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OMB Approval No. 2502-0265
A.
Settlement Statement {HUD-1)
B. Type of Loan
1.
4.
ILJ
IOI
C. Note:
FHA
VA
,
2. 0
5.o
RHS
3.
IL ii
Conv. Unins.
_
6.
.
7. Loan Number:
Conv. Ins.
This form is furnished to give you a statement of actual settlement costs'.
aunts• peld-to and by the settlement agej,~ ~re silo' " lie~ nlarked
"(p.o.c.)' were paid outside the clo.sins ; t~. ey.al't!. shpw~ here for l~fb~iii1ri~r~utPo!l~s·and are not Included In the totals." ' • ' • ' • ' • ' •
.......
D. Name & Address of Borrower:
E. Name & Address of Seller:
F. Name & Address of Lender:
G. Property Location :
H. Settlement Agent:
I. Settlement Date:
Place of Settlement:
.I, SumMary of Borrower's Transaction
I.<. Summary of Seller's Transaction
100. Gross Amount Due from Borrower
400. Gross Amount Dua to Seller
101. Contract sales price
401. Contract sales price
102. Personal property
402. Personal property
103. Settlement charges to borrower Oine 1400)
403.
104.
404.
105.
405.
Adjustment for Items paid by seller In advance
Adjustment for items paid by seller In advance
106. City/town taxes
to
406. Citynowntaxes
to
107. County taxes
to
407. County taxes
to
1OB. Assessments
to
408. Assessments
to
109.
409.
110.
410.
111 .
411 .
112.
412.
120. Gross Amount Due from Borrower
420. Gross Amount Dua to Seller
200. Amount Paid by or In Behalf of Borrower
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 seller (line 1400)
203. Existing loan(s) taken subject to
503. Existing loan(s) taken subject to
204.
504. Payoff of first mortgage loan
205.
505. Payoff of second mortgage loan
206.
506.
207.
507.
208.
508.
209.
509.
Adjustments for Items unpaid by seller
Adjustments for items unpaid by sailer
210.Citvnowntaxes
to
510. Citynown taxes
to
211 . Countvtaxes
to
511. County taxes
to
212. Assessments
In
512. Assessments
to
213.
513.
214.
514.
215.
515.
216.
516.
Form Approved
OMB No. 0960-0760
Social Security Administration
Authorization for the SocJal Security Administration (SSA) To Release Soo.ial
_________
s_e_c_a'.._ri__:ty_N_,__~,,_..!.~_,....,~'-.,-·~ '. (~S:N) Verification
Printed Name:
Date of Birth :
First Borrower
Social Security Number:
05/05/1995
111-20-3333
I want this information released because I am conpu~ti
Reason (s) for using CBSV: (Please select all that apply)
D Mortgage Service
D
D
D Banking Service
Background Check
Credit Check
D
D
License Requirement
Other
with the following company ("the Company"):
Company Name:
Mann Mortgage LLC
Company Address: 1220 Whitefish Stage Rd, Kalispell, MT 59901
I authorize the Social Security Administration to verify my name and SSN to the Company and/or the Company's
Agent, if applicable, for the purpose I identified.
The name and address of the Company's Agent is:
Mann Mortgage LLC
1220 Whitefish Stage Rd, Kalispell, MT 59901
I am the individual to whom the Social Security number was issued or the parent or legal guardian of a minor, or the
legal guardian of a legally incompetent adult. I declare and affirm under the penalty of perjury that the information
contained herein is true and correct. I acknowledge that if I make any representation that I know is false to obtain
information from Social Security records, I could be found guilty of a misdemeanor and fined up to $5,000.
This consent is valid only for 90 days from the date signed, unless indicated otherwise by the individual
named above. If you wish to change this timeframe, fill in the following:
This consent is valid for_ _ _ _ days from the date signed. _ _ __ (Please initial.)
Signature - - - - - - - - - - - - - - - - - Date Signed - - - - - - - - - - - - - - - Relationship (if not the individual to whom the SSN was issued):
Contact information of individual signing authorization:
Address
111 My street
City/State/Zip
Kalispell, MT 59901
Phone Number ~40~6~-5~5~5~-1~2~1~2~------------------------------
Form SSA-89 (06-2013)
SSA-89 Social Security Number Verification Page 1 (06-2013) - 10-2013 - Encompass®