     | 
    
     | 
    
     $   | 
    
     $   | 
   
 
  
______________________________________________________________________________________ 
 
 
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