Fillable Form Pt-1 - Vermont Propertty Transfer Tax Return

RATE SCHEDULE

1. Tax on Special Rate Property:

a. Value of purchaser's principal residence (not to exceed $100,000) (See Instructions) ...................................................

1. a. $ _____________________

b. Value of property enrolled in current use program ....................................................................................................

b. $ _____________________

c. Value of qualified working farm ..............................................................................................................................

c. $ _____________________

d. Add Lines 1a, b and c ............................................................................................................................................

d. $ _____________________

0.005

e. Tax rate ...............................................................................................................................................................

e. _____________________

f. Tax due on Special Rate Property: Multiply Line 1d by Line 1e ..................................................................................

f. $ _____________________

2. Tax on General Rate Property:

a. Enter amount from Line O on front of return .............................................................................................................

2. a. $ _____________________

b Enter amount from Line 1d of Rate Schedule above ...................................................................................................

b. $ _____________________

c. Subtract Line 2b from Line 2a .................................................................................................................................

c. $ _____________________

0.0125

d. Tax Rate ...............................................................................................................................................................

d. _____________________

e. Tax due on General Rate Property: Multiply Line 2c by Line 2d ..................................................................................

e. $ _____________________

3. Total Tax Due:

Add Lines 1f and 2e and enter here and on line P on front of return .............................................................................

$ ____________________

LOCAL AND STATE PERMITS AND ACT 250 CERTIFICATES

Buyer(s) and Seller(s) certify as follows:

A. That they have investigated and disclosed to every party to this transaction all of their knowledge relating to flood regulations, if any, affecting the property.

B. That the seller(s) advised the buyer(s) that local and state building regulations, zoning regulations and subdivision regulations and wastewater system and

potable water supply rules under Chapter 64 of Title 10 pertaining to the property may limit significantly the use of the property.

C. That this transfer is in compliance with or is exempt from the wastewater system and potable water supply rules of the Agency of Natural Resources for the

following reasons:

1. This property is the subject of Permit No. __________________ and is in compliance with said permit, or

2. This property and any retained parcel is exempt from the wastewater system and potable water supply rules because (see instructions for exemptions):

a. Parcel to be sold:

Exemption Number __________________________

b. Parcel retained:

Exemption Number __________________________

Seller(s) further certifies as follows:

D. That this transfer of real property and any development thereon is in compliance with or exempt from 10 V.S.A. Chapter 151, Vermont's Land Use and

Development law (Act 250), for the following reason:

1. This property is the subject of Act 250 Permit No. _________________ and is in compliance with said permit, or

2. This property is exempt from Act 250 because: (list exemption number from Line D in instructions) ____________________________________________

E. That this transfer does/does not (strike one) result in a partition or subdivision of land. Note: If it does, an Act 250 Disclosure Statement must be attached

to this return before filing with the town clerk (see Line E instructions).

WITHHOLDING CERTIFICATION

Buyer(s) certifies that Vermont income tax has been withheld from the purchase price and will be remitted to the

Commissioner of Taxes with Form RW-171 within 30 days from the transfer,

OR that the transfer is exempt from income tax withholding for the following reason (check one):

1. Under penalties of perjury, seller(s) certifies that at the time of transfer, each seller was a resident of Vermont or an estate.

2. Buyer(s) certifies that the parties obtained withholding certificate no. _________________from the Commissioner

of Taxes in advance of this sale.

3. Buyer(s) certifies that this is a transfer without consideration. (See instructions for Form RW-171).

Seller(s) is a mortgagor conveying the mortgaged property to a mortgagee in a foreclosure or transfer in lieu of

foreclosure, with no additional consideration.

WE HEREBY SWEAR AND AFFIRM THAT THIS RETURN, INCLUDING ALL CERTIFICATES, IS TRUE, CORRECT AND COMPLETE TO THE BEST OF OUR KNOWLEDGE.

SELLER(S) SIGNATURE(S)

DATE

BUYER(S) SIGNATURE(S)

DATE

Preparer's Signature ____________________________________________________ Prepared by ________________________________________________

Preparer's Address _____________________________________________________ Buyer's Representative _____________________ Tel. ________________

(Print or Type)

Rev. 9/05

FORM PT-1

Keep a copy of this return for your records.

Form Pt-1 - Vermont Propertty Transfer Tax Return - 2005 Page 2

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