Form 5402 - Realty Transfer Tax Return And Affidavit Of Gain And Value - 2010-2011

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2010 - 2011
REALTY TRANSFER TAX RETURN
DO NOT WRITE OR STAPLE IN THIS AREA
STATE OF DELAWARE
AND
Rev. Code 050
Division of Revenue
AFFIDAVIT OF GAIN AND VALUE
820 N. French Street
P.O. Box 8750
Wilmington, Delaware 19899-8750
FORM 5402
Form 5402 must be completed for all conveyances and must be presented at the time of recording.
PART A - TO BE COMPLETED BY GRANTOR/SELLER
The Grantor is a:
Enter Employer Identification Number
or Social Security Number of the Grantor
5.
Resident Individual
1.
Non-Resident Individual
Name of Grantor
Domestic Corporation (Delaware)
2.
Address
Foreign Corporation (Non-Delaware)
3.
S Corporation
Government Agency
Fiduciary (Estate or Trust)
City
County
Partnership
State
Zip Code
Non-Profit Corporation
Date of real estate conveyance
4.
PART B - TO BE COMPLETED BY THE GRANTEE/BUYER
The Grantee is a:
4.
Enter Employer Identification Number
or Social Security Number of the Grantee
Resident Individual
1.
Non-Resident Individual
Name of Grantee
Domestic Corporation (Delaware)
2.
Address
Foreign Corporation (Non-Delaware)
3.
S Corporation
Government Agency
Fiduciary (Estate or Trust)
County
City
Partnership
Zip Code
State
Non-Profit Corporation
PART C - PROPERTY LOCATION AND COMPUTATION OF THE TAX
Address
1.
City
County
State
Zip Code
Enter the amount of consideration received including cash, checks, mortgages, liens, encumbrances,
2.
and any other good and valuable consideration.
$
Was like kind property exchanged?
Yes
No (If yes, see instructions.)
Enter the highest assessed value (for local tax purposes) of the real estate being conveyed.
3.
$
Was like kind property exchanged?
Yes
No (If yes, see instructions.)
$
4.
Enter the greater of Line 2 or Line 3
3.0%
5.
Percentage rate of realty transfer tax paid to the State of Delaware, county and/or municipality
6.
Percentage rate of realty transfer tax paid to the county or municipality
7.
Delaware realty transfer tax percentage (Subtract Line 6 from Line 5)
$
8.
Delaware Realty Transfer Tax Due (Multiply Line 4 by Line 7)
PART D - EXEMPT CONVEYANCES
If transaction is exempt from Realty Transfer Tax, be certain that all of the above information (including market value of the real estate)
is complete and accurate and explain the basis for the exemption:
The seller authorizes the Division of Revenue or such other appropriate state agency as may be designated to obtain any appropriate or
necessary federal income tax forms, including their attached schedules or other attachments, and any other related papers filed by such seller
which relate solely to the said real estate to which title is purported to be conveyed by the deed or instrument being recorded. Delaware law
requires an income tax return to be filed for the taxable year during which there was disposition of real property within this state.
Sworn and Subscribed before me
on this
day of
Seller’s Signature
, 20
Title of Officer/Partner
(Revised 12/09/10)

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