Affidavit Of Property Value

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FOR RECORDER’S USE ONLY
AFFIDAVIT OF PROPERTY VALUE
1. ASSESSOR’S PARCEL IDENTIFICATION NUMBER(S)
Primary Parcel: _______ - _____ - _______ - ______
BOOK
MAP
PARCEL SPLIT
Does this sale include any parcels that are being split / divided?
Check one:
Yes
No
How many parcels, other than the Primary Parcel, are included
in this sale? ______________
Please list the additional parcels below (attach list if necessary):
(1) ________________________ (3) ________________________
(2) ________________________ (4) ________________________
9. TYPE OF DEED OR INSTRUMENT (Check Only One Box):
a.
Warranty Deed
d.
Contract or Agreement
2. SELLER’S NAME AND ADDRESS:
b.
Special Warranty Deed
e.
Quit Claim Deed
________________________________________________________
c.
Joint Tenancy Deed
f.
Other:
________________________________________________________
SALE PRICE:
$
00
10.
________________________________________________________
3. (a) BUYER’S NAME AND ADDRESS:
11. DATE OF SALE (Numeric Digits): ____________
Month / Year
________________________________________________________
$
00
12. DOWN PAYMENT
________________________________________________________
13. METHOD OF FINANCING:
________________________________________________________
a.
Cash (100% of Sale Price)
e.
New loan(s) from
(b) Are the Buyer and Seller related?
Yes
No
financial Institution:
If Yes, state relationship:
b.
Barter or trade
(1)
Conventional
4. ADDRESS OF PROPERTY:
(2)
VA
c.
Assumption of existing loan(s)
(3)
FHA
________________________________________________________
f.
Other financing; Specify:
d.
Seller Loan (Carryback)
_______________________
________________________________________________________
14. PERSONAL PROPERTY (see reverse side for definition):
________________________________________________________
(a) Did the Sale Price in Item 10 include Personal Property that
5. (a) MAIL TAX BILL TO: (Taxes due even if no bill received)
impacted the Sale Price by 5 percent or more?
Yes
No
________________________________________________________
(b) If Yes, provide the dollar amount of the Personal Property:
________________________________________________________
$
00
AND
________________________________________________________
briefly describe the Personal Property: _________________________
15. PARTIAL INTEREST: If only a partial ownership interest is being sold,
(b) Next tax payment due ______________________
briefly describe the partial interest:___________________________
6. PROPERTY TYPE (for Primary Parcel): NOTE: Check Only One Box
a.
Vacant Land
f.
Commercial or Industrial Use
16. SOLAR / ENERGY EFFICIENT COMPONENTS:
(a) Did the Sale Price in Item 10 include solar energy devices, energy
b.
Single Family Residence
g.
Agricultural
efficient building components, renewable energy equipment or
c.
Condo or Townhouse
h.
Mobile or Manufactured Home
combined heat and power systems that impacted the Sale Price by
Affixed
Not Affixed
5 percent or more?
Yes
No
d.
2-4 Plex
i.
Other Use; Specify:
If Yes, briefly describe the solar / energy efficient components:
e.
Apartment Building
_____________________
______________________________________________________
7. RESIDENTIAL BUYER’S USE: If you checked b, c, d or h in Item 6
_______________________________________________________
above, please check one of the following:
17. PARTY COMPLETING AFFIDAVIT (Name, Address, Phone Number):
a.
To be used as a primary residence.
b.
To be rented to someone other than a "qualified family member."
_________________________________________________________
c.
To be used as a non-primary or secondary residence.
_________________________________________________________
See reverse side for definition of a “primary residence, secondary
residence” and “family member.”
_________________________________________________________
8. If you checked e or f in Item 6 above, indicate the number of units: _____
18. LEGAL DESCRIPTION (attach copy if necessary):
For Apartments, Motels / Hotels, Mobile Home / RV Parks, etc.
THE UNDERSIGNED BEING DULY SWORN, ON OATH, SAYS THAT THE FOREGOING INFORMATION IS A TRUE AND CORRECT STATEMENT OF
THE FACTS PERTAINING TO THE TRANSFER OF THE ABOVE DESCRIBED PROPERTY.
____________________________________________________________
__________________________________________________________
Signature of Seller / Agent
Signature of Buyer / Agent
State of ______________________, County of ______________________
State of ______________________, County of ____________________
Subscribed and sworn to before me on this ____day of ____________ 20 __
Subscribed and sworn to before me on this ____day of ___________20 __
Notary Public _________________________________________________
Notary Public _______________________________________________
Notary Expiration Date _________________________________________
Notary Expiration Date ________________________________________
DOR FORM 82162 (04/2014)

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