Form 82-127 - Philadelphia Real Estate Transfer Tax Certification
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1
2Instructrions Regarding The Completion Of This Form
May Be Found On Page 2.
Please Report Any Technical Problems With This Form To:
Print Form
Clear Form
fred.fedak@phila.gov
BOOK NO.
PAGE NO.
PHILADELPHIA REAL ESTATE
TRANSFER TAX CERTIFICATION
DATE RECORDED
CITY TAX PAID
Complete each section and file in duplicate with Recorder of Deeds when (1) the full consideration/value is/is not set forth in the deed, (2) when
the deed is with consideration, or by gift, or (3) a tax exemption is claimed. If more space is needed, attach additional sheet(s).
A.
CORRESPONDENT — All inquiries may be directed to the following person:
NAME
TELEPHONE NUMBER:
AREA CODE (
)
STREET ADDRESS
CITY
STATE
ZIP CODE
B.
TRANSFER DATA
DATE OF ACCEPTANCE OF DOCUMENT:
GRANTOR(S)/LESSOR(S)
GRANTEE(S)/LESSEE(S)
STREET ADDRESS
STREET ADDRESS
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
C.
PROPERTY LOCATION
STREET ADDRESS
CITY, TOWNSHIP, BOROUGH
COUNTY
SCHOOL DISTRICT
TAX PARCEL NUMBER
D.
VALUATION DATA
1. ACTUAL CASH CONSIDERATION
2. OTHER CONSIDERATION
3. TOTAL CONSIDERATION
$0.00
+
=
4. COUNTY ASSESSED VALUE
5. COMMON LEVEL RATIO FACTOR
6. FAIR MARKET VALUE
$0.00
x
=
E.
EXEMPTION DATA
1A. PERCENTAGE OF EXEMPTION
1B. PERCENTAGE OF INTEREST CONVEYED
2. Check Appropriate Box Below for Exemption Claimed
Will or intestate succession ________________________________________________________________________ .
(NAME OF DECEDENT)
(ESTATE FILE NUMBER)
Transfer to Industrial Development Agency.
Transfer to agent or straw party. (Attach copy of agency/straw party agreement).
Transfer between principal and agent. (Attach copy of agency/straw trust agreement). Tax paid prior deed $ ___________.
Transfers to the Commonwealth, the United States, and Instrumentalities by gift, dedication, condemnation or in lieu
of condemnation. (Attach copy of resolution).
Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number ________ , Page Number _______ .
Mortgagee (grantor) sold property to Mortgagor (grantee) (Attach copy of prior deed).
Corrective deed (Attach copy of the prior deed).
Other (Please explain exemption claimed, if other than listed above.) ________________________________________
Under penalties of law or ordinance, I declare that I have examined this Statement, 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
82-127 (Rev. 6/93)
(SEE REVERSE)
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