Form Cd-57 - Real Estate Transfer Tax Declaration Of Consideration

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FORM
NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRATION
CD-57
REAL ESTATE TRANSFER TAX
DECLARATION OF CONSIDERATION
(RSA 78-B:10)
see reverse for instructions
PLEASE PRINT OR TYPE INFORMATION BELOW
PURCHASER,
GRANTEE, ASSIGNEE, TRANSFEREE (buyer):
1. IDENTITY:
NAME (S) (LAST, FIRST, M-INTL.) AND SOCIAL SECURITY NUMBER (S) OR ENTITY NAME (S) AND FEDERAL IDENTIFICATION NUMBER (S)
2.
NUMBER AND STREET
CITY OR TOWN
STATE AND ZIP CODE
SELLER,
GRANTOR, ASSIGNOR, TRANSFER0R:
3. IDENTITY:
NAME (S) (LAST, FIRST, M-INTL.) AND SOCIAL SECURITY NUMBER (S) OR ENTITY NAME (S) AND FEDERAL IDENTIFICATION NUMBER (S)
4.
NUMBER AND STREET
CITY OR TOWN
STATE AND ZIP CODE
PROPERTY:
5.
CITY/TOWN
COUNTY
BOOK NO
PAGE NO
BRIEF DESCRIPTION: (SUCH AS MAP AND LOT NUMBERS; LOCATED AT 17 ELM STREET, AUBURN, OR 10 ACRES, FARM HOUSE AND BARN KNOWN AS
SMITH FARM, MILL ROAD, MILTON.)
6.
DATE OF TRANSFER:
MONTH
YEAR
DAY
(use numerals)
PRICE OR CONSIDERATION:
7.
PRICE OR CONSIDERATION MEANS THE AMOUNT OF MONEY, OR OTHER PROPERTY AND SERVICES, OR PROPERTY OR SERVICES VALUED IN
MONEY WHICH IS GIVEN IN EXCHANGE FOR REAL ESTATE, AND MEASURED AT A TIME IMMEDIATELY AFTER THE TRANSFER OF THE REAL ESTATE.
THE UNDERSIGNED BUYER (S) AND SELLER (S) AGREE AND AFFIRM THAT THE FULL PRICE OR CONSIDERATION PAID FOR THE
REAL ESTATE TRANSFERRED BY THIS DEED OR INSTRUMENT IS......$
THE TAX DUE UPON THIS TRANSFER IS CALCULATED AT..................$
PER $100.00 OR ANY PART THEREOF
TAX DUE ..............................................................................................$
(computed to the nearest dollar)
8. SPECIAL CIRCUMSTANCES:
Were there special circumstances in the transfer which suggest that the full price or consideration of the property was either more or less than
it's fair market value?
NO
YES, if yes, please explain.
SIGNATURES:
BUYER (S):
SELLER (S):
WITNESS:
WITNESS:
DATE:
DATE:
NH DEPT OF REVENUE ADMINISTRATION
45 CHENELL DRIVE
PO BOX 1324
Mail
CONCORD NH 03302-1324
To:
CD-57
Tel. (603) 271-3701
Rev 12/98

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