Schedule A (Form Op-236) - Supplemental Information For Real Estate Conveyance Tax Return
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1Department of Revenue Services
OP-236 Schedule A
State of Connecticut
Supplemental Information for Real Estate Conveyance Tax Return
Rev. 09/08
Town: __________________________________________________________________
Grantor/seller
Location of property conveyed: ______________________________________________
Grantee/buyer
Date conveyed: ____________________
Date recorded: ______________________
Other: See Line 12
instructions.
Check here if the transaction is completed on one deed.
Yes
No
Use form OP-236 Schedule A to provide the required information if there are additional grantors/sellers or grantees/buyers. If the grantor is a
partnership, S corporation, LLC, estate, or trust, enter the name, address, and taxpayer identifi cation number of the partners, shareholders,
members, or benefi ciaries. Check a box above to indicate who is providing this information.
Last name, fi rst name, middle initial
Taxpayer identifi cation number
SSN
FEIN
Address after conveyance
City or town
State
ZIP code
Last name, fi rst name, middle initial
Taxpayer identifi cation number
SSN
FEIN
Address after conveyance
City or town
State
ZIP code
Last name, fi rst name, middle initial
Taxpayer identifi cation number
SSN
FEIN
Address after conveyance
City or town
State
ZIP code
Last name, fi rst name, middle initial
Taxpayer identifi cation number
SSN
FEIN
Address after conveyance
City or town
State
ZIP code
Last name, fi rst name, middle initial
Taxpayer identifi cation number
SSN
FEIN
Address after conveyance
City or town
State
ZIP code
Last name, fi rst name, middle initial
Taxpayer identifi cation number
SSN
FEIN
Address after conveyance
City or town
State
ZIP code
Last name, fi rst name, middle initial
Taxpayer identifi cation number
SSN
FEIN
Address after conveyance
City or town
State
ZIP code
Last name, fi rst name, middle initial
Taxpayer identifi cation number
SSN
FEIN
Address after conveyance
City or town
State
ZIP code
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