Form Ptt-173 - Property Transfer Tax Payment Voucher - 2016

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Vermont Department of Taxes
133 State Street
Montpelier, VT 05633-1401
*161731100*
Phone: (802) 828-5860
PROPERTY TRANSFER
VT Form
* 1 6 1 7 3 1 1 0 0 *
PTT-173
TAX PAYMENT VOUCHER
Please print clearly, using Blue or Black Ink Only
Web request key / Confirmation code
TRANSFEREE #1
(From Form PTT-172, Section B)
Entity TRANSFEREE Name
Federal ID Number
OR
OR
Individual TRANSFEREE Last Name
First Name
Initial
Social Security Number
TRANSFEREE Mailing Address Following Transfer
Daytime Telephone Number
Line 2 for Mailing Address Following Transfer (if needed)
Date of Closing (MM DD YYYY)
City
State
ZIP Code
For Department Use Only
Foreign Country (if not United States)
Email Address
1.
Did you determine a portion of value was eligible for the special
“principal residence” rate (see PTT-172, Line J1)? . . . . . . . . . . . . . . . . . . . . . . . . .1.
c
Yes
c
No
2.
Did you claim exemption “99” on your return (see PTT-172, Line E1)? . . . . . . . . .2.
c
c
Yes
No
3.
Amount of this payment. If “$0,” DO NOT file . . . . . . . . . . . . . . . . . . . 3. ________________________________
Make check payable to Vermont Department of Taxes and send with this voucher to:
Vermont Department of Taxes
133 State Street
Montpelier, VT 05633-1401
If you would like assistance or have questions, please call 802-828-5860, ext. 31.
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Form PTT-173
5454
Rev. 10/16

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