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A. Settlement Statement Settlement Statement <br />B. Type of Loan <br />Q 1. FHA O 2. FmHA O 3. Conv. Unins. 6. File Number 7. Loan Number 8. Mortg. Ins. Case Num. <br />0 4. V.A. O 5. Conv. Ins. 23-989 <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 Stale of Florida <br />Address of Buyer: 1801 27th Street, Vero Beach, Florida 32960 <br />E. NAME OF SELLER: Myron J. Madsen, Jr. and Davene Madsen, husband and wife <br />Address of Seller: 1427 32nd Ave., Vero Beach, Florida 32960 TIN: <br />F. NAME OF LENDER: <br />Address of Lender: <br />G. PROPERTY LOCATION: 1375 32nd Street, Vero Beach, Florida 32960 <br />H. SETTLEMENT AGENT: Barry G. Segal, P.A. TIN: 65-0953275 <br />Place of Settlement: 3096 Cardinal Drive, Suite 2C, Vero Beach, Florida 32963 Phone: 772-567-5552 <br />1. bC I I LtMtN 1 UAI L: d lo/C3 U15NUKJtMGN 1 UAt t: b/lti/2;s <br />J. Summary of buyer's transaction <br />11 <br />101. Contract sales price <br />K. Summary of seller's transaction <br />11 . Gross am o-unt-d-ue to seller: <br />1,100,000.00 401. Contract sales price <br />1,100,000.00 <br />102. Personal property <br />402. Personal property <br />103. Settlement charges to buyer (Line 1400) <br />5,928.25 403. <br />104. <br />1404. <br />105. <br />Adjustments for items paid by seller in advance: <br />106. City/town taxes <br />1405. <br />Adi S'or items - paid by seller in advance: <br />406. Glyltown taxes <br />107. County taxes <br />407. County taxes <br />108. Assessments from 06/16/23 to 09/30/23 <br />492.10 408. Assessments from 06/16/23 to 09/30/23 <br />492.10 <br />109. <br />409. <br />110. <br />410. <br />111. <br />411. <br />112. <br />412. <br />120. Gross amount due from buyer; <br />II <br />201. Deposit or earnest money <br />1,106,420.35 420. Gross amount due to seller: <br />11 . Reductions in amount due to seller <br />25,000.00 501. Excess deposit (see instructions) <br />1,100,492.10 <br />202. Principal amount of new loan(s) <br />502. Settlement charges to seller (line 1400) <br />77,855.55 <br />203. Existing loan(s) taken subject to <br />503. Existing loan(s) taken subject to <br />204. Principal amount of second mortgage <br />504, Payoff of first mortgage loan <br />205. <br />505. Payoff of second mortgage loan <br />206. <br />506. Deposits held by seller <br />207. Principal amt of mortgage held by seller <br />1507. Principal amt of mortgage held by seller <br />1208. <br />508. <br />1209. <br />Adjustments for items unpaid by seller: <br />210. City/town taxes <br />509. <br />Adjustments for items unpaid by seller: <br />1510. City/town taxes <br />211. County taxes from 01/01/23 to 06/16/23 <br />511. County taxes from 01/01/23 to 06/16/23 <br />212. Assessments <br />512. Assessments <br />213. <br />513. <br />214. <br />514. <br />215. <br />515. <br />216. <br />516. <br />217. <br />517. <br />218. <br />518. <br />219. <br />519. <br />220. Total paid by/for buyer: <br />11 <br />301. Gross amount due from buyer <br />(line 120) <br />25,000.011 520. Total reductions in amount due seller: <br />11 . Cash at settlement to/from seller: <br />1,106,420.35 601. Gross amount due to seller <br />(line 420) <br />77,855.55 <br />1,100,492.10 <br />302. Less amount paid by/for the buyer <br />(line 220) <br />(25,000.00) 602. Less total reductions in amount due seller <br />(line 520) <br />(77,855.55) <br />303. Cash ( Q✓ From ❑ To ) Buyer: <br />1,081,420.35 603. Cash ( 0 To EJ From ) Seller. <br />1,022,636.55 <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: To determine if you have to report the sale or exchange of your main home on your tax return, see Instructions for Schedule D <br />(Form 1040 or 1040 -SR). If not your main home, report the transaction on For i 4797, Form 6252, and/or Schedule D for the appropriate income tax form. <br />DoubleTime® <br />