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ESCROW STATEMENT Escrow No.________ Date______________ STATEMENT OF:___________________________ DEBITS CREDITS Deposits___________________________________|_______________ Loan Proceeds___________________________|_______________ Demand for Deed and/or Note________________|_______________ Interest___________________________________|_______________ Prepayment Bonus___________________________|_______________ Forwarding Fee_____________________________|_______________ ___________________________________________________________ Pro Taxes_________________________________|_______________ Rata Insurance_____________________________|_______________ Commission_________________________________|_______________ ___________________________________________________________ ___________________________________________________________ Mechanic's Lien Search_____________________|_______________ Title Company's Charge_____________________|_______________ Reconveyance Fee___________________________|_______________ Recording Deed of Trust____________________|_______________ Recording Reconveyance_____________________|_______________ Recording Deed_____________________________|_______________ ___________________________________________________________ ___________________________________________________________ Taxes______________________________________|_______________ Special Assessments________________________|_______________ Insurance__________________________________|_______________ ___________________________________________________________ Tax and Assessment Service_________________|_______________ Impounds___________________________________|_______________ Fee for Drawing Documents__________________|_______________ Credit Report______________________________|_______________ Appraisal Fee______________________________|_______________ Advance Reconveyance Fee___________________|_______________ Office Charge and Inspection Fee___________|_______________ ___________________________________________________________ Deposited to the account of________________________________ Check Herewith_____________________________________________ Balance due ____________________________________________

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