Form Pt-172 - Property Transfer Tax Return - Vermont Page 2
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1
2
3
4Buyer #1 or Entity ____________________________________________________
*081721200*
SSN or FID __________________________________________________________
Property Location ____________________________________________________
Date of Closing ______________________________________________________
* 0 8 1 7 2 1 2 0 0 *
Please use ALL CAPS.
C.
PROPERTY LOCATION
Number and Street or Road Name
City or Town
VT
D.
E.
DATE OF CLOSING
INTEREST IN PROPERTY - Write the number from the list
If “4”, enter
%
.
% Interest here
1. Fee Simple
3. Undivided 1/2 Interest
7. Easement/Row
5. Time-Share
M M
D
D
Y
Y
Y Y
2. Life Estate
4. Undivided __% Interest
6. Lease
8. Other ___________________________
G.
SPECIAL
F.
LAND SIZE (Acres or fraction thereof)
If sale was between family members,
Check if development rights
FACTORS
enter number from list below
have been conveyed
±
.
1. Husband/Wife 2. Parent/Child 3. Grandparent/Grandchild 4. Other ________________________
FINANCING:
Conventional/Bank
Owner Financing
Other _________________________________
H.
TYPE OF BUILDING CONSTRUCTION AT THE TIME OF TRANSFER (Check all that apply)
1.
None
5.
Farm Buildings
9.
Store
2.
Factory
6.
Multi-Family with
Dwelling Units Transferred
10.
Residential New Construction
3.
Single Family Dwelling
7.
Mobile Home
11.
Other _______________________
4.
Seasonal Dwelling
8.
Condominium with
Units Transferred
I.
SELLER’S USE OF PROPERTY
1. Primary Residence
4. Timberland
7. Commercial _____________________
BEFORE TRANSFER
2. Open Land
5. Operating Farm
8. Industrial _______________________
(Enter number from list)
3. Secondary Residence
6. Government Use
9. Other __________________________
Check if property was rented BEFORE transfer
J.
BUYER’S USE OF PROPERTY
4. Timberland
7. Commercial _____________________
1. Primary Residence
AFTER TRANSFER
2. Open Land
5. Operating Farm
8. Industrial _______________________
(Enter number from list)
6. Government Use
9. Other __________________________
3. Secondary Residence
Check if property will be rented AFTER transfer
Check if property was purchased by tenant
Check if buyer holds title to any adjoining property
K.
L.
AGRICULTURAL/MANAGED FOREST LAND USE VALUE PROGRAM, 32 V.S.A. Chapter 124
If transfer is exempt from Property Transfer
Tax, cite exemption number from instructions and
1. Check if property being conveyed is subject to a land use change tax lien
complete Sections M, N, and O below.
2. Check if new owner elects to continue enrollment of eligible property
M.
TOTAL Price Paid
N.
Price paid for Personal Property
O.
Price paid for Real Property
.
00
.
00
.
00
State type of Personal Property ____________________________________________________________________________________________________________________
If price paid for Real Property is less than fair market value, please explain __________________________________________________________________________________
Value of purchaser’s principal
P.
Q.
Fair market value of property enrolled in current use
R.
Fair market value of qualified working farm
residence included in Line O for
included in Line O for special tax rate
program included in Line O for special tax rate
special tax rate (See instructions)
.
00
.
00
.
00
S.
PROPERTY TRANSFER TAX DUE from rate schedule on page 3 of this form.
COMPLETE RATE SCHEDULE FOR ALL TRANSFERS.
.
Make checks payable to VERMONT DEPARTMENT OF TAXES
T.
DATE SELLER ACQUIRED
U.
IF A VERMONT LAND GAINS TAX RETURN IS NOT BEING FILED, cite exemption(s) from instructions on page 5 of
this booklet
M M
D
D
Y
Y
Y Y
Form PT-172,
Page 2 of 4
Rev. 11/10
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