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Affidavit Of Consideration Or Value Excise Tax On Conveyance Of Real Property Form - Currituck County Tax Department

AFFIDAVIT OF CONSIDERATION OR VALUE

EXCISE TAX ON CONVEYANCE OF REAL PROPERTY

CURRITUCK COUNTY TAX DEPARTMENT

PO BOX 9, CURRITUCK, NC 27929

Complete each section and sign in duplicate with original signature. File with Currituck County

Tax Department. An Affidavit may be required with any instrument conveying real property,

including leases and memorandum of leases.

1. TRANSFER DATA _________________________________________

GRANTOR

| GRANTEE

____________________________________|___________________________________

ADDRESS

| ADDRESS

____________________________________|___________________________________

CITY

STATE ZIP | CITY

STATE ZIP

____________________________________|___________________________________

2. PROPERTY LOCATION____________________________________

PIN#____________________________

SUBDIVISION____________________LOT_____BLOCK____SECT____

PHYSICAL ADDRESS (If Known)________________________________

DESCRIPTION – CHECK ONE

VACANT

_________

CONDOMINIUM________

OTHER_______

IMPROVED_________

TOWNHOUSE

________

3. CONSIDERATION OR VALUE DATA_________________________

________

ACTUAL CASH CONSIDERATION ____________ OTHER CONSIDERATION_

TOTAL CONSIDERATION ____________________ FAIR MARKET VALUE ____________

______________________________________________________________________________

EXPLANATION OF ABOVE OR LEASE VALUE COMPUTATION, IF APPLICABLE

EXPLANATORY NOTE REGARDING TAX______________________

The excise tax on instruments conveying interest in real property is $1.00 on each $100.00 or fraction

thereof of the total consideration or value of the interest conveyed, including the value of a lien or

remaining on the property at the time of the sale. The value of a lease shall be computed on the basis of the

present value of the fixed lease payments and, if the lease payments are based in whole or in part on the

lessee’s receipts, the estimated amount of the lessee’s receipts.

4. SIGNATURE

Under penalties of law, I declare that I have examined this affidavit, including accompanying statements,

and to the best of my knowledge and belief, it is true, correct and complete. I declare that the above real

estate has been reported at true market value.

________________________

______

SIGNATURE OF AFFIANT

(SEAL) DATE

SWORN TO AND SUBSCRIBED BEFORE ME THIS _____ DAY OF ____________, 20____

_____________________________________

Notary Public

Notary Seal

My commission expires: _______________________

Affidavit Of Consideration Or Value Excise Tax On Conveyance Of Real Property Form - Currituck County Tax Department

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