Form Dte 100 - Real Property Conveyance Fee Statement Of Value And Receipt
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Real Property Conveyance Fee Statement of Value and Receipt
DTE 100
Rev. 11/12
If exempt by Ohio Revised Code section 319.54(G)(3), use form DTE 100(EX).
FOR COUNTY AUDITOR’S USE ONLY
Type
Tax list
County
Tax. dist.
Date
number
number
instrument
year
Property located in
taxing district
Number
Name on tax duplicate
Tax duplicate year
Acct. or permanent parcel no.
Map book
Page
No. of Parcels
Description
Platted
Unplatted
Auditor’s comments:
Split
New plat
New improvements
Partial value
DTE Code No.
C.A.U.V
Building removed
Other
Grantee or Representative Must Complete All Questions in This Section
Type or print all information. See instructions on reverse.
Neigh. Code
1. Grantor’s name
Phone
2. Grantee’s name
Phone
No. of Acres
Grantee’s address
3. Address of property
4. Tax billing address
Land Value
5. Are there buildings on the land?
Yes
No
If yes, check type:
1, 2 or 3 family dwelling
Condominium
Apartment: No. of units
Manufactured (mobile) home
Farm buildings
Other
Bldg. Value
If land is vacant, what is intended use?
6. Conditions of sale (check all that apply)
Grantor is relative
Part interest transfer
Land contract
Trade
Life estate
Leased fee
Leasehold
Mineral rights reserved
Gift
Total Value
Grantor is mortgagee
Other
0.00
7. a) New mortgage amount (if any)............................................................................................$
b) Balance assumed (if any) ....................................................................................................$
DTE Use Only
c) Cash (if any) ........................................................................................................................$
0.00
d) Total consideration (add lines 7a, 7b and 7c) ......................................................................$
e) Portion, if any, of total consideration paid for items other than real property ......................$
DTE Use Only
f) Consideration for real property on which fee is to be paid (7d minus 7e) ...........................$
g) Name of mortgagee
h) Type of mortgage
Conv.
F.H.A.
V.A.
Other
DTE Use Only
i) If gift, in whole or part, estimated market value of real property ..........................................$
8. Has the grantor indicated that this property is entitled to receive the senior citizen, disabled person or surviving spouse
Consideration
homestead exemption for the preceding or current tax year?
Yes
No
If yes, complete form DTE 101.
9. Has the grantor indicated that this property qualifi ed for current agricultural use valuation for the preceding or current
tax year?
Yes
No
If yes, complete form DTE 102.
10. Application for 2.5% Reduction (Notice: Failure to complete this application prohibits the owner from receiving this
DTE Use Only
Valid sale
reduction until another proper and timely application is fi led.): Will this property be grantee’s principal residence by
Jan. 1 of next year?
Yes
No
If yes, is the property a multi-unit dwelling?
Yes
No
1. Yes
2. No
I declare under penalties of perjury that this statement has been examined by me and to the best of my knowledge
and belief it is a true, correct and complete statement.
Signature of grantee or representative
Date
Receipt Number
Receipt for Payment of Conveyance Fee
The conveyance fee required by Ohio Revised Code section (R.C.) 319.54(G)(3) and, if applicable, the fee required by R.C. 322, in the total amount
of $
has been paid by
and received by the
county auditor.
County auditor
Date
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