Statement Of Real Estate Full Consideration Form - North Dakota State Board Of Equalization
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1North Dakota State Board Of Equalization
The Information on
Statement Of Real Estate Full Consideration
This Form Is
Secretary of the State Board of Equalization
Mail to:
Confi dential
North Dakota Office of State Tax Commissioner
N.D.C.C. Sec. 11-18-02.2(7)
600 E. Boulevard Ave., Dept, 127
Bismarck, ND 58505-0599
1. Name of Grantee (Purchaser)
2. Address of Grantee (Purchaser)
3. Name of Grantor (Seller)
5. J City
J Township
4. Location of Property Transferred (Number & Street or R.R.)
6. County
7. Legal Description (Fill in legal description below or attach a copy of legal description from instrument of conveyance.)
Lot No.: _______________________ Block No.: _____________ Plat Name: ____________________________________
Or:
8. Date on which purchase agreement was made:
Month: ______________________ Year: ___________________
9. Total Purchase price
.................................. $ ____________________
(fi ll in amount paid or to be paid exclusive of any interest payments)
10. Total value of personal property included in purchase price:
...................................................................... $ ____________________
(furniture, appliances not built in, machinery, crops, livestock, etc.)
J Land Only
J New Building
J Building Previously Used
11. Kind Of Property:
J Agricultural
J Commercial/Industrial
J Residential
12. Principal Intended Use:
J Other (explain): _______________________________________________________
J Yes
J No
a. If agricultural, was property used to expand present farming unit?
b. If agricultural, the number of acres purchased was: _________________
c. If agricultural, did purchase include buildings? J Yes
J No
If yes, estimate the value of buildings $ ___________
13. Was the property: purchased from a relative, a gift, an exchange, a forced or tax sale, or sold to
J Yes
J No
settle an estate?
14. In your opinion, was the sale or transfer made at fair market value (willing buyer, willing seller)? J Yes
J No
If "no," briefl y explain why:
I (we) certify under penalty of law that this statement, including the legal description in "7" above, has been examined by me (us)
and to the best of my (our) knowledge and belief it is true, correct and complete.
Sign Here: _________________________________________________
__________________________________________
Signature of Grantee (Purchaser) or Authorized Agent
Date
24818
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