Form Tp-584 - Combined Real Estate Transfer Tax Return, Credit Line Mortgage Certificate, And Certification Of Exemption From The Payment Of Estimated Personal Income Tax

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TP-584 (4/13)
New York State Department of Taxation and Finance
Recording office time stamp
Combined Real Estate
Transfer Tax Return,
Credit Line Mortgage Certificate, and
Certification of Exemption from the
Payment of Estimated Personal Income Tax
See Form TP-584-I, Instructions for Form TP-584, before completing this form. Print or type.
Schedule A — Information relating to conveyance
Grantor/Transferor
Name
Social security number
(if individual, last, first, middle initial) (
check if more than one grantor)
Individual
Mailing address
Social security number
Corporation
Partnership
City
State
ZIP code
Federal EIN
Estate/Trust
Single member LLC
Single member EIN or SSN
Other
Single member’s name if grantor is a single member LLC
(see instructions)
Grantee/Transferee
Name
Social security number
(if individual, last, first, middle initial) (
check if more than one grantee)
Individual
Mailing address
Social security number
Corporation
Partnership
City
State
ZIP code
Federal EIN
Estate/Trust
Single member LLC
Single member EIN or SSN
Other
Single member’s name if grantee is a single member LLC
(see instructions)
Location and description of property conveyed
Tax map designation –
SWIS code
Street address
City, town, or village
County
(six digits)
Section, block & lot
(include dots and dashes)
Type of property conveyed
(check applicable box)
1
One- to three-family house
5
Commercial/Industrial
Date of conveyance
Percentage of real property
2
Residential cooperative
6
Apartment building
conveyed which is residential
%
3
Residential condominium
7
Office building
real property
month
day
year
4
Vacant land
8
Other
(see instructions)
Condition of conveyance
(check all that apply)
f.
Conveyance which consists of a
l.
Option assignment or surrender
mere change of identity or form of
a.
Conveyance of fee interest
ownership or organization
(attach
m.
Leasehold assignment or surrender
Form TP-584.1, Schedule F)
b.
Acquisition of a controlling interest (state
percentage acquired
%)
g.
Conveyance for which credit for tax
n.
Leasehold grant
previously paid will be claimed
(attach
Form TP-584.1, Schedule G)
c.
Transfer of a controlling interest (state
o.
Conveyance of an easement
h.
Conveyance of cooperative apartment(s)
percentage transferred
%)
p.
Conveyance for which exemption
from transfer tax claimed (complete
d.
Conveyance to cooperative housing
i.
Syndication
Schedule B, Part III)
corporation
j.
Conveyance of air rights or
q.
Conveyance of property partly within
development rights
and partly outside the state
e.
Conveyance pursuant to or in lieu of
foreclosure or enforcement of security
r.
Conveyance pursuant to divorce or separation
k.
Contract assignment
interest
(attach Form TP-584.1, Schedule E)
s.
Other
(describe)
For recording officer’s use
Amount received
Date received
Transaction number
Schedule B., Part I $
Schedule B., Part II $

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