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Buyer/Seller A. Settlement Statement Settlement Statement B. Type of Loan 0 1. FHA Q 2. FmHA ❑ 3. Conv. Unins. 6. File Number 7. Loan Number 8. Mortg. Ins. Case Num. 4. VA. 0 5. Conv. Ins. 01163 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: Indian River County, Florida, a political subdivision of the State of Florida Address of Buyer: 1801 27th Street, Bldg. A, Vero Beach, Florida 32960 E. NAME OF SELLER: Alexandra Van Der Rest as Trustee(s) of the Alexandra Van Der Rest Trust Address of Seller: 6830 69th Street, Vero Beach, Florida 32967 TIN: F. NAME OF LENDER: Address of Lender: G. PROPERTY LOCATION: 6830 69th Street, Vero Beach, Florida 32967 H. SETTLEMENT AGENT: Law Offices of Jennifer D. Peshke, P.A. TIN: 45-3801287 Place of Settlement: 4733 North Highway AlA, Suite 303, Vero Beach, Florida 32963 Phone: 772-231-1233 I. SETTLEMENT DATE: 9/12/18 DISBURSEMENT DATE: 9/12/18 J. Summary of buyer's transaction rr FK. -Summary of seller's transaction r0 Gross amount due to seller: 101. Contract sales price . 60,000.00 401. Contract sales price 60,000.00 102. Personal property 402. Personal property 103. Settlement charges to buyer (Line 1400) 1,217.00 403. 104. 404. 105. 405. 106. City/town taxes 406. City/town taxes 107. County taxes 407. County taxes 108. Assessments 408. Assessments 109. 409. 110. Attorney Fees 8,000.00 410. Attorney Fees 8,000.00 111. 411. 112. 412. 120. Gross amount due from bu er: 69,217.00 420. Gross amount due to seller: 1 68,000 00 rr 201. Deposit or earnest money it . Reductions in amount due to seller: 501. Excess deposit (see instructions) 202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 779.24 203. 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. 210. City/town taxes Adjustments for items unpaid by seller: 510. City/town taxes 211. County taxes 511. County taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total paid by/for buyer: 0.00 520. Total reductions in amount due seller: 779.24 rr 301. Gross amount due from buyer (line 120) .rr 69,217.00 601. Gross amount due to seller (line 420) 68,000.00 302. Less amount paid by/for the buyer (line 220) 0.00 602. Less total reductions in amount due seller (line 520) (779.24) 303. Cash ( ❑✓ From ❑ To ) Buyer: 69,217.00 603. Cash ( 0 To ❑ From ) Seller: 67,220.76 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). DoubleTime®