Declaration Of Value Form Page 2
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State of Nevada
Declaration of Value
FOR RECORDERS OPTIONAL USE ONLY
Document/Instrument #______________________
1.
Assessor Parcel Number(s)
Book:_________________Page:_______________
a)_________________________________
Date of Recording:__________________________
b)_________________________________
Notes:____________________________________
c)_________________________________
d)_________________________________
2.
Type of Property:
a)
Vacant Land
b)
Single Fam. Res.
c)
Condo/Twnhse d)
2-4 Plex
e)
Apt. Bldg.
f)
Comm’l/Ind’l
g)
Agricultural
h)
Mobile Home
i)
Other__________________________
3.
Total Value/Sales Price of Property:
$______________________________
Deed in Lieu of Foreclosure Only (value of property)
$______________________________
Transfer Tax Value per NRS 375.010, Section 2:
$______________________________
Real Property Transfer Tax Due:
$______________________________
4.
If Exemption Claimed:
a. Transfer Tax Exemption, per NRS 375.090, Section: ______________________________________
b. Explain Reason for Exemption: _______________________________________________________
____________________________________________________________________________________
5.
Partial Interest: Percentage being transferred:__________%
The undersigned declares and acknowledges, under penalty of perjury, pursuant to NRS 375.060 and NRS 375.110, that the information provided is
correct to the best of their information and belief, and can be supported by documentation if called upon to substantiate the information provided
herein. Furthermore, the disallowance of any claimed exemption, or other determination of additional tax due, may result in a penalty of 10% of the
tax due plus interest at 1% per month.
Pursuant to NRS 375.030, the Buyer and Seller shall be jointly and severally liable for any additional
amount owed.
Signature________________________________________________Capacity___________________________
Signature________________________________________________Capacity___________________________
SELLER (GRANTOR) INFORMATION
BUYER (GRANTEE) INFORMATION
(REQUIRED)
(REQUIRED)
Print Name:______________________________________________
Print Name:____________________________________________
Address:________________________________________________
Address:_______________________________________________
City:___________________________________________________
City:__________________________________________________
State:______________________________Zip:_________________
State:_______________________________Zip:_______________
COMPANY REQUESTING RECORDING
(REQUIRED IF NOT THE SELLER OR BUYER)
Print Name:_________________________________________________Escrow #______________________
Address:_________________________________________________________________________________
City:_______________________________________________State:_____________Zip:________________
(AS A PUBLIC RECORD THIS FORM MAY BE RECORDED/MICROFILMED)
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