Affidavit Form - State Of South Carolina

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STATE OF SOUTH CAROLINA
)
COUNTY OF ____________________)
Affidavit
PERSONALLY appeared before me the undersigned, who being duly sworn, deposes and says:
1.
I have read the information on this affidavit and I understand such information.
2.
The property being transferred is located at______________________________________________________________,
bearing_____________ County Tax Map Number ____________________, was transferred
by_______________________________________________________________________________________________
to ________________________________________________________________on_____________________________.
3.
Check one of the following: The deed is
(a) _________ subject to the deed recording fee as a transfer for consideration paid or to be paid in money or money’s
worth.
(b) _________ subject to the deed recording fee as a transfer between a corporation, a partnership, or other entity and a
stockholder, partner, or owner of the entity, or is a transfer to a trust or as a distribution to a trust beneficiary.
(c) _________ exempt from the deed recording fee because (see information section of affidavit):
_______________________________________________________________ (If exempt, please skip items 4 – 7 and go to
item 8 of this affidavit.)
4.
Check one of the following if either item 3(a) or item 3(b) above has been checked (see information section of this
affidavit):
(a) _________ The fee is computed on the consideration paid or to be paid in money or money’s worth in the amount of
___________________________________________.
(b) _________ The fee is computed on the fair market value of the realty which is ____________________.
(c) _________ The fee is computed on the fair market value of the realty as established for property tax purposes which is
_____________________________________________.
5.
Check Yes ______ or No ______ to the following: A lien or encumbrance existed on the land, tenement, or realty before the
transfer and remained on the land, tenement, or realty after the transfer. If “yes” the amount of the outstanding balance of
this lien or encumbrance is: _____________________________.
6.
The deed recording fee is computed as follows:
(a) Place the amount listed in item 4 above here:
______________
(b) Place the amount listed in item 5 above here:
______________
(If no amount is listed, place zero here)
(c) Subtract line 6(b) from line 6(a) and place result here:
______________
7.
The deed recording fee due is based on the amount listed on line 6(c) above and the deed recording fee due is :
___________________________________.
8.
As required by Code Section 12-24-70, I state that I am a responsible person who was connected with the transaction as:
___________________________________________________________.
9.
I understand that a person required to furnish this affidavit who willfully furnishes a false or fraudulent affidavit is guilty of
a misdemeanor and, upon conviction, must be fined not more than one thousand dollars or imprisoned not more than one
year, or both.
__________________________________________
Responsible Person Connected with the Transaction
SWORN to before me this _________
_________________________________________
day of ______________ ___20______
Print or Type Name Here
_______________________________
Notary Public for _________________
My Commission Expires:___________
1

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