Form Pt-1 - Vermont Propertty Transfer Tax Return - 2005
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1
2VERMONT PROPERTY TRANSFER TAX RETURN
VERMONT DEPARTMENT OF TAXES
MONTPELIER, VERMONT 05633
(PLEASE TYPE OR PRINT CLEARLY)
A
SOCIAL SECURITY NO. OR
SELLER'S (TRANSFEROR'S) NAME(S)
COMPLETE MAILING ADDRESS FOLLOWING TRANSFER
TAXPAYER IDENT. NO.
BLACK OUT ON TOWN COPY ONLY
B
COMPLETE MAILING ADDRESS FOLLOWING TRANSFER
SOCIAL SECURITY NO. OR
BUYER'S (TRANSFEREE'S) NAME(S)
TAXPAYER IDENT. NO.
BLACK OUT ON TOWN COPY ONLY
D
C
DATE OF CLOSING
PROPERTY LOCATION (Address in full)
E
INTEREST IN PROPERTY
1.
FEE SIMPLE
3.
UNDIVIDED 1/2 INTEREST
5.
TIME-SHARE
7.
EASEMENT/ROW
%
2.
LIFE ESTATE
4.
UNDIVIDED ________
INTEREST
6.
LEASE
8.
OTHER _________________
F
LAND SIZE (Acres or fraction
G
SPECIAL FACTORS: HAVE DEVELOPMENT RIGHTS BEEN CONVEYED _________ NO _________ YES
F
thereof)
WAS SALE BETWEEN FAMILY MEMBERS ________ NO
________ YES STATE RELATIONSHIP ___________________
FINANCING:
CONVENTIONAL/BANK
OWNER FINANCING
OTHER ______________________________
H
BUILDINGS ON PROPERTY AT THE TIME OF TRANSFER (CHECK ALL THAT APPLY):
1.
NONE
5.
FARM BUILDINGS
9.
STORE
DWELLING UNITS
INSERT
2.
FACTORY
6.
MULTI-FAMILY WITH __________ (
)
10.
OTHER ________________________
NUMBER
TRANSFERRED
DESCRIBE
3.
SINGLE FAMILY DWELLING
7.
MOBILE HOME YEAR __________ MAKE ___________________ SER. NO. ________________________
INSERT
4.
CAMP/VACATION HOME
8.
CONDOMINIUM WITH _________ (
)
UNITS TRANSFERRED
NUMBER
CHECK WHETHER THE BUILDINGS WERE EVER
OCCUPIED
RENTED
WILL BE RENTED AFTER SALE
I
PRIMARY USE OF PROPERTY BEFORE TRANSFER (CHECK ONE):
1.
PRIMARY RESIDENCE
3.
CAMP/VACATION 5.
OPERATING FARM
7.
COMMERCIAL/INDUSTRIAL _____________________
DESCRIBE
2.
OPEN LAND
4.
TIMBERLAND
6.
GOVERNMENT USE
8.
OTHER ________________________
DESCRIBE
J
PRIMARY USE OF PROPERTY AFTER TRANSFER (CHECK ONE):
1.
PRIMARY RESIDENCE
3.
CAMP/VACATION
5.
OPERATING FARM
7.
COMMERCIAL/INDUSTRIAL _____________________
DESCRIBE
2.
OPEN LAND
4.
TIMBERLAND
6.
GOVERNMENT USE
8.
OTHER ________________________
DESCRIBE
WAS PROPERTY PURCHASED BY TENANT _______ NO _______ YES
DOES BUYER HOLD TITLE TO ANY ADJOINING PROPERTY ______ NO ______ YES
CURRENT USE VALUE PROGRAM: IS ANY PORTION OF THE LAND BEING CONVEYED SUBJECT TO A LIEN OR OTHER RESTRICTIONS UNDER THE AGRICUL-
K
TURAL AND MANAGED FOREST LAND USE VALUE PROGRAM CHAPTER 124 OF 32 V.S.A.
YES
NO
L
IF TRANSFER IS EXEMPT FROM PROPERTY TRANSFER TAX, CITE EXEMPTION FROM INSTRUCTIONS AND COMPLETE SECTIONS M, N, AND O BELOW.
O
M
N
TOTAL
PRICE PAID FOR
PRICE PAID FOR
PRICE PAID $ ____________________
PERSONAL PROPERTY $ ____________________
REAL PROPERTY $ ________________________
STATE TYPE OF PERSONAL PROPERTY _______________________________________________
IF PRICE PAID FOR REAL PROPERTY IS LESS THAN FAIR MARKET VALUE, PLEASE EXPLAIN: _____________________________________________________
PROPERTY TRANSFER TAX
MAKE CHECKS PAYABLE TO: VERMONT DEPARTMENT OF TAXES
$
TAX DUE: Enter amount from rate schedule on reverse side. COMPLETE RATE SCHEDULE FOR ALL TRANSFERS
P
Q
DATE SELLER ACQUIRED ___________________________________________
R
IF A VERMONT LAND GAINS TAX RETURN IS NOT BEING FILED, CITE EXEMPTION FROM INSTRUCTIONS ON PAGE 4 OF THIS BOOKLET _______________
(CONTINUED ON REVERSE SIDE)
THIS SECTION TO BE COMPLETED BY TOWN OR CITY CLERK
TOWN/CITY ______________________________________________________
ACKNOWLEDGMENT
TOWN NUMBER
DATE OF RECORD ________________________________________________
RETURN RECEIVED (INCLUDING CERTIFICATES AND
BOOK NUMBER __________________________ PAGE NO. ________________
ACT 250 DISCLOSURE STATEMENT) AND TAX PAID.
LISTED VALUE $ _____________________ GRAND LIST YEAR OF ___________
PARCEL ID NO. ___________________________________________________
CLERK
SIGNED _______________________________________
GRAND LIST CATEGORY ___________________________________________
DATE _________________________________________
SPAN ___________________________________________________________
(Rev. 9/05)
FORM PT-1
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