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- I <br /> Buyer/Seller <br /> A. Settlement Statement Settlement Statement <br /> B. Type of Loan <br /> Q 1 FHA C)2.FmHA V 3.Conv.Unins. 6.File Number 7 Loan Number 8. Mortg.Ins.Case Num. <br /> Q 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 /> 1. SETTLEMENT DATE: 5/16/16 DISBURSEMENT DATE:5/16/16 <br /> it _ •ri <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) 1,355.78 403. <br /> 104, 404 <br /> 105. 405. <br /> 911FIT-ITT14 j--no <br /> 106.City/town taxes 406.City/town taxes <br /> 107 County taxes 407 County taxes <br /> 108.Assessments 408.Assessments <br /> toy 409. <br /> 110. 410. <br /> 111 411 <br /> 112. 412. <br /> 120.Gross amount due from buyer: 52.355.78 420.Gross amount due to seller. 51.000.00 <br /> ri <br /> 201.Depositor earnest money 501.Excess deposit(see instructions) <br /> 202.Principal amount of new loan(s) 502.Settlement charges to seller(line 1400) 27.00 <br /> 203.Existing bans)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 /> 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: 0.00 520.Total reductions in amount due seller. 27.00 <br /> .r� <br /> rr --- <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 0.00 602.Less total reductions in amount due seller (27.00) <br /> (line 220) (line 520) <br /> 303.Cash( QQ From ❑To )Buyer. 52,355.78 603.Cash( Q 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 /> Seiler 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,Forth 6262 and/or Schedule D(Form 1040). <br />