Form Tsd-385 - Application For Partial Release Of State Tax Lien - West Virginia State Tax Department Page 3
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3West Virginia State Tax Department
Application For Partial Release Of State Tax Lien
To:
Director, Compliance Division
Re:
Taxpayer __________________________
State Tax Commissioner
TID #
__________________________
P. O. Box 229
Address ___________________________
Charleston, WV 25321-0229
___________________________
1.
This request for a Partial Release of State Tax Lien(s) pursuant to W.Va. Code ?11-10-12(d) is made by:
____________________________________________.
2.
The legal owner of the property is: ___________________________________
3.
The property to be released is described in the deed(s) to the present owner of the property, a copy of which is
attached.
4.
The state tax liens to be released, with copies attached, are:
Lien Date
Record Date
County
Book/Page
Amount
5.
The property is subject to these lien(s) other than the state tax lien(s) above:
Type
Creditor
Record Date
Amount
Balance Due
6.
The property has a fair market value of $__________, as shown by an attached deed, contract of sale, or
appraisal; and, if applicable, a forced sale value of $_________.
7.
The amount of $___________ will be paid in consideration for this release.
8.
The proceeds of sale are intended to be distributed as follows:
9.
The date and manner taxpayer divested of interest in property.
10.
The taxpayer owns other real property in West Virginia as follows:
County
Description
Value
11.
The partial release is requested for the following reasons:
Date:____________
Applicant: _________________________________
By: _______________________________________
Its: _______________________________________
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