Declaration Of Documentary Transfer Tax Form

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DECLARATION_OF_DOCUMENTARY_TRANSFER_TAX
The undersigned, having knowledge of the transaction, does hereby disclose the following information to the
Recorder of Placer County for the purpose of determining transfer tax on the documents submitted for recording in
connection with this transaction.
APN:______________________________________ STREET ADDRESS:_______________________________________________
:_______________________________________________________________
TYPE OF TRANSACTION
COMPUTATION INFORMATION
Sale Price of Property
$_______________________________________________
Value if other than sale
$_______________________________________________
Encumbrances or liens
$_______________________________________________
Amount tax based on
$_______________________________________________
Tax
$_______________________________________________
($.55 per $500. Or portion thereof)
YES_______________
NO__________________
Value obtained by appraisal
REASON FOR NO TAX DUE:
_____Gift Deed
_____Deed to or by a trustee not pursuant to a sale.
_____Deed to confirm title already vested in grantee, to correct a flaw in title.
_____Deed given by an executor in accordance with the terms of the will.
_____Ordinary leases of real property for less than 35 years.
_____Deed to a trustee for the benefit of creditors.
_____Deed from an agent to this principal conveying real estate purchases for and with
funds of the principal.
_____Conveyance by a corporation in liquidation or in dissolution to its shareholders
made solely for the cancellation and retirement capital stock.
_____Conveyance from a corporation in liquidation to a partnership wherein the corporate
shareholders are the only partners of the partnership and hold proportional interests
in each entity.
_____Conveyance is in dissolution of marriage by one spouse to the other.
_____Conveyance from one spouse to the other as sole and separate property.
_____Other: (explain below)
______________________________________________________________________________
______________________________________________________________________________
______________________________
_________________________________________________________
I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT TO
THE BEST OF MY KNOWLEDGE.
SIGNED:________________________________________________________ DATE:____________________________________
FIRM NAME:____________________________________________________ PLACE:___________________________________
:
This information is not made a part of the recorded document but is made available to the Internal Revenue Service and
NOTE
other taxing agencies.

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