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EL-11-2260Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP- 173865 Permit Number: EL -12 -11 -2260 Scheduled Inspection Date: May 22, 2012 Inspector: Devaney, Michael Owner: GREGORIOU, PERRY Job Address: 490 NE 96 Street Miami Shores, FL 33138- Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1132060140550 Phone: (786)331 -3967 Building Department Comments BURGLAR ALARM Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Com "lay 21, 2012 For Inspections please call: (305)762 -4949 Page 22 of 22 BUILDING PERMIT APPLICATION FBC 20 Miami Shores Village RECEIVED DEC 0 2011 Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 3313E3�' Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305) 762.4949 Permit No. eu I aafeo Master Permit No. Permit Type: Electrical OWNER: Name (Fee Simple Titleholder): P ChCite H UCT I er Phone #: 3O'1 C1 1 ��Gi Address: ,s" City: M \ arr.\ i SfOreS State: ' Zip: a� r 1 Tenant/Lessee Name: Phone#: Email: JOB ADDRESS: Z) q 0 N � C(0 . " f City: Miami Shores County: Miami Dade Zip: Folio/Parcel #: \ \ 32Ote b(•-4 boS0 Is the Building Historically Designated: Yes NO V Flood Zone: an Name: �►flT SECURITY SERVICES CONTRACTOR: Company y 10785 MARKS WAY Phone #: —° 6 Address: MIRAMAR, FL 33025 City: State: Zip: Qualifier Name: aear.ge rv1 igfl nil 1, Phone #: State Certification or Registration #: Certificate of Competency #: E f 1�0l 12— Contact Phone #: " 7 U(F 507 �- Email Address: aal C � e G,f 'U c yi DESIGNER: Architect/Engineer: Phone #: Value of Work for this Permit: $ l61 Square/Linear Footage of Work: Type of Work: ❑Address teration ONew ORepair/Replace ODemolition Description of Work: rCj la- A- 14 r, 1 * * * * ** * * ** ** * * * *** * * * * * * * **** **** ** Fees* 114,* 1 Mcipti Wt. ********* **** Submittal Fee $ Permit Fee $ /00 e0e) CCF $ CO /CC $ Scanning Fee $ Radon Fee $ DBPR $ Bond $ Notary $ Training/Education Fee $ Technology Fee $ Double Fee $ Structural Review $ TOTAL FEE NOW DUE $ Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not b ed and a reinspection fee will be charged. (/ Signature/ er or Agent The foregoing instrument was acknowledged before me this 04,4 day ofjc e. If , 20 _L, by M e..ka.‹.. t 14o aP,•6,6c who is personally known to me or who has produced As identification and who did take an oath. NOTARY PUBLIC: Sign: Print: My Commission Expires: Signature Contractor The foregoin instrument was acknowldged before me this day of , 20 _, by Mai" /417 who is personally known to me or who has produced as identification and who did take an oath. NOTARY PUBLIC: Sign: Print: LAT e (c My Commission Exp * * * * * * * * ** * ** * ***** * * *** MY COMMIS •. 131i599 ," Erma TniNouyPtoicUnti dta av `- /17Plans Examiner Zoning Structural Review (Revised 07 /10 /07)(Revised 06 /10 /2009)(Revised 3/15/09) Clerk My Home Show Me: 'Property Information Search By: Select Item Text only Property Appraiser Tax Estimator Property Appraiser Tax Comparison ummary Details: ACTIVE TOOL: SELECT Folio No.: 11- 3206- 014 -0550 Property: 490 NE 96 ST Mailing Address: PERICLES GREGORIOU 490 NE 96 ST MIAMI SHORES FL 33138 -2734 Property Information: Primary Zone: 1400 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/4 Floors: 2 Living Units: 1 Adj Sq Footage: 3,893 Lot Size: 14,843.40 SQ FT Year Built: 1941 Legal Description: MIAMI SHORES SEC 2 PB 10 -37 LOTS 1 & 2 BLK 53 LOT SIZE 103.800 X 143 OR 19713 -1348 06 2001 1 COC 26252 -1135 02 2008 1 OR 26252 -1135 0208 00 Assessment Information: Year: 2011 2010 Land Value: $183,801 $230,292 Building Value: $324,805 $326,856 Market Value: $508,606 $557,148 Assessed Value: $508,606 $557,148 xable Value Information: Year: 2011 2010 Taxing Authority: Applied Exemption/ Taxable Value: Applied Exemption/ Taxable Value: Regional: $0/$508,606 $0/$557,148 County: $0/$508,606 $0/$557,148 City: $0/$508,606 $0/$557,148 c..ti..,,i o,..,.,+. Ien/e an Aerial Photography - 2009 0 114 ft My Home I Property Information I Property Taxes 1 Mi Neighborhood I PropertyAppraiser Home 1 Using Our Site I Phone Directory I Privacy 1 Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. htt // isims2.miamidade. ov /M Home/ ro ma as 12/1/2011 p: g� g Y p p p� p MIAMI SHORES VILLAGE ALARM PERMIT APPLICATION Is this a new permit or a renewal? (circle one): Li go Address of alarm: (Street #) New ) Renewal Ne cc" -t s-fr (Street Name) (Apt. /Suite) Is this a residential or a business alarm? (circle one): '`'RESIDENTIAL BUSINESS If a business, business name: Mailing / Billing Address: 490 kJ crc. " s-hr (Street #) (Street Name) (Apt. / Suite) AAi0. vt t SH o re 5 33132 (City) (State) (Zip Code) Nance of Pere, r Holder: A.Ale heee..l l4{ ..Flince C Phone numbers of Permit Holder: ,,,)HOME (aOS ) - 1495 - 7G:49 WORK ( ) - CELL ( ) - eMAIL Is this a silent or audible? (circle one): SILENT AUDIBL Do you have any pets at the residence /business that could prevent officer's access: Yes * * ** *Emergency Contacts: Primdry Contacts should have key access and alarm codes. * * * ** (Please provide the name, address and phone numbers of three emergency contacts.) Name: G simian na gee.0rn92.f HOME ( ) Address: J WORK ( ) - CELL (7$(0 ) $q7 - q q 4 1 eMAIL Name: A (c e (4 i,„ Address: HOME ( ) WORK ( ) - CFtI (30 S ) y9I 07/7 eMAIL Name: HOME ( ) Address: WORK ( ) Alarm System Installed By: ADT CFI ( eMAIL Alarm System Monitored By: , Yr Address: i 7: ttr Iit%Lt. A` Phone: (gg2 -2.3g - 7 7C/ A fee of $ 35.00 is required at the time that this permit is issued. Checks should be made payable to the Village of Miami Shores. The permit expires one year from the date of issuance. All permit holders are allowed two false alarms within a twelve month period. For each false alarm thereafter, fines win be issued. See Miami Shores Ordinance #666 -08 for full Alarm System regulations. Mall payment and application to Miami Shores Village Alamt Program P.O. Box t' ng, TX 75014-0396. natu g (2 - 2 -11 (Date) Permit #: (Internal Use Only) Prepared by: Guaranty Trust & Title, Inc. 1909 Tyler St., Suite 306 Hollywood, Florida 33020 Elie Number: 110317 THIS INDENTURE, made this WARRANTY DEED between: 11111111111111111111111111111111111111111111 CFN 2011R0788672 OR Bk 27903 Pss 3487 - 34831 (toss) RECORDED 11/22/2011 15:55:34 DEED DOC TAX 4r440.00 HARVEY RUVIN, CLERK OF COURT MIAMI -DADE COUNTY, FLORIDA Pericles Gregor lou, a married man joined by his spouse, Ronda Kelli Gregoriou as Grantor*, whose address Is: 490 NE 96 Street, Miami Shores, Florida 33138, and Michael Hoefiinger and Glovanna Hoef linger, husband and wife as Grantee *, whose address is: 490 NE 96 Street, Miami Shores, Florida 33138. * Singular and plural are interchangeable as context requires. WITNESSETH: That the Grantor, for and in consideration of the sum of TEN DOLLARS ($10.00) and other valuable considerations to said Grantors in hand paid by said Grantee, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the grantee and grantee's heirs forever the following described land located in the County of Miami -Dade, State of Florida , to-wit Lot (s) 1 and 2, Block 63, Miami Shores Section No. 2, according to the map or plat thereof, as recorded in Plat Book 10, Page(s) 37, of the Public Records of Miami -Dade County, Florida. Parcel ID Number. 114206. 014-0650 SUBJECT TO easements, restrictions and reservations of record, if any, and taxes for current year and subsequent years. Said grantor does hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. IN WITNESS WHEREOF, Grantor has hereunto set grantor's hand and seal the day and year first above written. WITNESS 1. fro Printed Name / 'P f$e, WITNESS 2. �.' %.L'z� 10 Printed Name ` li n io ice State of Florida County of Broward (Seal) Pericles tlre8dneu ' (Seal) Ronda Ke11i Gr The foregoing instrument was acknowledged before me on aArrled �n in by his spousfi,, who is/are person .j f�. G as identification *Ronda Kelli Gregoriou by Pericles Gregorlou, to me or who has produced take an oath. BY MONIER ttl * * EXPIRES: Bay 24,2013 solisisimagrose slobs FLORIDA: DEED IPIDIYIDUAL WARRANTY DEED - GTT Book27903/Page3487 CFN #20110788672 Page 1 of 2 A. Settlement Statement (HUD -1) B. Tvae of Loan OMB Approval No. 2502 -0265 1. FHA 2. RHS 3. X CONV. UNINS. 8. File Number: 110317 7. Loan Number: 5001902990 8. Mortgage Insurance Case Number. 4. VA 5. ❑ CONV. INS. C. Note: This form is fumished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.e.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name & Address of Borrower: Michael Hoefllinger and Giovanna Hoeflinger ( Non - Borrower), husband and wife 490 NE 96 Street Miami Shores, Florida 33138 8. Name & Address of Seller: Pericles Gregoriou 490 NE 98 Street Miami Shores, Florida 33138 F. Name & Address of Lender: TD Bank, NA One Portland Square Portland, Maine 04101 G. Property Locatkm: 490 NE 98 Street Miami Shores, Florida 33138 Miami Shores Sec 2 PB 10-37 Lots 1 & 2 Bik 533 H. Settlement Agent Guaranty Trust & Title, Inc. 1909 Tyler St. Suite 306 Hollywood, Florida 33020 954-920-0766 fax: 954-920 -0729 I. Settlement Date: November 18, 2011 Place of Settlement Guaranty Trust & Title, Inc. 1909 Tyler St., Suite 306 Hollywood, Florida 33020 Phone: (954) 920-0766 J. Summary of Borrower's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due From Borrower. 101. Contract Sales Price 102. Personal Property 103. Settlement Charges to Borrower (line 1400) Adjustments for Items Pald by Seller In Advance: 106. City / Town Taxes 740,000.00 36,122.54 107. County 1 Parish Taxes 108. Assessments 120. Gross Amount Due from Borrower. 400. Gross Amount Due To Seller 401. Contract Sales Price 402. Personal Property 403. Adjustments for Items Paid by Seller in Advance: 406. City / Town Taxes 407. County / Parish Taxes 408. Assessments 740.000.00 776,122.54 420. Gross Amount Due to Seller 740,000.00 200. Amounts Paid by or In Behalf of Borrower. 201. Deposit or Earnest Money 202. Principal Amount of New Loan 203. Existing Loan(s) taken sublect to 204. Lender Paid Credits 500. Reductions In Amount Due to Seller. 26 000.00 592,000.00 205. Home Equity Loan - Suordinate Financing 206. Misc. closing credit from Listing Agent 207. Additional closing credit from Listing Agent Adjustments for Items Unpaid by Seller. 210. City / Town Taxes 211. County / Parish Taxes Jan 1, 2011 thru Nov 17, 2011 7.70 73,926.00 1 800.00 1 200.00 501. Excess Deposit (see instructions) 502. Settlement Charges to Seller (Line 1400) 503. Existing Loan(s) taken subiect to 504. Payoff of First Mortgage Loan 505. Payoff of Second Mortgage Loan 506. Purchase Money Mortgage 507. 48.299.47 11 ,503.55 Adjustments for Items Unpaid by Seller. 510. City / Town Taxes 511. County / Parish Taxes Jan 1, 2011 . thru Nov 17, 2011 11,503.55 212. Assessments 213. Seller roof maintenance credit 220. Total Pald by / for Borrower 1 700.00 708,137.25 512. Assessments 513. Seller roof maintenance credit 520. Total Reductions in Amount Due Seller. 1,700.00 61,503.02 300. Cash at Settlement from / to Borrower. 301. Gross Amount due from Borrower (line 120) 302. Less Amount Paid by/for Borrower (line 220) 303. Cash From Borrower. 778 122.54 708,137.25 600. Cash at Settlement to / from Seller 601. Gross Amount due to Seller (line 420) 602. Less Reductions Amount due Seller (line 520) $67,985.29 603. Cash To Seller. 740 000.00 61,503.02 $678,486.98 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 Page 1 of 4 HUD-1 Settlement Date: November 18, 2011 Loan Number. 5001902990 File Number. 110317 L. Settlement Charges 700. Total Sales / Broker's Commission:, $35,000.00 Division of Commission (line 700) as follows 701. 17,500,00 to Keller Williams Realty 702. 17,500.00 to Keller Williams Realty 703. Commission Paid at Settlement 800. Items Payable In Connection with Loan: 801. Our origination charge Paid from Paid from Borrower's Sellers Funds at Funds at Settlement Settlement 35,000.00 (from GFE #1) $467.70 802. Your credit or charge (points) for the specific interest rate chosen (from GFE #2) $0.00 803. Your adiusted origination charges 804. Appraisal Fee to Appraisal Associates of Dade. Inc 805. Credit Report to CBC Innovis 806. Tax Service to Corelogic Tax Services 807. Flood Certification to Corelogic Flood Services 808. . (from GFE #A) (from GFE #3) (from GFE #3) (from GFE #3) (from GFE #3) 467.70 400.00 7.73 68.00 5.00 809. . 810. Customer Authorization Report (from GFE #3) to. CBC Innovis 0.85 900. Items Required by Lender to be Paid In Advance; 901. Daily interest charge from Nov 18, 2011 to Dec 1, 2011 @ 68.9315 / day for 13 (from GFE #10) days to TD Bank, NA 896.11 902. Mortgage Insurance Premium (from GFE #3) 903. Homeowner's Insurance policy for 1 year # FRJM6047587- 01-0000 (from GFE #11) to Citizens. Property Insurance Corp 9,178.00 904. . 905. 2011 RE Taxes folio# 11- 3206 - 014 -0550 (from GFE #11) to Miami -Dade County Tax Collector 13,080.36 1000. Reserves Deposited with Lender. 1001. Initial deposit for your escrow account (from GFE #9) to TD Bank, NA 3,270.09 1002. Homeowner's Insurance 1003. Mortgage Insurance 1004. Property Taxes 3 months a $1490.03 per month $3,270.09 1099. Aggregate Adiustment $0.00 1100. Title Charges: 1101. Title services and lender's title insurance (from GFE #4) 1 506.20 1102. Settlement or Closing Fee - to Guaranty Trust & Title, Inc. $470.00 1103. Owner's Title Insurance (Fidelity National Title Insurance Company) (from GFE #5) to Guaranty Trust & Title Inc. 3 775.00 1104. Lender's Title Insurance (Fidelity National Title Insurance Company) to Guaranty Trust & Title, Inc. - Lender's Premium $25.00 - Endorsement FL Form $380.00 - Endorsement 8.1(25) $35.00 1105. Lender's TItie Policy Limit $592,000.00 1106. Owner's Title Policy Limit $740 000.00 1107. Agent's Portion of the Total Title Insurance Premium - Guaranty Trust & Title, Inc $2,950.50 1108, Underwriter's Portion of the Total Title Insurance Premium - Fidelity National Title $1 26450 Insurance Company 350.00 1109. Title Search Fee to Guaranty Trust & Tttle, Inc. 1110. Courthouse Courier - Two Hands and More Ins - $ 31.25 1111. Storage/Copy/Fax Fee - MPB/HOV Services LLC - $ 39.95 1112. Independent closing agent - HL Cameron & Associates, Inc - $ 175.00 1113. Survey fee Global Dimensions Inc - $350.00 1200. Government Recording and Transfer Charges: 1201. Govemment Recording Charges (from GFE #7) 181.50 1202. Deed $10.00 Mortgage $171.50 Releases $0.00 1203. Transfer Taxes (from GFE #8) 3,256.00 1204. City /County tax/stamps Deed $0.00 Mortgage $0.00 1205. State tax/stamps Deed $4 440.00 Mortgage $2,072.00 1206. Intangible Tax to Clerk of the Circuit Court $1 184.00 1207. Other Tax 2nd Mtq Intangible 1208. (from GFE #7) 295.00 4,440.00 1209. (from GFE #7) 1300. Additional Settlement Charges: 1301. Required services that you can shop for (from GFE #6) 1302. Municipal Lien Search inv # 11 -6347 to Lightning Lien Letters, Inc. 195.00 1303. Courthouse Courier to Two Hands and More, Inc. 31.25 1304. Overnight Handling Fee to Guaranty Trust & Title Inc. 45.00 1305. 30 day water escrow to 30 day water escrow GTT 250.00 1306. Re- occupancy cert fee refund to Georgee !Cluck 30.00 30.00 1307. Post Occupancy escrow to Guaranty Trust & Title, Inc. 5,224.92 1308. Post Occupancy Fee to Michael Hoefllinger 2,438.30 Previous editions are obsolete Page 2 of 4 HUD-1 Settlement Date: November 18, 2011 Loan Number. 5001902990 File Number. 110317 1400. Total Settlement Charges (Enter online 103, Section J and line 502, Section K) $36,122.54 $48,299.47 I have carefully reviewed the HUD -1 Settlement Statement, and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of HUD -1 Settlement Statement. Borrower. Seller. Michael Hoefliinger Pericles Gregoriou Borrower. Giovanna Hoeflinger ( Non - Borrower) The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement. Settlement Agent: Date: November 18, 2011 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 and imprisonment. For details see Title 18 U.S. Code Section 1001 and Section 1010. Previous editions are obsolete Page 3 of 4 HUD-1 Settlement Date: November 18, 2011 Loan Number. 5001902990 File Number. 110317 Comparison of Good Faith Estimate (GFE) and HUD Charges Charges That Cannot Increase HUD Line No Good Faith Estimate HUD Our origination charge # 801 467.70 467.70 Your credit or charge (points) for the specific interest rate chosen # 802 0.00 0.00 Your adiusted origination charges # 803 467.70 467.70 Transfer taxes #1203 7,696.35 3,256.00 Charges That In Total Cannot Increase More Than 10% HUD Line No. Good Faith Estimate HUD Govemment Recording Charges #1201 251.00 181.50 Appraisal Fee # 804 400.00 400.00 Credit Report # 805 7.73 7.73 Tax Service # 806 68.00 68.00 Flood Certification # 807 5.00 5.00 Customer Authorization Report # 810 0.85 0.85 Total 732.58 663.08 Increase between GFE and HUD Charges - 69.50 -9.49% Charges That Can Change HUD Line No Good Faith Estimate HUD Initial deposit for your escrow account #1001 5,937.46 3,270.09 Daily interest charge from Nov 18 2011 to Dec 1 2011 Ci 68.9315 / day for 13 days # 901 88.93 898.11 Homeowner's Insurance policy for 1 year FRJM6047587 -01 -0000 # 903 1 850.04 9,178.00 2011 RE Taxes folio# 11- 3206- 014-0550 # 905 0.00 13,080.36 Title services and lender's title insurance #1101 4185.00 1 506.20 Owner's Title Insurance #1103 3,925.00 3,775.00 n Terms Your Initial loan amount Is $592,000.00 Your loan term is 30 years Your Initial interest rate is 4.25 % Your Initial monthly amount owed for principal, Interest, and any mortgage insurance Is $2,912.28 Includes [ X ] Principal [ X ] Interest 1 1 Mortgage Insurance Can your Interest rate rise? [ X ] No. [ ] Yes, It can rise to a maximum of %. The first change will be on _ and can change again every after . Every change date, your Interest rate can increase or decrease by _ %. Over the life of the loan, your interest rate is guaranteed to never be LOWER than % or HIGHER than %. Even If you make payments on time, can your loan balance rise? [ X ] No. [ 1 Yes, it can rise to a maximum of $ . Even if you make payments on time, can your monthly amount owed for principal, interest, and mortgage Insurance riser [ X] No. [ ] Yes, the first increase can be on and the monthly amount owed can rise to $ . The maximum it can ever rise to is $ . Does your loan have a prepayment penalty? [ X ] No. [ 1 Yes, your maximum prepayment penalty is $ Does your, loan have a balloon payment? . - [ X] No. [ ] Yes, you have a balloon payment of $ due in years on Total monthly amount owed Including escrow account payments [ ] You do not have a monthly escrow payment for items, such as property taxes and homeowner's insurance. You must pay these items directly yourself. [ X ] You have an additional monthly escrow payment of $1,854.88 that results in a total initial monthly amount owed of $4,767.14. This includes principal, Interest, any mortgage insurance and any items checked below: [ X ] Property taxes 1 1 [ ] Flood Insurance 1 1 1 X] Homeowner's insurance 1 1 Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Previous editions are obsolete Page 4 of 4 HUD-1