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Real Property Conveyance Fee Statement Of Value And Receipt - Ohio
| Real Property Conveyance Fee Statement Of Value And Receipt Form. This is a Ohio form and can be used in Real Estate Cuyahoga County (Court Of Common Pleas) . |
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DTE FORM 100 Revised: 03/2011 CUYAHOGA COUNTY FISCAL OFFICE REAL PROPERTY CONVEYANCE FEE STATEMENT OF VALUE AND RECEIPT If exempt by O.R.C. 319.54 (F) (3), Use DTE Form 100(Ex) PERMANMENT PARCEL NO. FOR COUNTY FISCAL OFFICER'S OFFICE USE ONLY Type Instrument Tax List year County Number 18 Tax Dist. Number Date: SUBLOT NO: __________ AUDITOR'S COMMENTS: ___ Split ____New Plat ____New Improvements ____Partial Value DTE Code No. ____ C.A.U.V. ____Building Removed ____ Other ___________ sc al O GRANTEE OR REPRESENTATIVE MUST COMPLETE ALL QUESTIONS IN THIS SECTION TYPE OR PRINT ALL INFORMATION SEE INSTRUCTIONS REVERSE 1. Grantor's Name _________________________________________ Phone: ________________ 2. Grantee's Name ________________________________________ Phone: ________________ 2a. Grantee's Address ______________________________________________________________________ 3. Address of Property ______________________________________________________________________ 4. Tax Billing Address ______________________________________________________________________ 5. Are there buildings on the land? ____ Yes ____No If yes, check type: __ 1, 2, 3 Family Dwlng. __ Condominium (Unit No. ___ Condo Name _________) ____ Apt: No. of Units ___Manufactured (mobile) home ___ Farm Buildings ___ Other _________________________________ If land is vacant, what is intended use? ______________________________________________________ Conditions of Sale (Check all that apply): ___ Grant is Relative ___Part Interest Transfer ___ Land Contract ___Trade ___ Life Estate ___ Leased Fee ___ Leasehold ___ Mineral Rights reserved ___ Gift a. New Mortage Amount (if any) .................................................. $ ______________ b. Balance Assumed (if any) ........................................................ $ ______________ c. Cash (If any) ......................................................................... $ ______________ d. Total Consideration (Add lines 7a, 7b and 7c) ................................. $ ______________ e. Portion, if any, of total consideration paid for items other than real property .... $ ______________ f. Consideration for real property on which fee is to be paid (7d minus 7e) ......... $ ______________ g. Name of Mortgagee ______________________________________________ h. Type of Mortgage ___ Conv. ____ F.H.A. ____ V.A. ____ Other: _________ i. If gift, in whole or part, estimated market value of the real property ..................... $ ______________ has the grantor indicated that this property is entitled to receive the senior citizen, disabled person, or surviving spouse homestead exemption for the preceding or current tax year? _____ YES _____NO, If yes, complete DTE form 101. Has the grantor indicated that this property qualified for current agricultural use valuation for the preceding or current tax year? ____YES _____NO. If yes, complete DTE Form 102. Application For 21/2 % Reduction (NOTICE; failure to complete this application prohibits the owner from receiving this reduction until another proper and timely application is filed): Will this property be to grantee's principal residence by January 1 of next year? ____YES ____NO. If yes, is the property a multi-unit dwelling? ____YES ____NO. ffi ce r Property Located in ____________________________________________________ Taxing District Name on Tax Duplicate ______________________________________ Tax Duplicate Year _______ PERMANENT PARCEL NO. Description ____Platted ____Un-Platted Number No. of Parcels Neigh. Code No. of Acres Land Value 6. 7. Bldg. Value Fi Total Value DTE Use Only DTE Use Only 8. 9. 10. DTE Use Only Consideration DTE Use Only Valid Sale 1.Yes __ 2. No__ _____________ Receipt Number I DECLARE UNDER PENALTIES OF PERJURY THAT THIS STATEMENT HAS BEEN EXAMINED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF IT IS A TRUE, CORRECT AND COMPLETE STATEMENT. ___________________________ DATE ________________________________________________ SIGNATURE OF GRANTEE OR REPRESENTATIVE RECEIPT FOR PAYMENT OF CONVEYANCE FEE The conveyance fee required by section 319.54 (F) (3) R.C., and if applicable, the fee required by Chapter 322 R.C., in The total amount of $ ______________ has been paid by ______________________________and received by the Cuyahoga County Fiscal Officer. American LegalNet, Inc. www.FormsWorkFlow.com DTE FORM 100 Revised: 03/2011 CUYAHOGA COUNTY FISCAL OFFICE REAL PROPERTY CONVEYANCE FEE STATEMENT OF VALUE AND RECEIPT If exempt by O.R.C. 319.54 (F) (3), Use DTE Form 100(Ex) PERMANMENT PARCEL NO. FOR COUNTY FISCAL OFFICER'S OFFICE USE ONLY Type Instrument Tax List year County Number 18 Tax Dist. Number Date: Property Located in ____________________________________________________ Taxing District Name on Tax Duplicate ______________________________________ Tax Duplicate Year _______ PERMANENT PARCEL NO. Description ____Platted ____Un-Platted SUBLOT NO: __________ AUDITOR'S COMMENTS: ___ Split ____New Plat ____New Improvements ____Partial Value Number No. of Parcels DTE Code No. Fo rD GRANTEE OR REPRESENTATIVE MUST COMPLETE ALL QUESTIONS IN THIS SECTION TYPE OR PRINT ALL INFORMATION SEE INSTRUCTIONS REVERSE 1. Grantor's Name _________________________________________ Phone: ________________ 2. Grantee's Name ________________________________________ Phone: ________________ 2a. Grantee's Address ______________________________________________________________________ 3. Address of Property ______________________________________________________________________ 4. Tax Billing Address ______________________________________________________________________ 5. Are there buildings on the land? ____ Yes ____No If yes, check type: __ 1, 2, 3 Family Dwlng. __ Condominium (Unit No. ___ Condo Name _________) ____ Apt: No. of Units ___Manufactured (mobile) home ___ Farm Buildings ___ Other _________________________________ If land is vacant, what is intended use? ______________________________________________________ Conditions of Sale (Check all that apply): ___ Grant is Relative ___Part Interest Transfer ___ Land Contract ___Trade ___ Life Estate ___ Leased Fee ___ Leasehold ___ Mineral Rights reserved ___ Gift a. New Mortage Amount (if any) .................................................. $ ______________ b. Balance Assumed (if any) ........................................................ $ ______________ c. Cash (If any) ......................................................................... $ ______________
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