ESCROW

ESCROW 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 ____________________________________________