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*IDRDOV*
REAL ESTATE TRANSFER - DECLARATION OF VALUE
Please read the instructions on the reverse side BEFORE completing and filing this form.
Part I - TO BE COMPLETED BY BUYER, SELLER OR AGENT
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Date of Instrument:
Deed _1
Contract _ 2
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SELLER:
Phone:
Seller Address:
e-mail:
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BUYER:
Phone: _______________________________________
Buyer Address:
e-mail:
Address of Property Conveyed:
Legal Description:
Type of Sale:
Sale between related parties/family
Sale of partial interest
Trade
Quit Claim Deed
Auction
AG LAND
Was this a sale of
to:
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Corporation
Trust
Alien
Non-Resident Alien
Limited Partnership
DECLARATION OF VALUE STATEMENT
1. Total Amount Paid
$____________________________
2. Amount Paid for Personal Property (see instructions)
$____________________________
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3. Amount Paid for Real Property Only (1 minus 2)
$____________________________
I HEREBY DECLARE THAT THE INFORMATION CONTAINED IN PART I OF THIS FORM IS TRUE AND CORRECT AS
DETAILED ON THE BACK OF THIS FORM .
Printed Name:
Phone #:
Buyer or
Seller or
Agent or
Attorney
Signature
PART II - TO BE COMPLETED BY THE ASSESSOR
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Primary Classification:
Res _4_
Com _5_
Ind _2_
Ag _ 1_
MultiRes _7_
City/Township____________________
Primary Parcel Number _______________________________________________ YearBlt ____________ Occ ___________ NUTC
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Classification
Land
Building
Dwelling
Total
Residential
Commercial
Industrial
Agricultural
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Multi Residential
Comments:
Effective On or Before 09/01/14
Iowa Department of Revenue
57006a (07/23/14)