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Residential Lots Application Form

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CITY OF PEEKSKILL

DEPARTMENT OF FINANCE

CITY HALL

840 Main Street

Peekskill, NY 10566

REAL PROPERTY TRANSFER TAX RETURN PURSUANT TO

CHAPTER 521 OF THE CODE OF THE ClTY OF PEEKSKILL, NY

Grantee/Buyer

Grantor Seller

Grantee Atty.

Grantor Atty.

Name

Address

Zip

Code

LOCATION OF PROPERTY TRANSFERRED

Address

City Tax Map

Section

Block

Lot

DATE OF DELIVERY OF DEED TO GRANTEE

TOTAL AMOUNT DUE (from pa g e two of form)

MAKE CERTIFIED CHECK PAYABLE TO THE ORDER OF THE CITY OF PEEKSKILL

Notes:

This return must be completed and filed w i t h the Comptroller of the City of Peekskill.

The tax due thereon must be paid within thirty (30) days after delivery of the deed by the grantor to the grantee but before the

recording of such deed.

Where the transfer is by a corporation in liquidation or to a corporation in exchange for capital stock, submit balance sheet.

Penalty of 8% of the tax due for the first month of delay plus interest at the rate of 1.5% of such tax for each additional month of

delay must be added if payment is not made on or before the due date.

AFFIDAVIT OF GRANTEE

I swear (or affirm) that this return, i n c lud i n g the accompanying schedules or statements, has been examined by me. And

is, to the best of my knowledge and belief, a true and complete return, made in good faith, pursuant to Chapter 521, Section 521-52 of

the Code of the City of Peekskill. NY and the regulations issued under authority thereof.

Sworn to and subscribed to before me

________________________________________

this _______ day of ___________ ,20

Name of Grantee

Signature of Officer Administering Oath ______________ Signature of owner, partner, officer of corporation, etc

AFFIDAVIT OF GRANTOR

I swear (or affirm) that this return, including the accompanying schedules or statements, has been examined by me. And is,

to the best of my knowledge and belief, a true and complete return, made in good faith, pursuant to Chapter 521, Section 521-52 of the

Code of the City of Peekskill, NY and the regulations issued under authority thereof.

Sworn to and subscribed to before me on

______________________________________

this _ _________day of ______________,20

Name of Grantor

Signature of Officer Administering Oath

Signature of owner, partner, officer of corporation, etc

Residential Lots Application Form

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