Form Acr 521p-As4ex0 - Documentary Transfer Tax Affidavit - County Of Riverside
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1Recorder
LARRY W. WARD
P.O. Box 751
COUNTY OF RIVERSIDE
Riverside, CA 92502-0751
(951) 486-7000
ASSESSOR-COUNTY CLERK-RECORDER
Website:
DOCUMENTARY TRANSFER TAX AFFIDAVIT
WARNING
ANY PERSON WHO MAKES ANY MATERIAL MISREPRESENTATION OF FACT FOR THE PURPOSE OF AVOIDING ALL OR ANY PART
OF THE DOCUMENTARY TRANSFER TAX IS GUILTY OF A MISDEMEANOR UNDER SECTION 5 OF ORDINANCE 516 OF THE COUNTY
OF RIVERSIDE AND IS SUBJECT TO PROSECUTION FOR SUCH OFFENSE.
ASSESSOR’S PARCEL NO. ______--______--______
I declare that the documentary transfer tax for this
Property Address: ___________________________________
transaction is: $__________.
If this transaction is exempt from Documentary Transfer Tax, the reason must be identified below.
I CLAIM THAT THIS TRANSACTION IS EXEMPT FROM DOCUMENTARY TRANSFER TAX BECAUSE: (The
Sections listed below are taken from the Revenue and Taxation Code. Please check one or explain in “Other”.)
1. ___ Section 11911. The document is a lease for a term of less than thirty-five (35) years (
.
including options)
2. ___ Section 11911. The easement is not perpetual, permanent, or for life.
3. ___ Section 11921. The instrument was given to secure a debt.
4. ___ Section 11922. The conveyance is to a governmental entity or political subdivision.
5. ___ Section 11925. The transfer is between individuals and a legal entity, or between legal entities,
and does not change the proportional interests held.
6. ___ Section 11926. The instrument is from a trustor to a beneficiary, in lieu of foreclosure, and no
additional consideration was paid.
7. ___ Section 11926. The grantee is the foreclosing beneficiary and the consideration paid by the
foreclosing beneficiary does not exceed the unpaid debt.
8. ___ Section 11927. The conveyance relates to a dissolution of marriage or legal separation.
9. ___ Section 11930. The conveyance is an inter vivos gift* or a transfer by death.
*Please be aware that information stated on this document may be given to and used by governmental
agencies, including the Internal Revenue Service. Also, certain gifts in excess of the annual Federal gift
tax exemption may trigger a Federal Gift Tax. In such cases, the Transferor (donor/grantor) may be
required to file Form 709 (Federal Gift Tax Return) with the Internal Revenue Service.
10. ___ Section 11930. The conveyance is to the grantor’s revocable living trust.
11. ___ Other (Include explanation and authority) ____________________________________
______________________________________________________________________
______________________________________________________________________
I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Executed this ____ day of ___________________, 20___ at _____________________________________________.
City
State
_________________________________________
_______________________________________________
Signature of Affiant
Printed Name of Affiant
______________________________________________
_____________________________________________________
Name of Firm (if applicable)
Address of Affiant
_____________________________________________________
Telephone Number of Affiant (including area code)
This form is subject to the California Public Records Act (Government Code 6250 et. seq.)
For Recorder’s Use:
Affix PCOR Label Here
ACR 521P-AS4EX0 (Rev. 11/2010)
Available in Alternative Formats
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