Controlling Interest Transfer Tax - Return/declaration Of Value Form
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1MAINE REVENUE SERVICES
CONTROLLING INTEREST TRANSFER TAX
RETURN/DECLARATION OF VALUE
For Registry Use Only
This form must be used for reporting transfer or acquisition of a controlling interest in an entity with a fee interest in real property.
Do not use this form for transfers of real property by deed. FILE THIS RETURN WITH THE COUNTY REGISTRY OF DEEDS
Title 36, M.R.S.A. Sections 4641 through 4641-N
1. TRANSFEROR/SELLER
2. TRANSFEREE/BUYER
Name_______________________________________________________
Name_________________________________________________
_________________________________________________________
______________________________________________________
Address_____________________________________________________
Address_______________________________________________
_________________________________________________________
______________________________________________________
City________________________________________________________City___________________________________________________
State__________________________________ Zip________________ State_______________________________Zip_______________
Federal ID Number______________________________
Federal ID Number_____________________________
Percent of Entity Ownership Sold___________%
Percent of Entity Ownership Bought___________%
3.
Name and address of each entity being transferred that directly holds fee title to real property :
Preparer of this document
Name___________________________________________________________________________
Name
________________________________________________________________________________
Firm
Address_________________________________________________________________________
Full Address
________________________________________________________________________________
City_____________________________________State____________________________________
Zip____________________________________ Date of Transfer___________________________ Telephone
Federal ID Number or SSN____________________________________________________
Fax
4. REAL PROPERTY VALUES: (Attach extra sheet as necessary)
Describe each parcel located in this county according to its tax jurisdiction and include the value attributed to real property owned by the entity listed in
Block 3 whose ownership was transferred. In the space { } that precedes the value dollar sign $, enter the letter which best describes the source of value.
Choose from the following letters: C = CONSIDERATION
P = PURCHASE PRICE ALLOCATION
A = APPRAISAL
O = OTHER __________________
Municipality
Map
Lot
Value
WARNING TO BUYER!
{ }$
If the property is classified as
Farmland, Open Space or Tree
{ }$
Growth, a substantial financial
penatly could be triggered by
{ }$
development, subdivision, partition,
or change in use of the property.
{ }$
{ }$
___ Classified
__ Not Classified
$
Transfer Tax based on total value of real property interest in this County
5. EXEMPTION: Explain basis for claiming exemption from transfer tax.
6. AFFIDAVIT
AFFIDAVIT
I certify under penalty of perjury under the laws of the state of Maine that the information on
I certify under penalty of perjury under the laws of the state of Maine that the
this return is true and correct.
information on this return is true and correct.
Transferor/Agent___________________________________________
Transferee/Agent________________________________________
Name (print)_______________________________________________
Name (print)____________________________________________
Date & Place of Signing_____________________________________
Date & Place of Signing__________________________________
Telephone Number (____)____________________________________
Telephone Number (_____)________________________________
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