STATE OF WISCONSIN, DEPARTMENT OF VETERANS AFFAIRS

201 West Washington Avenue, P.O. Box 7843, Madison, WI 53707-7843

(608) 266-1311 1-800-WIS-VETS (947-8387)

CUSTODIAL ACCOUNT ANALYSIS
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04(1)(m)].

Servicer Name:
Address:
Report Month & Year:	Servicer Number _____ _____ _____
Line # and Description	Amount	#04	–	Adjustments

*Explanation of	#11	–	Variance

#16	–	Insurance Loss Drafts

#19	–	Other
1	Custodial account balance forwarded (Line 5, last month)	$
2	Plus: Receipts this statement
3	Minus: Disbursements this statement
4	Adjustments (Explain)*
5	Ending custodial account balance
(Attach bank statement)	$
Summary of Disbursements (Line 3)
6	Disbursements (Line 3)	$
7	Minus: Funds reported on prior report month WDVA 1701 that were withdrawn this statement
8	Plus: Funds reported on current report month WDVA 1701 that were NOT withdrawn this statement
9	Subtotal
10	Minus: Funds reported on current month WDVA 1701
11	Variance (Explain)*	$
Summary of Ending Balance (Line 5)
12	Regular P & I	$
13	Payoff P & I
14	Servicing fees
15	Advances to cover overdrafts
16	Insurance loss drafts (Itemize)*
17	Partial payments (Unapplied)
18	T & I funds
19	Other (Itemize in detail)*
20	Total (Must equal Line 5)	$
Signature	Title	Date

WDVA 1409

CUSTODIAL ACCOUNT ANALYSIS

Purpose:	To reconcile withdrawals from the Custodial Account to the amount remitted to WDVA, and to identify the components of the end-of-month Custodial Account balance.

Prepared By:	Servicer

Distribution:	Original to: Wisconsin Department of Veterans Affairs

ATTN: Loan Accounting

P.O. Box 7843

Madison, WI 53707-7843

Instructions

Servicer Name and Address:	Corporate name and address.

Report Month and Year.

Servicer Number:	Three-digit number assigned by WDVA.

Lines 1 through 5 summarize the Custodial Account activity from the beginning to the ending balance. These figures are usually provided in a monthly activity summary on the bank statement.

Summary of Disbursements

Lines 6 through 11 provide a summary of variances between the Servicer Remittance Record, WDVA 1701, and the Custodial Account withdrawals.

Line 6:	Enter withdrawals from Custodial Account as reported on bank statement and line 3 of this form.

Line 7:	Enter TCRS remittances from last month’s WDVA 1701 that were withdrawn this statement.

Line 8:	Enter TCRS remittances from this report month’s WDVA 1701 that were not withdrawn this statement.

Line 9:	Subtotal

Line 10:	Subtract total remittances to WDVA on the Servicer Remittance Summary, WDVA 1701, from the Subtotal on line 9, and enter the remainder on line 11.

Line 11:	Explain the contents of the remainder in the right hand column, i.e., servicing fees, NSF fees, Late Charges.

Summary of Ending Balance

Lines 12 through 20 identify the components of the Custodial Account ending balance.

Line 12:	Regular P & I payments.

Line 13:	P & I components of payoffs not disbursed at month-end.

Line 14:	Servicing Fees.

Line 15:	Advances to cover overdrafts.

Line 16:	Itemize insurance loss drafts.

Line 17:	Partial (unapplied) payments.

Line 18:	T & I funds.

Line 19:	Other (Itemize in detail)

Line 20:	Total of lines 12 through 19. This amount should equal the Ending Custodial Account balance on the bank statement and the amount on line 5.

Signature:	Authorized representative of the Servicer.

Title:	Title of person completing the form.

Date:	Date the analysis was completed.

NOTE:	1.	Attach a copy of the bank statement.

2.	Submit the completed Custodial Account Analysis when requested.

WDVA 1409 (04/07) Page 3 of 3	You can print the most recent version of this form

W:\Templates\WDVA_1409_Custodial_Account_Analysis.dot	from the WDVA website at www.WisVets.com/Forms.

WDVA 1409 (04/07) Page 1 of 3	You can print the most recent version of this form

Wis. Stats. Chapter 45

WDVA 1409 - Custodial Account Analysis

memerka

2012-01-23

Karen Emery

Dept of Veterans Affairs