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 ____________________________________________