Escrow Agent Quarterly Report Form
State of Washington
150 Israel Rd. SW
Department of Financial Institutions
Tumwater, WA 98501
Telephone: (360) 902-8703
P.O. Box 41200
Fax: (360) 586-0062
Olympia, WA 98504-1200
Agent Name (as shown on license): _______________________________________________________________________
D.b.a. and previous business names: ______________________________________________________________________
License No. 540-EA - __ __ __ __ __
Report for Quarter Ended: ________________________________
Contact Name: _________________________________ Phone: _______________ E-Mail: _________________________
Part A. Trust Account Information (See WAC 208-680E-011 and RCW 18.44.400) i
Account Number: _____________________________ Bank/Location: _________________________________________
If more than one escrow trust account ("trust account") is used, you must complete a separate and individually signed
Part A of this form for each account.
If you have branch offices that share this account, indicate their locations: ________________________________
1. Was the trust account reconciled at least monthly during the period covered by this quarterly report? Yes _____ No _____
If your answer is "No," identify the months that were not reconciled and attach a brief explanation.
2. Were reconciliations of the trust account completed within 30 days of the end of each month?
Yes _____ No _____ If your answer is "No," attach a detailed explanation.
3. Did you verify and correct all exceptions/adjustments between the monthly bank statement balance for the trust account
and the monthly trial balance of the client ledger as of the quarter end date? Yes ____ No _____
If your answer is "No," please complete and submit a reconciliation summary report using the attached worksheet.
Provide an explanation for each adjustment/exception that includes a description, dollar amount, transaction date and
the corrective action.
4. Did all individual client