Form 521 - Real Estate Transfer Statement

Download a blank fillable Form 521 - Real Estate Transfer Statement in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form 521 - Real Estate Transfer Statement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

Print
Reset
Real Estate Transfer Statement
FORM
521
• To be filed with the Register of Deeds. • Read instructions on reverse side.
• If additional space is needed, add an attachment and identify the item.
The deed will not be recorded unless this statement is signed and items 1-25 are accurately completed.
1
2 County Number
3 Date of Sale/Transfer
4 Date of Deed
County Name
Mo.
Day
Yr.
Mo.
Day
Yr.
Select County & County Number
5 Grantor’s Name, Address, and Telephone (Please Print)
6 Grantee’s Name, Address, and Telephone (Please Print)
Grantor’s Name (Seller)
Grantee’s Name (Buyer)
Street or Other Mailing Address
Street or Other Mailing Address
City
State
Zip Code
City
State
Zip Code
Telephone Number
Telephone Number
Is the grantee a 501(c)(3) organization?
Yes
No
If Yes, is the grantee a 509(a) foundation?
Yes
No
Email Address
Email Address
7 Property Classification Number. Check one box in categories A and B. Check C if property is also a mobile home.
(A) Status
(B) Property Type
(C)
Improved
Single Family
Industrial
Mineral Interests-Nonproducing
State Assessed
Mobile Home
Unimproved
Multi-Family
Agricultural
Mineral Interests-Producing
Exempt
IOLL
Commercial
Recreational
8 Type of Deed
Conservator
Distribution
Land Contract/Memo
Partition
Sheriff
Other______________
Bill of Sale
Corrective
Easement
Lease
Personal Rep.
Trust/Trustee
Cemetery
Death Certificate – Transfer on Death
Executor
Mineral
Quit Claim
Warranty
9 Was the property purchased as
10 Type of Transfer
Distribution
Foreclosure
Irrevocable Trust
Revocable Trust
Transfer on Death
part of an IRS like-kind exchange?
Auction
Easement
Gift
Life Estate
Sale
Trustee to Beneficiary
(I.R.C. § 1031 Exchange)
Yes
No
Court Decree
Exchange
Grantor Trust
Partition
Satisfaction of Contract
Other (Explain) __________
11 Was ownership transferred in full? (If No, explain the division.)
12 Was real estate purchased for same use? (If No, state the intended use.)
Yes
No ____________________________________________________________
Yes
No ________________________________________
13 Was the transfer between relatives, or if to a trustee, are the trustor and beneficiary relatives? (If Yes, check the appropriate box.)
Yes
No
Aunt or Uncle to Niece or Nephew
Family Corp., Partnership, or LLC
Self
Other ____________________
Brothers and Sisters
Grandparents and Grandchild
Spouse
Ex-spouse
Parents and Child
Step-parent and Step-child
14 What is the current market value of the real property?
15 Was the mortgage assumed? (If Yes, state the amount and interest rate.)
Yes
No
$ _____________________
___________ %
16 Does this conveyance divide a current parcel of land?
17 Was transfer through a real estate agent or a title company? (If Yes, include the name
of the agent or title company contact.)
Yes
No
Yes _______________________
No
18 Address of Property
19 Name and Address of Person to Whom the Tax Statement Should be Sent
18a
No address assigned
18b
Vacant land
20 Legal Description
21 If agricultural, list total number of acres ___________________ .
$
22 Total purchase price, including any liabilities assumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
22
$
23 Was non-real property included in the purchase?
Yes
No (If Yes, enter dollar amount and attach itemized list.) 23
$
0.00
24 Adjusted purchase price paid for real estate (line 22 minus line 23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24
25 If this transfer is exempt from the documentary stamp tax, list the exemption number ___________________ .
Under penalties of law, I declare that I have examined this statement and that it is, to the best of my knowledge and belief, true, complete, and
correct, and that I am duly authorized to sign this statement.
Print or Type Name of Grantee or Authorized Representative
Phone Number
sign
here
Signature of Grantee or Authorized Representative
Title
Date
Register of Deed’s Use Only
For Dept. Use Only
26 Date Deed Recorded
27 Value of Stamp or Exempt Number
28 Recording Data
$
Mo.
Day
Yr.
Nebraska Department of Revenue
Authorized by Neb. Rev. Stat. §§ 76-214, 77-1327(2)
Form No. 96-269-2008 7-2014 Rev. Supersedes 96-269-2008 Rev. 7-2013
Grantee — Retain a copy of this document for your records.

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Financial
Go
Page of 2