Form Pt-172-S - Property Transfer Tax Return June 2015 Page 2

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Buyer #1 or Entity _____________________________________________________
*151721600*
SSN or FID ___________________________________________________________
Property Location _____________________________________________________
Date of Closing _______________________________________________________
* 1 5 1 7 2 1 6 0 0 *
Attachment for
Additional
VERMONT
SELLERS
(cont.)
Property Transfer Tax Return
BLACK OUT ALL ID NUMBERS BELOW ON TOWN COPY ONLY
SELLER #7
Individual SELLER #7 Last Name
First Name
Initial
Individual SELLER #7 Social Security Number
For Department Use Only
SELLER #7 Mailing Address Following Transfer
City
State
ZIP Code
Foreign Country (if not United States)
SELLER #8
Individual SELLER #8 Last Name
First Name
Initial
Individual SELLER #8 Social Security Number
For Department Use Only
SELLER #8 Mailing Address Following Transfer
City
State
ZIP Code
Foreign Country (if not United States)
SELLER #9
Individual SELLER #9 Last Name
First Name
Initial
Individual SELLER #9 Social Security Number
For Department Use Only
SELLER #9 Mailing Address Following Transfer
City
State
ZIP Code
Foreign Country (if not United States)
SELLER #10
Individual SELLER #10 Last Name
First Name
Initial
Individual SELLER #10 Social Security Number
For Department Use Only
SELLER #10 Mailing Address Following Transfer
City
State
ZIP Code
Foreign Country (if not United States)
For Town Use Only
Form PT-172-S,
Additional SELLERS
(Attach to Form PT-172)
Rev. 06/15
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