Form Hud 1a - Settlement Statement
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2OMB Approval No. 2502-0265
Settlement Statement (HUD-1A)
Optional Form for Transactions without Sellers
Name and Address of Borrower:
Name and Address of Lender:
Property Location: (if different from above)
Settlement Agent:
Place of Settlement:
Loan Number:
Settlement Date:
L. Settlement Charges
M. Disbursements to Others
800. Items Payable in Connection with Loan
1501.
801. Our origination charge
(from GFE #1) $
1502.
802. Your credit or charge (points) for the specific interest rate chosen (from GFE #2) $
803. Your adjusted origination charges
(from GFE A)
1503.
804. Appraisal fee to
(from GFE #3)
805. Credit report to
(from GFE #3)
1504.
806. Tax service to
(from GFE #3)
807. Flood certification
(from GFE #3)
1505.
808.
900. Items Required by Lender to Be Paid in Advance
1506.
901. Daily interest charges from
to
@ $
/day
(from GFE #10)
902. Mortgage insurance premium
for
months to
(from GFE #3)
1507.
903. Homeowner’s insurance
for
years to
(from GFE #11)
904.
1508.
1000. Reserves Deposited with Lender
1001. Initial deposit for your escrow account
(from GFE #9)
1509
1002. Homeowner’s insurance
months @ $
per month
$
1003. Mortgage insurance
months @ $
per month
$
1510.
1004. Property taxes
months @ $
per month
$
1005.
months @ $
per month
$
1511.
1006.
months @ $
per month
$
1007. Aggregate Adjustment
–$
1512.
1100. Title Charges
1101. Title services and lender’s title insurance
(from GFE #4)
1513.
1102. Settlement or closing fee
$
1103. Owner’s title insurance
(from GFE #5)
1514.
1104. Lender’s title insurance
$
1105. Lender’s title policy limit $
1515.
1106. Owner’s title policy limit $
1107. Agent’s portion of the total title insurance premium
$
1520. Total Disbursed
1108. Underwriter’s portion of the total title insurance premium
$
(enter on line 1603)
1200. Government Recording and Transfer Charges
1201. Government recording charges
(from GFE #7)
1202. Deed $
Mortgage $
Releases $
N. Net Settlement
1203. Transfer taxes
(from GFE #8)
1600. Loan Amount
$
1601. Plus Cash/Check from Borrower $
1204. City/County tax/stamps
Deed $
Mortgage $
1205. State tax/stamps
Deed $
Mortgage $
1602. Minus Total Settlement Charges $
(line 1400)
1206.
1603. Minus Total Disbursements
$
1300. Additional Settlement Charges
to Others (line 1520)
1604. Equals Total Disbursements
$
1301. Required services that you can shop for
(from GFE #6)
to Borrower
1302.
$
(after expiration of any applicable
rescission period required by law)
1303.
$
1304.
1305.
1400. Total Settlement Charges (enter on line 1602, Section N)
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and
reporting the data. This agency may not collect this information, and you are not required to complete this form, unless it displays a
currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to
a RESPA covered transaction with information during the settlement process.
Previous editions are obsolete
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HUD-1A
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