Form Ptt-172 - Vermont Property Transfer Tax Return - 2017 Page 4
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4Transferee’s Name _____________________________________________________
*171722400*
Property Location _____________________________________________________
Date of this Closing ____________________________________________________
* 1 7 1 7 2 2 4 0 0 *
LOCAL AND STATE PERMITS AND ACT 250 NOTICE
This serves as notice that:
• The property being transferred may be subject to regulations governing potable water supplies and wastewater systems
under 10 V .S .A . chapter 64 and building, zoning and subdivision regulations;
• The property being transferred may be subject to Act 250 regulations regarding land use and development under 10 V .S .A .
chapter 151;
• The parties have an obligation to investigate and disclose knowledge regarding flood regulations affecting the property .
To determine if the property is in compliance with or exempt from these rules, contact the relevant agency . Contact information
is provided in the instructions .
Transferor and Transferee state that the information submitted on this return is true, correct and complete to the best of their knowledge .
Prepared by (print or type) ____________________________________________ *
Preparer’s Address _________________________________________________ *
Preparer’s Email Address ______________________________________________ *
__________________________________________________________________
Preparer’s Telephone __________________________________________________ *
Town or City: Please forward original to the Vermont Department of Taxes within 30 days of receipt.
This section to be completed by Town or City Clerk
Book Number
Page Number
Grand List year
City or Town
Parcel ID Number
Date of Record
Grand List Value
Grand List Category*
SPAN
Comments, additional information, etc.
c
c
c
Duplicate Return Suspected
Portion of the property sold
Original Return Waiting on Deed
ACKNOWLEDGMENT
Return received.
SIGNED __________________________________________________________________ , Clerk
DATE ______________________________________________
* Please use the following numeric two-digit grand list category codes
Residential <6 Acres . . . . . . . . . . 01
Seasonal >6 Acres . . . . . . . . . . . . 06
Utilities Other . . . . . . . . . . . . . . . 11
Residential >6 Acres . . . . . . . . . . 02
Commercial . . . . . . . . . . . . . . . . . 07
Farm . . . . . . . . . . . . . . . . . . . . . . 12
Mobile Home/Un . . . . . . . . . . . . 03
Commercial Apt . . . . . . . . . . . . . 08
Other . . . . . . . . . . . . . . . . . . . . . . 13
Mobile Home/La . . . . . . . . . . . . . 04
Industrial . . . . . . . . . . . . . . . . . . . 09
Woodland . . . . . . . . . . . . . . . . . . 14
Seasonal <6 Acres . . . . . . . . . . . . 05
Utilities Elec . . . . . . . . . . . . . . . . 10
Miscellaneous . . . . . . . . . . . . . . . 15
Form PTT-172
For Town Use Only
Page 4 of 4
5454
Rev. 03/17
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