Form Rev-1728 - Realty Transfer Tax Declaration Of Acquisition
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1
2RECORDER’S USE ONLY
REV-1728 EX (8-04)
REALTY TRANSFER TAX
State Tax Paid
DECLARATION OF ACQUISITION
Book Number
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
Page Number
See Reverse for Instructions
BUREAU OF INDIVIDUAL TAXES
PO BOX 280603
Date Recorded
(Must be filed in Duplicate)
HARRISBURG, PA 17128-0603
A Corporation or Association that qualifies as a “Real Estate Company” must file a Declaration of Acquisition form within thirty (30) days after becom-
ing an “Acquired Company” as defined in 72 P.S. §8102-C.5 in every county in which the corporation or association owns real estate.
A. CORRESPONDENT – All inquiries may be directed to the following person:
Name
Telephone Number
START
Street Address
City
State
Zip Code
B. TRANSFER DATA
1. Company Name
Employer Identification Number (EIN)
Street Address
City
State
Zip Code
2. Date on which the company became an acquired company:
3. County in which this Declaration of Acquisition is being recorded:
4. List all other counties in which a Declaration of Acquisition must be recorded:
C. PROPERTY LOCATION
D. PROPERTY VALUATION
1. County Assessed
2. Common Level
School District
Political Subdivision
Tax Parcel Number
3. Fair Market Value
Value
Ratio Factor
=
x
=
x
=
x
x
=
x
=
x
=
4. Total Fair
Market Value
Under penalties of law, I declare that I have examined this Declaration, including accompanying information, and to the best
of my knowledge and belief, it is true, correct and complete.
Signature of Correspondent or Responsible Party
Date
PLEASE SIGN AFTER PRINTING.
▼ RECORDER’S USE ONLY ▼
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