Form Pt-172 - Property Transfer Tax Return - Vermont Page 4

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Buyer #1 or Entity ____________________________________________________
*081721400*
SSN or FID __________________________________________________________
Property Location ____________________________________________________
Date of Closing ______________________________________________________
* 0 8 1 7 2 1 4 0 0 *
Please use ALL CAPS.
SIGNATURES
We hereby swear and affirm that this return, including all certificates, is true, correct and complete to the best of our knowledge.
Signature ____________________________________________________________________________________
Date ___________________________
Signature ____________________________________________________________________________________
Date ___________________________
Signature ____________________________________________________________________________________
Date ___________________________
Signature ____________________________________________________________________________________
Date ___________________________
Signature ____________________________________________________________________________________
Date ___________________________
Signature ____________________________________________________________________________________
Date ___________________________
Signature ____________________________________________________________________________________
Date ___________________________
Signature ____________________________________________________________________________________
Date ___________________________
Prepared by (print or type) ____________________________________________
Preparer’s Signature __________________________________________________
Preparer’s Address _________________________________________________
Buyer’s Representative ________________________________________________
_________________________________________________________________
Buyer’s Representative Telephone ______________________________________
Click here to RESET
Click here to PRINT
Town or City: Please forward original to the VT Department of Taxes within 30 days of receipt.
THIS SECTION TO BE COMPLETED BY TOWN OR CITY CLERK
Book Number _________________________________________
Page Number _____________________ Grand List year of ___________________________________
City or Town
Date of Record
M M
D
D
Y
Y
Y Y
Grand List Value
Parcel ID Number
.
Grand List Category*
SPAN
ACKNOWLEDGMENT
Return received (including certificates and Act 250 disclosure statement).
SIGNED _________________________________________________________________ , Clerk
DATE ______________________________________________
* Please use the following numeric two-digit grand list category codes
Residential <6 Acres . . . . . . . . . . . . 01
Seasonal >6 Acres . . . . . . . . . . . . . 06
Utilities Other . . . . . . . . . . . . . . . . . . 11
Residential >6 Acres . . . . . . . . . . . . 02
Commercial . . . . . . . . . . . . . . . . . . . 07
Farm . . . . . . . . . . . . . . . . . . . . . . . . 12
Mobile Home/Un . . . . . . . . . . . . . . . 03
Commercial Apt . . . . . . . . . . . . . . . . 08
Other . . . . . . . . . . . . . . . . . . . . . . . . 13
Mobile Home/La . . . . . . . . . . . . . . . 04
Industrial . . . . . . . . . . . . . . . . . . . . . 09
Woodland . . . . . . . . . . . . . . . . . . . . 14
Seasonal <6 Acres . . . . . . . . . . . . . 05
Utilities Elec . . . . . . . . . . . . . . . . . . . 10
Miscellaneous . . . . . . . . . . . . . . . . . 15
Form PT-172,
Page 4 of 4
NOTE: If Forms PT-172S or PT-172B are not used, only print pages 1-4, and page 9 for
Rev. 11/10
Form PT-173. Print Forms PT-172S and/or PT-172B as needed and attach to pages 1-4.

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