Real Estate Proceed Form

REAL ESTATE PROCEED FORM

Transaction Date:    Escrow/Closing File No.:

Recitals

This Real Estate Proceed Form is executed to direct and authorize the distribution of sale proceeds and adjustments resulting from the transfer of the property identified below. The undersigned parties certify authority to execute this document and request that the closing agent disburse funds in accordance with the closing statement and the instructions provided herein.

Property Identification

Property Address:

Parties

Transaction and Financial Terms

Sale Price: $    Earnest Money/Deposit Received: $

Closing Date:    Possession Date:

Financing Contingency Period (days):    Inspection Period (days):

Closing Statement — Deductions and Payoffs

Mortgage Payoff(s): $    Liens / Judgments: $

Real Estate Commission: $    Prorated Taxes / Assessments: $

HOA / Association Balances: $    Other Deductions (specify below): $

Net Proceeds and Disbursement Instructions

Gross Sale Price: $    Total Deductions: $

Estimated Net Proceeds to Seller: $

Wire to bank (complete wire instructions below)     Issue check payable to payee

ABA/Routing Number:    Account Number:

Disclosures

Lead-Based Paint Disclosure:   Yes   No

Known Mold or Water Intrusion:   Yes   No

Prior Structural/Fire Damage:   Yes   No

Representations, Authorizations and Certifications

The undersigned represent and warrant that they have full authority to execute this form and authorize the closing agent to disburse funds in accordance with the instructions contained herein. The undersigned hereby indemnify and hold harmless the closing agent from any loss, liability or expense arising from disbursement made in accordance with these instructions unless such disbursement was made with actual knowledge of a competing claim or contrary court order.

The undersigned further certify under penalty of perjury that the taxpayer identification information provided to the closing agent is true and correct, and that the payee is not subject to backup withholding unless indicated in writing to the closing agent prior to disbursement.

Default, Remedies and Governing Law

If any party breaches representations or instructions in this form, the non-breaching party may pursue any remedy available at law or equity. The closing agent may withhold disbursement if reasonably necessary to resolve a dispute or until instructed by written agreement of the parties or a final court order. This agreement shall be governed by the laws of the state where the property is located.

Miscellaneous

Entire Agreement: This Real Estate Proceed Form constitutes the entire understanding between the parties regarding the distribution of proceeds and supersedes prior oral or written communications on this subject. Any amendment must be in writing and signed by the parties.

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