Employee Application For Reimbursement Of Expenses Incurred Upon Sale Or Purchase (Or Both) Of Residence Upon Change Of Official Station Page 2

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COST INCURRED AND PAID IN SELLING RESIDENCE AT OLD OFFICIAL STATION OR

PURCHASING RESIDENCE AT NEW OFFICIAL STATION LOCATION (OR BOTH)

ITEM

EXPLANATION

FOMER RESIDENCE

NEW RESIDENCE

LOAN AMOUNT.

BROKERAGE FEES.: The sales commission paid to a broker or real estate agent for selling former residence. Also,

fees for listing a residence and payment for multiple listing service, if not included in commission paid to the broker

or agent.

ADVERTISING: Expenses paid for newspaper and other advertising when a direct sale is made without the

services of a real estate broker or real estate agent.

APPRAISAL FEE: The amount paid to a professional appraiser for establishing a suggested sale price for the

residence.

LOAN ORIGINATION FEE: Amount charged to cover the administrative overhead cost of processing the loan.

(Subject to limitations contained in FTR 2-6.2d(1)(b).).

SETTLEMENT FEE: Amount paid to escrow agent, title company, or similar entity for closing a real estate

transaction.

ATTORNEY FEE: Searching title, preparing abstract and legal fees for a title opinion (does not include costs of

litigation).

TITLE INSURANCE POLICY: Owners coverage only on sale where customarily furnished; Lenders coverage only

on purchase when required by the lending institution.

CERTIFICATIONS: The amount paid for any required certifications as to structural soundness or physical condition

of property, when required by mortgagee-lender, FHA or VA (includes termite inspection fee).

10.

LOAN APPLICATION FEE: The amount paid.

11.

STATE REVENUE STAMPS: The amount paid.

CREDIT REPORT: The amount paid for credit or factual data report on the buyer, if required by mortgagee/lender,

12.

FHA or VA.

RECORDING FEES AND RECORDING TAXES: Other charges paid incident to recordation (e.g., mortgage

13.

discharge recording fees).

PREPAYMENT CHARGE: The amount paid as required in the mortgage or other security instrument as a charge for

14.

prepayment; or if not specifically required by the mortgage instrument, the amount paid limited to 3 months

prevailing interest on the loan balance.

15.

SURVEY:

16.

SALES OR TRANSFER TAXES; MORTGAGE TAX, IF ANY: The amount paid.

OTHER INCIDENTAL EXPENSES: Such other reasonable and customary charges or fees paid as may be

17.

authorized and not properly includable in items listed above (itemize and explain; if necessary, attach separate

sheet).

1) and 3)

2) and 3)

TOTAL

0.00

Note: In accordance with the real estate expense provision of the Federal Travel Regulation, costs of insurance against damage or loss of property, maintenance and

operating costs and property taxes are not reimbursable. Also, mortgage discounts, points, interest on loans, and losses in connection with the sale or purchase of a

residence due to price or market conditions are not reimbursable. Notwithstanding the above, no fee, cost, charge, or expense is reimbursable which is determined to

be a part of the finance charge under the Truth in Lending Act, Title I, Public Law 90-321 and Regulation Z issued pursuant thereto by the Board of Governors of

the Federal Reserve System.

Footnotes:

The aggregate amount of expenses which may be reimbursed is the amount which should not exceed 10% of sale price or the maximum allowances as stated in

FTR 2-6.2g.

The aggregate amount of expenses which may be reimbursed is the amount which should not exceed 5% of purchase price or the maximum allowances as

stated in FTR 2-6.2g.

If property is multiple family unit type (excluding condominium), expenses will be prorated and allowed for residence unit only.

Privacy Act Notice. The following information is provided to comply with the Privacy Act of 1974 (P.L. 93-579). The information requested on this form is

required under the provisions of 5 USC, Chapter 57 (as amended) and Executive Orders 11609 of July 22, 1971, and 11012 of March 27, 1962, for the purpose of

recording travel expenses incurred by the employee and to claim other entitlements and allowances as prescribed in the Federal Travel Reguation (41 CFR 101-7).

The information contained in this form will be used by Federal Agency officers and employees who have a need for such information in the performance of their

duties. Information will be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal, or regulatory investigations or

prosecutions or pursuant to a requirement by GSA or such other agency in connection with the hiring or firing, or security clearance, or such other investigations of

the performance of official duty in Government service, Failure to privide the information required will result in delay or suspension of the employee’s claim for

reimbursement.