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3501 Civic Center Dr., Room 208 225 P.O. Box C 225 San Rafael, CA 94913 225 www.marincounty.org225 415.473.7215 225 FAX 415.473.6542 Documentary Transfer Tax Transmittal Document Number Date of Recording TRA or Unic Note: County Transfer Tax is $.55 per $500.00 or portion thereof, exclusive of assumed liens and encumbrances. City Transfer Tax for City of San Rafael is $2.00 per $1,000 or portion thereof (in addition to applicable County Tax.) There is no exclusion for assumed liens on San Rafael tax portion Fair Market Value of Property $ (Tax Basis for San Rafael tax portion) Less Existing Encumbrance(s) $ (Not applicable to San Rafael tax portion) Net Value $ Percentage of Property Being Transferred % Total for Transfer Tax Basis for County Tax $ County Tax $ City of San Rafael Tax (if applicable) $ Transfer Tax Due $ Document Reference Numbers and Remaining Amount of Existing Deed(s) of Trust: 1. # $ 2. # $ 3. # $ Any other information which may be pertinent: I declare, under penalty of perjury, that the foregoing facts are true and correct to the best of my knowledge. By Contact person Phone number American LegalNet, Inc. www.FormsWorkFlow.com