Escrow No………
Date…………..
STATEMENT OF:………………………
DEBITS CREDITS
Deposits……………………………………………
Loan Proceeds…………………………………….
Demand for Deed and/or Note…………………………..
Interest……………………………………………
Prepayment Bonus…………………………………….
Forwarding Charge………………………………………
…………………………………………………..
Pro Taxes………………………………………….
Rata Insurance………………………………………
Commission………………………………………….
…………………………………………………..
…………………………………………………..
Mechanic’s Lien Search……………………………….
Title Organization’s Charge……………………………….
Reconveyance Charge…………………………………….
Recording Deed of Trust………………………………
Recording Reconveyance……………………………….
Recording Deed………………………………………
…………………………………………………..
…………………………………………………..
Taxes………………………………………………
Special Assessments………………………………….
Insurance…………………………………………..
…………………………………………………..
Tax and Assessment Service……………………………
Impounds……………………………………………
Charge for Drawing Documents…………………………….
Credit Report……………………………………….
Appraisal Charge……………………………………….
Advance Reconveyance Charge……………………………..
Office Charge and Inspection Charge………………………
…………………………………………………..
Deposited to the account of…………………………..
Check Herewith………………………………………
Balance due ……………………………………..