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1 Buyer/Seller <br /> A. Settlement Statement Settlement Statement <br /> B. Type of Loan <br /> 0 1 FHA 0 2. FmHA 0 3 Conv Unins. 6. File Number 7. Loan Number 8. Mortg.Ins.Case Num. <br /> 0 4 V.A. 0 5 Conv. Ins. 1807-004 <br /> ID- <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 shown. Items <br /> marked"(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. <br /> D.NAME OF BUYER: Indian River County,a political subdivision of the State of Florida <br /> Address of Buyer: 1801 27th Street,Vero Beach, Florida 32960 <br /> E.NAME OF SELLER: Bent Pine Golf Club, Inc.,a Florida not-for-profit corporation <br /> Address of Seller: 6001 Club House Drive,Vero Beach, Florida 32967 TIN: 51-0198590 <br /> F.NAME OF LENDER: <br /> Address of Lender: <br /> G.PROPERTY LOCATION: 58th Avenue,Vero Beach, Florida 32967 <br /> H.SETTLEMENT AGENT- Rossway Swan Tierney Barry Lacey&Oliver P L. TIN:59-3590034 <br /> Place of Settlement: 2101 Indian River Blvd., Suite 200,Vero Beach, Florida 32960 Phone:772-231-4440 <br /> I. SETTLEMENT DATE: 5/16/16 DISBURSEMENT DATE: 5/16/16 <br /> J.Summary . transaction <br /> 00400.Gross amount due to seller: <br /> 101 Contract sales price 51,000 00 401 Contract sales price 51,000.00 <br /> 102.Personal property 402. Personal property <br /> 103.Settlement charges to buyer(Line 1400) 1,35578 403. <br /> 104 404 <br /> 105. 1405 <br /> Adjustments for items .. ..id . <br /> 106.City/town taxes 406.City/town taxes <br /> 107 County taxes 407 County taxes <br /> 108.Assessments 408 Assessments <br /> 109. 409 <br /> 110 410 <br /> 111 411 <br /> 112. 1412. <br /> 120.Gross amount due from buyer: 52,355 781420.Gross amount due to seller: 51,000 00 <br /> ii500.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) 2700 <br /> 203. Existing loan(s)taken subject to 503. Existing loan(s)taken subject to <br /> 204 Principal amount of second mortgage 504 Payoff of first mortgage loan <br /> 205 505 Payoff of second mortgage loan <br /> 206. 506 Deposits held by seller <br /> 207 Principal amt of mortgage held by seller 507 Principal amt of mortgage held by seller <br /> 208. 508. <br /> 209 509 <br /> unpaidAdjustments for items ..id . <br /> 210. 510. <br /> 211 511 <br /> 212. 512. <br /> 213. 513 <br /> 214 514 <br /> 215. 515. <br /> 216. 516. <br /> 217 517 <br /> 218. 518 <br /> 219 519 <br /> 220.Total paid by/for buyer: 0 001520.Total reductions in amount due seller: 27 00 <br /> 00 Cash at settlement from/to . 600.Cash at settlement to/from seller-, <br /> 301 Gross amount due from buyer 52,355 78 601 Gross amount due to seller 51,000.00 <br /> (line 120) (line 420) <br /> 302.Less amount paid by/for the buyer 000 602. Less total reductions in amount due seller (27 00) <br /> (line 220) (line 520) <br /> 303.Cash( ❑✓ From ❑ To )Buyer- 52,355 78 603.Cash( ❑✓ To ❑ From )Seller- 50,973 00 <br /> Substitute Form 1099 Seller Statement: The information contained in blocks E,G, H,and I and on line 401 is important tax information and is being <br /> furnished to the IRS. If you are required to file a return,a negligence penalty or other sanction will be imposed on you if this item is required to be reported and <br /> the IRS determines that it has not been reported. <br /> Seller Instructions: If this real estate was your principal residence,file Form 2119,Sale or Exchange of Principal Residence,for any gain,with your tax <br /> return;for other transactions,complete the applicable parts of Form 4797, Form 6262 and/or Schedule D(Form 1040). <br /> DoubleTime(D <br />