Agency Name:____________________________________________________________ A Income Title Insurance Escrow Non-Policy Total for Other Combined Abstract Business Operations Totals Not Reported on Form A (whole dollars only) (whole dollars only) (whole dollars only) (whole dollars only) (whole dollars only) 1. Title Insurance Premiums 2. <less> Remitted Title Premiums < > 3. Retained Title Premiums 4. Fees Received for Title Examination and Furnishing Title Evidence 5. Fees Received for Closing 6. Tax Certificates 7. Recording Fees 8. Restrictions 9. Inspection Fees 10. Courier and Overnight Delivery 11. Telephone and Facsimile 12. Interest Income 13. Other Income 14. Total for Each Column 15. Total Income (sum of lines 1-13, all columns) Agency Name:____________________________________________________________ B Expenses Title Insurance Escrow Non-Policy Total for Other Combined Abstract Business Operations Totals Not Reported on Form A (whole dollars only) (whole dollars only) (whole dollars only) (whole dollars only) (whole dollars only) 1. Salaries/Wages: a. Employees, Including Temp and Contract b. Owners and Partners
Agency Name:____________________________________________________________ A Income Title Insurance (whole dollars only) Escrow (whole dollars only) Non-Policy Abstract (whole dollars only) Total for Other Business Operations Not Reported on Form A (whole dollars only) Combined Totals (whole dollars only) 1. Title Insurance Premiums 2. <less> Remitted Title Premiums < > 3. Retained Title Premiums 4. Fees Received for Title Examination and Furnishing Title Evidence 5. Fees Received for Closing 6. Tax Certificates 7. Recording Fees 8. Restrictions 9. Inspection Fees 10. Courier and Overnight Delivery 11. Telephone and Facsimile 12. Interest Income 13. Other Income 14. Total for Each Column 15. Total Income (sum of lines 1-13, all columns) Agency Name:____________________________________________________________ B Expenses Title Insurance (whole dollars only) Escrow (whole dollars only) Non-Policy Abstract (whole dollars only) Total for Other Business Operations Not Reported on Form A (whole dollars only) Combined Totals (whole dollars only) 1. Salaries/Wages: a. Employees, Including Temp and Contract b. Owners and Partners
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