PINELLAS COUNTY (9)
'- _,r
(C(Q)[PY
RFTI JRN TO:
Somers Title Company
1290 Court Street
Clearwater, FI. 33756
File No. 01120022
THIS SPECIAL WARRANTY DEED
Made this 24th day of May, 2004 by the CITY OF CLEARWATER, FLORIDA, a municipal
corporation of the State of Florida hereinafter called the "Grantor", to PINELLAS COUNTY, a
political subdivision of the State of Florida, whose Post Office address is: 440 Court Street,
Clearwater, Florida 33756, hereinafter called the "Grantee":
(Whenever used herein the term 'grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals, and the
successors and assigns of corporations)
Witnesseth, that the grantor, for and in consideration of $10.00 and other valuable
considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens,
remises, releases, conveys and confirms unto the grantee, all of the following real property situate
in Pinellas County, Florida, viz:
PARCEL B
A portion of the existing Right of Way of Pierce Boulevard, recorded in Official
Record Book 4273, Page 523, Public Records of Pinellas County, Florida, lying in
Section 16, Township 29 South, Range 15 Eastt Pinellas County, Florida, as more
particularly described and depicted in EXHIBIT "An, pages 1 & 2, appended hereto,
PARCEL C
A portion of the existing Right of Way of Pierce Boulevard, recorded in Official
Record Book 4273, Page 523, Public Records of Pinellas County, Floridat lying in
Section 16, Township 29 South, Range 15 East, Pinellas County, Florida, and a
portion of the existing Right of Way of Court Street, recorded in Official Record
Book 4867t Page 1480, Public Records of Pinellas County, Florida, lying in Section
16, Township 29 South, Range 15 East, Pinellas County, Florida, being more
particularly described and depicted in EXHIBIT "An, pages 3 & 4, appended hereto.
Together with all the tenements, hereditaments and appurtenances thereto belonging or in
anywise appertaining. To have and to hold, the same in fee simple forever.
Subject to nondelinquent ad valorem taxes and current installments of special assessments not
yet due and payable, to highways, rights-of-way, licenses, easements and restrictions of record
generally, zoning ordinances and other governmental limitations, or others which might be
disclosed by an accurate inspection and architectural survey,
And the said Grantor does specifically warrant the title to said land and will defend the same
against the lawful claim of all persons claiming by, through or under Grantor except taxes for the
year 2004 and subsequent, and subject to the matters hereinabove mentioned.
In Witness whereof, the grantor has caused these presents to be executed in its name, and its
corporate seal to be hereunto affixed, by its proper officers thereunto duly authorized, the day and
yearfirst above written.
CITY OF CLEARWATER, FLORIDA
B6J~-Z. ~-"1l
William B. Horne, II, City Manager
Attest:
: S5
i r1w. ~.~
C rk (f
STATE OF FLORIDA
COUNTY OF PINELLAS
BEFORE ME, the undersigned, personally appeared Brian J. Aungst, Mayor of the City of
Clearwater, Florida, who executed the foregoing instrument and acknowledged the execution
thereof to be his free act and deed for the use and purposes herein set forth, and who is
personally known to me.
Officiaj seal this c21
? .
L I,
Notary Public - ~ of Flor. ida A
Print/type name: e/.J ( ,c; e...J .
day of
)loa-
,2004.
..<;;'.~:'f::"" Denise A Wilson
:}...tb.~~ MY COMMISSION # CC914107 EXPIRES
~~:.~.il'} June 18, 2004
"<74'.</"; ",if.:'~ BONDfO lHR~ TROY FAIN INSUAANCllNC
""11'\
STATE OF FLORIDA
:SS
COUNTY OF PINELLAS
BEFORE ME, the undersigned, personally appeared William B. Horne, II, the City
Manager of the City of Clearwater, Florida, who executed the foregoing instrument and
acknowledged the execution thereof to be his free act and deed for the use and purposes herein
set forth, and who is personally known to me.
d offici I ~eal thisc1l day of
q. f fHiL)
of Fl,orida A (J / . tJ
ffiJ I se/. ,so
~
,2004.
.\~~~''Ii::t,,~ .
/~&' ..>,;:-. Denise A Wilson
~~~ i~ MY COMMISSION # CC914107 EXPIRE,
....i......:;;.~~ June 18, 2004
,P,r..f,;1" BONDeD THRU TROY FAIN INSURANCllNC
ApProv~
Laura Lipowski, Assistant City Attorney
Leltmed to: CIty 01 Clearwater; Pll1el1as County; :Somers TItle Company; Amencan PIOneer TItle
Insurance Company EXHIBIT "A" (Page 1 of 4)
Scale:-r'';6()'u --J6-b--No. 1099FD.B Section 16 ,Township 29 South, Range~ East.
Uee of this survey by an~ne other than those certlfled to, wOI be the re-users sole risk without liability to lBI, or the undersigned surve~r. There may be
additional restrictions affecting this property that may be found in the Public Records of this County. This survey was prepared without the benefit of 0 title
palley. Underground Installations and Improvements hove not been located unless otherwise noted. The property description listed hereon was
lIupplied by the City Of Clearwater. Unless otherwise noted, all bearings and distances were measured within on acCeptoble accuracy tolerance with their
described value. Bearings are based upon on ossumed datum utDlzlng the described value of: lHE: EAST UNEOF LOT 1 BLOCK 7 as N 00-oO'29"E
EAST RIGHT OF
WAY UNE OF
BAY . AVE.
(CPB 102, PG.96)
FIR 5/8"
(LS 2995)
~
U)
w
0::
~
J:
~
W CI
~ ;:
~ ~
m ~
lL.
0
~
:I:
CJ
0::
r
CURVE
C1
C2
C3
RADIUS
265.25'
265.25'
+46.00'
DELTA ANGLE
02"29'420
73"45'01"
2741'36"
ARC LENGTH
1 1.55'
341.43'
215.57'
~
----z.- REMAINDER Of" LOTS -t---
1-4 BlOCK 7
(PB H-1, PG.53)
.POC
SOUTHEAST CORNER OF
LOT 1 BLOCK 7
MAP Of TURNER'S SUBOMSION NO.3
PLAT BOOk 1 PAGE 53
HIUSBOROUGH coljNlY, MRIDA
(WHICH PINEUAS COUNlY WIQ fORMERLY A pART)
Iii
~
o
....
U
III
o
:::i
RODGERS ST.
BOUNDARY DESCRIPTION
Page 1 of 2 SEE PAGE 2 FOR
A BOUNDARY SURVEY OF
PIERCE BOULEVARD
PARCEL B
CHORD LENGlH
11.55'
318.34'
213..o\a'
CHORD BfARlNG
N 81'00'540 W
N 42"53'300 W
5 48'31'110 E
UNE BEARING
L1 N 00'00'29" E
l2 N OS'.o\a'32" W
L3 S 33"54'59 E
L4 S 00'09'010 W
DISTANCE
107.02'
4-2.36'
109.56
43.05'
o
60'
1"= 60'
(2)
AVE = AIIDIUE
ea.~ : ~8~1f~:ulot PLAT BOOI<
E - El..EClRIC
DB = DEED BOOK
FIR - FOUND RON ROO
1.S - lAND SURVEYOR
IoILP - IoIETAL UGHT POlL
OIl. - DVE:RAU.
OR = DFFlClAL RECORDS BOOK
PB - PLAT BOOK
PG. - PAGE
PDB _. POINT OF BEGlNING
PDC- POINT OF COIoIMENCDolENT
R/W - RIGHT OF WAY
SF = SQUARE FEET
ST - SlREET
s/W - S1DEWAIJ(
lSCB - "TRAFFIC SIGNAL CDNlROL BOX
NOTE: Subject property lies within Flood Zone X per
Flood Insurance Rate Map #12103CI08G dated September 3,.2003.
BOUNDARY + MAP
3-26-04
DATES OF FIELD WORK
toil
LB 6472
I hereby certIfy that this survey meets the mInImum
technical standards os set forth by the Florida Board
of Professional Land Surve)\:lrs in Chapter 61 G17-6,
Florida AdmInistrative Code, pursuant to Section
4 .027, Florida Statutes
Survey not alld wIthout the signature and the
original aised seal af o.~ D~r.i ido Licensed
surve)\:lr and L~er
ZARRA BOYD, INC.
Engineering, SurVeying and Planning
1480 Beltrees, Dunedin, Florida 3469B
(727)7.38-901 0 Fox: (727)733-0083
Jack L. Boyd
SIONAL LAND SURVEYOR # 3000
STATE OF FLORIDA
Certifiedto:'City of Clearwater; Pinellas County; Somen; Title Company; American Pioneer Title Insurance Company -
_ ___ _ __ ___ _ _ _ _ EXHlBJT" A" (Page 2 of 4)
Job No. 1099FD.8 Section 16 ,Township 29 South, Range ~ East.
PROPERTY DESCRIPTION: Pierce Boulevard - Parcel B
A portion of the existing Right of Way of Pierce Boulevard, recorded in Official :Record Book 4273,
Page 523, Public Records of Pine lIas County, Florida, lying in Section 16, Township 29 South, Range
15 East, PinelIas County, Florida, being more particularly described as follows:
Commence at the Southeast comer of Lot 1, Block 7, Map of Turner's Subdivision No.3, recorded in
Plat Book 1, Page 53 of the Public Records of Hillsborough County of which Pinellas County was
formerly a part; thence N 00000'29" E, 107.02 feet along the East line of said Lot 1 to a point on a
curve which is concave Northerly, said point lying on the South Right of Way line of Pierce Boulevard
Recorded in Official Record Book 4273, Page 523, Public Records of Pine lIas County, Florida; thence
along said South Right of Way line running along a curve to the right, having a radius of 265 .25 feet, a
central angle of 02029'42", the chord of which bears N 81000'54" W, a chord distance of 11.55 feet, an
arc distance of 11.55 feet to the POINT OF BEGINNING, said point lying on a curve which is
concave Northeasterly and lying on the aforementioned South Right of Way line of Pierce Boulevard
Recorded in Official Record Book 4273, page 523, Public Records of Pine lIas County, Florida; thence
along said South Right of Way line running along a curve to the right, having a radius of265.25 feet, a
central angle of7304nt01 It, the chord of which bears N 42053'30" W, a chord distance of318.34 feet,
an arc distance of 341.43 feet to a point on the aforementioned South Right of Way line of Pierce
Boulevard Recorded in Official Record Book 4273, Page 523, Public Records of Pine lIas County,
Florida; thence along sa~d South Right of Way line, N 05048'32" W, 42.36 feet to a point on the East
Right of Way line of Bay Avenue, recorded in Condominium Plat Book 102, Page 96 of the Public
Records of Pin ell as County, Florida; thence S 33054'59" E, 109.56 feet to a point on a curve which is
concave Northeasterly; thence nmning along the said curve to the left, having a radius of 446.00 feet, a
central angle of27041'36", the chord of which bears S 48031'11" E, a chord distance of213.48 feet,
and arc distance of215.57 feet to a point; thence S 00009'01 "W, 43.05 feet to the POINT OF
BEGINNING.
Said lands containing 15,547 square feet, more or less.
PAGE 2 OF 2
SEE PAGE 1 FOR SURVEY DRAWING
DA TES OF FIELD WORK
BOUNDARY + MAP " )
3- 26-04 ML
A BOUNDARY SURVEY OF
PIERCE BOULEVARD - PARCEL B
ZARRA BOYD, INC.
I hereby certify that this survey meets the minimum
technical standards os set forth by the Florida Board
of Professional land Surveyors in Chapter 61 G17-6,
florida Administrative Code, pursuant to Section
472.027, Florida Statutes
Survey not lid without the signature and the
original alscd seol of a Flori a Ucensed
su eyer an mapp r
LB 6472
Engineering, Surveying and Planning
1480 Beltrees, Dunedin, Florida 34698
(727)738-9010 Fax: (727)733-0083
,Ccrlified !<l. <:ity of Clearwater; l'im:llas County; Somers Tille Company; American Pioneer Tille Insurance Company
Scale: 1"=60'
Job No.
1099FD.8
Section 16
, Township
EXHIBIT "A" (Page 3 of 4)
29 South, Range ~ East.
Use of this survey by anyone other than thoBe certified to, will be the re-users sole risk without Iiabmty, to 281, 01" the undersigned IIUl"Vllyor. There may be
additional restrictions affacting this property that may be found in the Public Records of this County. This sUI"VllY was prepared without the benefit of a title
policy. Undarground installations and improvements hova not been locatad unless otherwiu notad. The property description listed horaon was
supplied by the City Of Clearwater. Unless otherwise noted, all bearlngs and distances were measured within an acceptabla accuracy tolerance with their
described value. Bearings ore basad upan an assumed datum utDizing the described valua at: lHE NORlH UNE OF BLOCK 6 as N BS'32'48-W
U) ___~ COURT STREET _____ NOTE: Subject property lies wilhin Flood Zone X per
W ~ Flood Inswance Rate Map #12103CI08G daled September 3,2003.
a:: 60' R/W -............
w ~ SIT =0.20,' sIT = 1,2' S/T=4.1' ,NE CORNER LOT 1
) ~ II- c/T 57 /T' SOUTH RIGHT OF WAY BLOCK 6 (DB K PG 475)
=. C =5.7 C/T=13,7' LINE OF COURT STREET (NOT FOUND OR SET)
~Q
ID ~ G~ C4 <'.p L1 15.61'
~ \ L2 . P .O.B. BEARING BASIS I ..........
S/f=0.20' a:: ~ ~ ........... POC (NOT FOUND OR sET)
C/T=6.1' s> {:; BLOCK 6 (DB K, PG 475) NORTH LINE BLOCK 6
~ PLAN OF CLEARWATER HARBOR,FL.
S{!/T=26~~: <~ ~ EAST RIGHT OF WAY COMPRISING A.C. TURNER SUBDIVISION
'\.,'" LINE OF BAY AVE. (DB K, PG 475)
S/T=2.6' (CPB 102, PG.96) HILLSBOROUGH COUNlY, flORIDA
C/f=7.6' OF WHICH PINELU\S COUNlY WAS FORMERLY A PART
\
PIERCE BLVD.
60' R/W PER
OR 4273, PG.523
! 2' CONC CURB
(lYP)
EAST RIGHT OF WAY
LINE OF PIERCE BLVD
(OR 4273, PG.523)
NOTE: Subject property lies within an area that is currently
undec construction. All nearby swvey controls have been
destroyed or disturbed. The swvey conlJols utilized for this
swvey were swvey markers lying outside the area of construction
activities. Due to space constraints, these markers are not shown hereon.
5' CONC S/W
(lYp)
';
S/T=2.6'
C/f=7.6'
.B. =
13 =
.
A
CURB INLET
GRATE INLET
SET 5/B- IRON ROD (LB6472)
SET NAIL + DISK (ZBI LB6472)
UNE
L1
l2
LJ
L4
LS
L6
L7
UI
L9
BEARING
N 89"32'48 W
N 89'32'480 W
S 00'02 04 E
S 06"00 59 E
N 33"53 420 W
N 56'06 OS E
N 33'54'000 W
N 4S"46 38 E
S 3710.]80 E
DISTANCE
137.29
81.39
50.48
31.24
195.47
1.84
14.83
34.71
11.15
o
60'
CURVE
C1
C2
C3
C4
RADIUS
260.00'
17.00'
86.00
442.00'
oaTA ANGLE
32'22 03-
.]4'42'2.3-
41'13"58-
05"38 010
ARC LENG1tt
146.88'
10.30'
61.89'
43.46
CHORD LENGTH
144.93
10.14
60.56'
43.44'
CHORD BEARING
S 22'12'00 E
N 32'27'190 E
N 70'23 450 E
S 86'1001- E
1"= 60'
Page 1 of 2 SEE PAGE 2 FOR PROPERTY DESCRIPTION
A BOUNDARY SURVEY OF CPB = CONDOMINIMUIA PLAT800K PG. - PAGE sIT = SIDEWALK TIE
C/T = CURB TIE PCB = POINT Of BEGINING
PIERCE BOULEVARD DB = DEED BOOK POC = POINT OF COMMENCEMENT
PARCEL C LB = CORPORATE CERTIfiCATE R/W = RIGHT Of WAY
OR - OFFlCAl RECORDS BOOK SF = SQUARE FEET
BOUNDARY + MAP
3-26-04
ML
I hereby certify that thIs sUr'lleY meets the mInimum
technical standards as lIet forth by the Florida Board
of Professional Land Surwyars In Chapter 61 G17-6,
Florida Administrative Code. pursuont to Section
472.027, Florida Statvtes
Survey not wild thout the signature and the
original rais olaf a FI~~~ Licensed
B yor and mapb
DATES OF FIELD WORK
ZARRA BOYD, INC.
LB 6472
Engineering, Surveying and Planning
14BO Beltrees, Dunedin, Florida 3469B
(727)738-9010 .' Fox: (727)733-0083
Job No.
1099FD.8
Section 16
, Township
29 South, Range ~ East.
PROPERTYDESCRIPTlON : Pierce Boulevard - Parcel C
A portion of the existing Right of Way of Pierce Boulevard, recorded in Official Record Book 4273,
Page 523, Public Records of Pinellas County, Florida, lying in Section 16, Township 29 South, Range
15 East, Pine lias County, Florida, and a portion ofthe existing Right of Way of Court Street, recorded
in Official Record Book 4867, Page 1480, Public Records of Pinellas County, Florida, lying in Section
16, Township 29 South, Range IS East, Pinellas County, Florida, and being more particularly
described as follows:
Commence at a point on the north line of Block 6, Plan of Clearwater Harbor, Florida comprising AC.
Turner's Subdivision, recorded in Deed Book K, Page 475 of the Public Records of Hillsborough
County, Florida of which Pinellas County was formerly a part, 15.61 feet west of the Northeast comer
of Lot 1, Block 6, Plan of Clearwater Harbor, Florida comprising A.C. Turner's Subdivision, recorded
in Deed .Book K, Page 475 of the Public Records of Hillsborough County, Florida; thence running
along said north line and along the South Right of Way line of Court Street, N 89032'48" W, 137.29
feet to the POINT OF BEGINNING; thence continue N 89"32'48" W, along said South Right of Way
line, 81.39 feet to a point, said point lying on the East Right of Way line of Bay A venue, recorded in
Condominium Plat Book 102, Page 96 of the Public Records of Pine lias County, Florida; thence along
said East Right of Way line of Bay A venue, S 00002'04" E, 50.48 feet to a point, said point is on a
curve which is concave Southwesterly, said point also lies on the aforementioned Easterly Right of
Way line of Pierce Boulevard Recorded in Official Record Book 4273, Page 523, Public Records of
Pinellas County, Florida; thence running along the said curve to the right, having a radius of260.00
feet, a central angle of 32022'03", the chord of which bears S 22012'00" E, a chord distance of 144.93
feet, an arc distance of 146.88 feet to a point on the aforementioned Easterly Right of Way line of
Pierce Boulevard Recorded in Official Record Book 4273, Page 523, Public Records of Pine lias
County, Florida; thence continuing along said Easterly Right of Way line of Pierce Boulevard S
06000'59" E, 31.24 feet to a point on the aforementioned Easterly Right of Way line of Pierce
Boulevard Recordedjn Official Record Book 4273, Page 523, Public Records of Pine lIas County,
Florida; thence N 33053'42" W, 195.47 feet to a point; thence N 56"06'09" E, 1.84 feet to a point;
thence N 33054'00" W, 14.83 feet to a point, said point is on a curve which is concave Southeasterly;
thence running along the said curve to the right, having a radius of 17.00 feet, a central angle of
34042'23", the chord of which bears N 32"27'19" E, a chord distance of 10.14 feet, an arc distance of
10.30 feet to a point; thence N 49046'38" E, 34.71 feet to a point, said point is on a curve which is
concave Southerly; thence running along the said curve to the right, having a radius of 86.00 feet, a
central angle of 410] 3'58", the chord of which bears N 70"23'45" E, a chord distance of 60.56 feet, an
arc distance of 61.89 feet to a point, said point is on a curve which is concave Southeasterly; thence
running along the said curve to the right, having a radius of 442.00 feet, a central angle of 05"38'0 1 ",
the chord of which bears S 86010'01" E, a chord distance of 43.44 feet, an arc distance of 43.46 feet to
a point; thence S 370IO'38"E, 1 1.15 feet to the POINT OF BEGINNING.
Said lands containing 8,918 square feet, more or less.
PAGE 2 OF 2
SEE PAGE 1 FOR SURVEY DRAWING
DA TES OF FIELD WORK
BOUNDARY + MAP
3-26-04
A BOUNDARY SURVEY OF
PIERCE BOULEVARD - PARCEL C
ZARRA BOYD,
INC.
I hereby certify that this. survey meets the minimum
technical standards os set forth by the Florida Board
of Professional Land SUn/C)'OI'S in Chapter 61 G17-6,
florida Admlnlstratlw Code, pursuant to Section
472.027. Florida Statutes
Survey nat 'd without the signature and the
original r ed seol of 0 Florida Ucensed
sUn/C)IOr and per
ML
LB 6472
Engineering, Surveying and Planning
1480 8eltrees, Dunedin, Florida 34698
(727)738-9010 Fox: (727)733-0083
P
(Printed ooJul12, 2004@ 16:36)
A. 1 ~
B.
1. [] FHA 2. [ ] FmHA 3. [] Conv. Unins. 6. File Number:
4. VA 5. Conv. Ins. 01120022 7. Loan Number:
c. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked 'POC' were paid outside the closing: they are shown here for infonnation
US Department of Housing and Urban Development
SETTLEMENT STATEMENT
OMB No. 2502-0265
D. NAME AND ADDRESS OF BORROWERlBUYER:
PINELLAS COUNTY, a olitical subdivision of the State of Florida 440 Court Street Clearwater, FL 33756
E. NAME AND ADDRESS OF SELLER:
CITY OF CLEARWATER P.O. Box 4748 Clearwater, FL 33758
F. NAME AND ADDRESS OF LENDER:
G. PROPERTY LOCATION (Brief Legal):
CLEARWATER, FL
H. SETTLEMENT AGENT:
SOMERS TITLE COMPANY 727-441-1088 Contact: MARIANNE
SCHAFFER
I. SETTLEMENT DATE:
Jul 22 2004
I J. SUMMARY OF BORROWER(S) TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER:
101. Contract sales rice 293580.00
102. Personal Pro ert
103. Settlement char es to borrower
104.
105.
Ad'ustments for items aid b Seller in advance
106. Cit /town taxes
107. Count taxes
108. Assessments
109.
110.
111.
112.
120. Gross Amount Due From Borrower 293 580.00
200 AMOUNTS PAID BY OR IN BEHALF OF BORROWER:
PLACE OF SETTLEMENT:
819 COURT STREET CLEARWATER, FL 33756
DISBURSEMENT DATE:
Jul 22 2004
I K. SUMMARY OF SELLER(S) TRANSACTION
400. GROSS AMOUNT DUE TO SELLER :
401. Contract sales rice
402. Personal Pro e
403.
404.
405.
293 580.00
aid b Seller in advance
201. Deposit or earnest money 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 1 693.00
203. Existilll! loan(s) taken subiect 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. EOUITABLE CONSIDERATION 293,580.00 508. EQUITABLE CONSIDERATION 293 580.00
209. 509.
Adjustments for items unpaid by Seller in advance Adjustments for items unpaid by Seller in advance
210. Citv/town taxes 510. City/town taxes
211. County taxes 511. County taxes
212. Assessments 512. Assessments
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid Bv/For Borrower 293,580.00 520. Total Reduction Amount Due Seller 295 273.00
407.
408. Assessments
409.
410.
411.
412.
420. Gross Amount Due Seller
500. REDUCTIONS IN AMOUNT DUE TO SELLER :
293 580.00
293 580.00
293 580.00
0.00 603. Cash
293 580.00
295273.00
1 693.00
SUBSTITUTION FORM 1099 SELLER STATEMENT: The information contained in Blocks E,G,H and I on line 401(or if 401 is asterisked, line 403 and 404) is
important tax information and is being furnished to the Internal Revenue Service. If you are required to file a return, a negligence penalty or other sanction will be
imposed on you if this item is required to be reported and the IRS determines that it has not been reported.
SELLER, you are required by law to provide the settlement agent with your correct taxpayer identification number. If you do not provide the settlement agent with
your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law.
Under penalties of pe~ury, I certify that the number shown on this statement is my correct taxpayer identification number.
Seller(s):
CITY OF CLEARWATER
(Printed on Jul12, 2004@ 16:41) US Department of Housing and Urban Development OMB No. 2502-0265
L. SETTLEMENT CHARGES
,
700. total SaleslBroker's Commission based on price Paid from Paid from
Borrower's Seller's
70 I. Listinl!: Realtor Commission Funds at Funds at
702. Selling Realtor Commission Settlement Settlement
703. Commission paid at Settlement
704.
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee
802. Loan Discount
803. Appraisal Fee
804. Credit Report
805. Lender's Inspection Fee
806. Mortl!:al!:e Application Fee
807.
808.
809.
810.
900. ITEMS REOUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest from
902. Mortgage Insurance Premium for
903. Hazard Insurance Premium for
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard insurance
1002. Mortl!:al!:einsurance
1003. City oronerty taxes
1004. County oropertv taxes
1005. Annual assessments
1006.
1007.
1008. Al!:lITel!:ate Accounting Adiustment
1100. TITLE CHARGES
1101. Settlement or c\osinl!: fee To: STC 50.00
1102. Abstract or title search To: T. GATLlFF/ STC 75.00
1103. Title examination To: STC 25.00
1104. Title insurance binder
1105. Document preparation
1106. Attorney's Fees
1107. FL Risk Rate 1693.00
(Includes above item numbers: )
1108. Title Insurance To: SOMERS TITLE COMPANY 1,543.00
(Includes above item numbers: )
1109. Lender's coverage@
1110. Owner's coverage 293,580.00 @ 1,543.00
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording fees: NO CHARGE To: Clerk ofthe Court
1202. City/county tax/stamps:
1203. State taxlstamps:EXEMPT
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey
1302. Pest inspection
1303.
1304.
1305.
1400. Total Settlement Char!!es (enter on lines 103 Section J and 502 Section K\ Il Illl 1 "::0':1 00
I have carefully reviewed the HUD,1 Settlement Statement and to the best. of my know1~dge and belief, it is a true and accUrate statement of all receipts ,and disQufsements made on my
'=""'~by~"". l.rth,,~rury""'lhoW~",d'OO~~
~~W~): 1/01. /. ___ ~. ~. . LL .
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PINELLAS'tO~NTY, a political subdivi~Gh of the State of Florida TY OF CLEARWATER ~~ ~.
Tho Hu~'1I:"tS~-:rJ I ..,../,,,.,,,,,,, t, , I.. '''d ,=.... ~'" of~" ",,,,,",,,,,. I how 000"'" ",,;. OOOM "'" ."d, 10 .. d1,bo"'" to "'''''''o~ "'h '"
statemen ij} ~~)
r; j:) i?'! I i July 22, 2004
SOMERS MPAN'9t::/ :J i Date
NOTE: Taxes h<i,ye been prorated based on taxes for the year Any re-proration will be handled between the buyer and seller. All utility bills (water, sewer, electric, cable and maintenance
fees) have been paid or will be paid upon receipt of final bills.
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine or imprisonment. For details
see: Title 18 U.S. Code Section 1001 and Section 1010.