Form 82-127 - Philadelphia Real Estate Transfer Tax Certification 1998

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DOCUMENT I.D. NUMBER
GRANTEE'S NAME
GRANTEE'S SOCIAL SECURITY NO.
GRANTEE'S NAME
GRANTEE'S SOCIAL SECURITY NO.
GRANTEE'S NAME
GRANTEE'S SOCIAL SECURITY NO.
P H I L A D E L P H I A
P H I L A D E L P H I A
P H I L A D E L P H I A
P H I L A D E L P H I A
P H I L A D E L P H I A
RE
RE
AL EST
AL EST
AL ESTA A A A A TE
TE
TE
RE
RE
REAL EST
AL EST
TE
TE
GRANTEE'S NAME
GRANTEE'S SOCIAL SECURITY NO.
TR
TR
ANSFER T
ANSFER T
ANSFER TA A A A A X CER
X CER
X CER
TIFIC
TIFIC
TIFICA A A A A TI
TI TI
TI TIO O O O O N N N N N
TR
TRANSFER T
TR
ANSFER T
X CER
X CERTIFIC
TIFIC
DATE RECORDED
CITY TAX PAID
Complete each section and file with Recorder of Deeds when (1) the full consideration/value is/is not set forth in the deed, (2) when the deed is
with consideration, or by gift, or (3) a tax exemption is claimed. If more space is needed, attach additional sheet(s).
A. CORRESPONDENT — All inquiries may be directed to the following person:
NAME
TELEPHONE NUMBER:
( )
AREA CODE (
)
STREET ADDRESS
CITY
STATE
ZIP CODE
B. TRANSFER DATA
DATE OF ACCEPTANCE OF DOCUMENT:
GRANTOR(S)/LESSOR(S)
GRANTEE(S)/LESSEE(S)
STREET ADDRESS
STREET ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
C. PROPERTY LOCATION
STREET ADDRESS
TAX PARCEL NUMBER
D. VALUATION DATA
1. ACTUAL CASH CONSIDERATION
2. OTHER CONSIDERATION
3. TOTAL CONSIDERATION
+
=
4. COUNTY ASSESSED VALUE
5. COMMON LEVEL RATIO FACTOR
6. FAIR MARKET VALUE
x
=
1A. PERCENTAGE OF INTEREST CONVEYED
1B. TAXABLE PERCENTAGE
E. Check Appropriate Box Below for Exemption Claimed
Will or intestate succession ________________________________________________________________________
(NAME OF DECEDENT)
(ESTATE FILE NUMBER)
Transfer to Industrial Development Agency.
Transfer to agent or straw party. (Attach copy of agency/straw party agreement).
Transfer between principal and agent. (Attach copy of agency/straw trust agreement). Tax paid prior deed $ __________.
Transfer to the Commonwealth, the United States, and Instrumentalities by gift, dedication, condemnation or in lieu
of condemnation. (Attach copy of resolution).
Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number _______ , Page Number _______ .
Mortgagee (grantor) sold property to Mortgagor (grantee) (Attach copy of prior deed).
Corrective deed (Attach copy of the prior deed and explain corrections being made).
Other (Please explain exemption claimed, if other than listed above.) ________________________________________
________________________________________________________________________________________________
Under penalties of law or ordinance, I declare that I have examined this Statement, including accompanying information, and to the best of
my knowledge and belief, it is true, correct and complete.
SIGNATURE OF CORRESPONDENT OR RESPONSIBLE PARTY
DATE
type your first and last name here.
IF YOU HAVE A DISABILITY AND REQUIRE AN ACCOMMODATION IN ORDER TO COMPLETE THIS FORM AND/OR TO
PARTICIPATE IN A PROGRAM OR SERVICE, CONTACT THE ADA COORDINATOR AT 686-2263.
82-127 (Rev. 10/98)
(SEE REVERSE)
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