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Buyer/Seller A TRUE COPY A. Settlement Statement Settlement Statement r r P T(r J[r AT I q i'9 ON LAST PAGE B.Type of Loan J.H. SMITH, CLERK Q 1.FHA 0 2.FmHA Q 3.Cony.Unins. 6.File Number 7.Loan Number 8. Mortg.Ins.Case Num. Q 4.VA 0 5.Cony.Ins. 01308 ID: 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 marked"(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included In the totals. D.NAME OF BUYER: Youth Guidance Donation Fund of Indian River County,Inc..a Florida not for profit corporation, Address of Buyer: P.O.Box 121,Vero Beach,Florida 32961 E NAME OF SELLER: Indian River County,Florida,a political subdivision of the State of Florida 'Address of Seller. do Indian River CountyAtty.,1801 27th St.,Vero Beach,Florida 32960 TIN: F.NAME OF LENDER: Address of Lender: G.PROPERTY LOCATION: 1028 20th Place,Vero Beach,Florida 32960 H.SETTLEMENT AGENT Law Offices of Jennifer D.Peshke,PA TIN:45-3801287 Place of Settlement 4733 North HghwayAlA,Suite 303,Vero Beach,Florida 32963 Phone:772-231-1233 I. SETTLEMENT DATE: 9128/17 DISBURSEMENT DATE:9/28/17 J.Summary of buyer's transaction _ K.Summary of seller's transaction 100.Gross amount due from buyer 400.Gross amount due to seller: 101.Contract sales price 225,000.00 401.Contract sales price 225,000.00 102.Personal property 402.Personal property 103.Settlement charges to buyer(Line 1400) 3,825.00 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance: Adjustments for items paid by seller in advance: 106.City/town taxes 406.City/town taxes 107.County taxes 407.County taxes 108.Assessments 408.Assessments 109. 409. 110. 410. 111. 411. 112. 412. 120.Gross amount due from bu r: 228.825.00 420.Gross amount due to seller. 225,000.00 200.Amounts paid or in behalf of buyer: 500.Reductions in amount due to seller: 201.Deposit or earnest money 501.Excess deposit(see instructions) 202.Principal amount of new loan(s) 502.Settlement charges to setter(line 1400) 25.00 203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to 204.Principal amount of second mortgage 504.Payoff of first mortgage loan 205. 505.Payoff of second mortgage loan 206. 506.Deposits held by seller 207.Principal amt of mortgage held by seller 507.Principal amt of mortgage held by seller 208. 508. 209. 509. Adjustments for items unpaid by seller: Adjustments for items unpaid by seller: 210.City/towrr taxes 510.City/town taxes 211.County taxes from 01/01/17 to 09/28/17 457.57 511.County taxes from 01/01/17 to 09/28/17 457.57 212.Assessments 512.Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220.Total paid by/for buyer: 457.57 520.Total reductions in amount due seller: 482.57 300.Cash at settlement fromito buyer: 600.Cash at settlement tolfrom seller: 301.Gross amount due from buyer 228,825.00 601.Gross amount due to seller 225,000.00 (line 120) (8ne 420) 302.Less amount paid by/for the buyer (457.57) 602.Less total reductions In amount due seller (482.57) (line 220) (line 520) 303.Cash( ❑✓ From To )Buyer: 228,367.43 603.Cash( Q✓ To ❑From )Seller. 224,517.43 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 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 the IRS determines that it has not been reported. 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 return;for other transactions,complete the applicable parts of Form 4797,Form 6262 and/or Schedule D(Form 1040). Buffs InItial(s): Seller's Initi I(s): Ui DoubleTime®