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SPECIAL INSTRUCTIONS

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FILING INSTRUCTIONS: Iowa law requires that a “Declaration of Value” statement reflecting the full consideration paid in certain

nonexempt real estate conveyances be submitted to the county recorder at the time a deed, contract, instrument, or other writing is

presented for recording. Part I of this form is the prescribed “Declaration of Value” statement that must be completed by the buyer or seller

or either’s agent for nonexempt transactions. Part II of this form is to be completed only by the assessor. The blank area at the top of the

form is for use by the county recorder. In this area the recorder will provide the following information: Date of Recording, Book and Page

Number or Instrument Number, County, Real Estate Transfer Tax, Deed or Contract.

IMPORTANT: This form does not have to be completed for any document presented for recording which clearly indicates on such

document that it is an exempt transaction. Refer to Iowa Administrative Code 701-79.5. If the transaction is exempt, but the reason for

exemption is not stated on the actual document presented for recording, Part I of this form must be completed. If this form is not completed

accurately and completely for nonexempt transactions by the buyer or seller or either’s agent, the county recorder is required by law to

refuse to record the contract, deed or other instrument conveying the affected property.

Social Security Numbers (SSNs) and Federal ID Numbers (FEINs) are required by 701 IAC 79.5(5), pursuant to Iowa Code sections

428A.1 and 428A.7, as authorized by 42 U.S.C. §405(c)(2)(C)(i). All Social Security Numbers and Federal ID Numbers must be redacted

prior to release to the public.

TYPE OF SALE: Check all box or boxes that designate conditions that apply to the sale on the front section of the form.

For purposes of indicating a “Sale Between Family Members” only the following relationships are to be considered:

Mother

Stepsister

Foster Child

Father

Stepbrother

Grandson

Stepmother

Uncle

Daughter

Mother-in-law

Foster parent

Son

Father-in-law

Granddaughter

Stepfather

Aunt

Sister

Daughter-in-law

Foster brother

Brother

Son-in-law

Grandfather

Stepson

Sister-in-law

Niece

Foster sister

Brother-in-law

Nephew

Grandmother

Stepdaughter

DECLARATION OF VALUE STATEMENT:

Total Amount Paid – Enter the entire and full purchase price of the property transferred, including down payment.

Reporting of personal property should conform to the transfer document and any related income tax filings.

Amount Paid for Personal Property – Enter the amount of the purchase price that was paid for personal property. For residential sales,

personal property includes items that are not attached (“built in”) to the home that are normally removed by the owner, when he or she

vacates. This includes, but is not limited to items such as washers, dryers, drapes, stoves, refrigerators, and portable dishwashers.

Personal property for commercial or industrial sales includes inventories, as well as equipment and fixtures classified and assessed as

personal property. Reporting of personal property should conform to the transfer document and any related income tax filings.

Amount Paid for Real Property Only – Subtract Line 2 from Line 1 and enter the difference here.

IF THIS TRANSACTION IS EXEMPT FROM THE TRANSFER TAX, you may not be required to complete this form UNLESS

you are claiming exemption number 1, 6,14, or 15, which require a Declaration of Value Statement.

Exceptions Iowa Code 428A.2

(DOV required)

Any executory contract for the sale of land under which the

14.

(DOV

required)The making or delivering of instruments of transfer resulting

vendee is entitled to or does take possession thereof, or any assignment or

from a corporate merger, consolidation, or reorganization or a merger, consolidation,

cancellation thereof.

or reorganization of a limited liability company under the laws of the United States or

2. Any instrument of mortgage, assignment, extension, partial release, or

any state thereof, where such instrument states such fact on the face thereof.

satisfaction thereof.

Deeds between a family corporation, partnership, limited

15.

(DOV required)

3. Any will.

partnership, limited liability partnership, or limited liability company and its

4. Any plat.

stockholders, partners, or members for the purpose of transferring real property in an

5. Any lease.

incorporation or corporate dissolution or the organization or dissolution of a

(DOV required for federal agency or instrumentality)

Any deed, instrument,

partnership, limited partnership, limited liability partnership, or limited liability company

or writing in which the United States or any agency or instrumentality thereof or

under the laws of this state, where the deeds are given for no actual consideration

the state of Iowa or any agency, instrumentality, or governmental or political

other than for shares or for debt securities of the corporation, partnership, limited

subdivision thereof is the grantor, assignor, transferor, or conveyor; and any deed,

partnership, limited liability partnership, or limited liability company. For purposes of

instrument or writing in which any of such unit of government is the grantee or

this

subsection, a family corporation, partnership, limited partnership, limited liability

assignee where there is no consideration.

partnership, or limited liability company is a corporation, partnership, limited

7. Deeds for cemetery lots.

partnership, limited liability partnership, or limited liability company where the majority

8. Deeds which secure a debt or other obligation, except those included in the

of the voting stock of the corporation, or of the ownership shares of the partnership,

sale of real property.

limited partnership, limited liability partnership, or limited liability company is held by

9. Deeds for the release of a security interest in property excepting those pertaining

and the majority of the stockholders, partners, or members are persons related to

to the sale of real estate.

each other as spouse, parent, grandparent, lineal ascendants of grandparents or

10. Deeds which, without additional consideration, confirm, correct, modify or

their spouses and other lineal descendants of the grandparents or their spouses, or

supplement a deed previously recorded.

persons acting in a fiduciary capacity for persons so related and where all of its

11. Deeds between husband and wife, or parent and child, without actual

stockholders, partners, or members are natural persons or persons acting in a fiduciary

consideration. A cancellation of indebtedness alone which is secured by the

capacity for the benefit of natural persons.

property being transferred and which is not greater than the fair market value of

16. Deeds for the transfer of property or the transfer of an interest in property when

the property being transferred is not actual consideration within the meaning of

the deed is executed between former spouses pursuant to a decree of dissolution of

this subsection.

marriage.

12. Tax deeds.

17. Deeds transferring easements.

13. Deeds of partition where the interest conveyed is without consideration.

18. Deeds giving back real property to lienholders in lieu of forfeitures or foreclosures.

However, if any of the parties take shares greater in value than their undivided

19. Deeds executed by public officials in the performance of their official duties.

interest a tax is due on the greater values, computed at the rate set out in section

20. Deeds transferring distributions of assets to heirs at law or devisees under a will.

428A.1.

21. Deeds in which the consideration is five hundred dollars or less.

57006b (03/23/12)

Form 57006a - Real Estate Transfer - Declaration Of Value - Iowa Department Of Revenue Page 2

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