CUYAHOGA COUNTY FISCAL OFFICE › pdf_fiscal...Fiscal Officer CUYAHOGA COUNTY FISCAL OFFICE REAL...
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Fiscal Officer 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) DTE FORM 100 Revised 5/2011 FOR COUNTY FISCAL OFFICER USE ONLY PERMANENT PARCEL NO. Type Instrument Tax List Year County Number Tax Dist. Number Date Number No. of Parcels DTE Code No. Neigh. Code No. of Acres Land Value Bldg. Value Total Value DTE Use Only DTE Use Only DTE Use Only Consideration DTE Use Only Valid Sale l. YES 2. NO Property Located in Taxing District Name on Tax Duplicate Tax Duplicate Year PERMANENT PARCEL NO. Description AUDITOR’S COMMENTS: q Split q New Plat q New Improvements q Partial Value q C.A.U.V. q Building Removed q Other q Platted q Unplatted SUBLOT NO: GRANTEE OR REPRESENTATIVE MUST COMPLETE ALL QUESTIONS IN THIS SECTION TYPE OR PRINT ALL INFORMATION SEE INSTRUCTIONS ON 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? q YES q NO If yes, check type: q 1, 2, or 3 Family Dwlg. q Condominium (Unit No. Condo Name ) q Apartment: No. of Units q Manufactured (mobile) home q Farm buildings q Other If land is vacant, what is intended use? 6. Conditions of Sale (Check all that apply): q Grantor is Relative q Part Interest Transfer q Land Contract q Trade q Life Estate q Leased Fee q Leasehold q Mineral Rights Reserved q Giſt q Grantor is Mortgagee q Other: 7. a)New Mortgage 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 q Conv. q F.H.A. q V.A. q Other: i) If giſt, in whole or part, estimated market value of the real property ............................ $ 8. 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? q YES q NO. If yes, complete DTE Form 101. 9. Has the grantor indicated that this property qualified for current agricultural use valuation for the preceding or current tax year? q YES q NO. If yes, complete DTE Form 102. 10. Application For 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 grantee’s principal residence by January 1 of next year? q YES q NO. If yes, is the property a multi-unit dwelling? q YES q NO. 11. Is this property leased or otherwise rented to tenants solely for residential purposes? q YES q NO. If yes, new owner must complete and submit a Rental Registration Form to the County Auditor within 60 days (including weekends and holidays) of the date of this transfer to avoid a penalty on their tax bill. 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. PRINTED NAME OF GRANTEE or REPRESENTATIVE SIGNATURE OF GRANTEE or REPRESENTATIVE DATE 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 Auditor Receipt Number 18 COUNTY AUDITOR FISCAL OFFICER
Transcript of CUYAHOGA COUNTY FISCAL OFFICE › pdf_fiscal...Fiscal Officer CUYAHOGA COUNTY FISCAL OFFICE REAL...
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Fisca
l Offic
er
CUYAHOGA COUNTY FISCAL OFFICE
REAL PROPERTY CONVEYANCE FEE STATEMENT OF VALUE AND RECEIPTIf exempt by O.R.C. 319.54 (F) (3), Use DTE Form 100 (Ex)
DTE FORM 100 Revised 5/2011
FOR COUNTY FISCAL OFFICER USE ONLY
PERMANENT PARCEL NO.
TypeInstrument
Tax List Year
County Number
Tax Dist. Number
Date
Number
No. of Parcels
DTE Code No.
Neigh. Code
No. of Acres
Land Value
Bldg. Value
Total Value
DTE Use Only
DTE Use Only
DTE Use Only
Consideration
DTE Use Only Valid Sale
l. YES 2. NO
Property Located in Taxing District
Name on Tax Duplicate Tax Duplicate Year PERMANENT PARCEL NO.
Description
AUDITOR’S COMMENTS: q Split q New Plat q New Improvements q Partial Value q C.A.U.V. q Building Removed q Other
q Platted q Unplatted
SUBLOT NO:
GRANTEE OR REPRESENTATIVE MUST COMPLETE ALL QUESTIONS IN THIS SECTIONTYPE OR PRINT ALL INFORMATION SEE INSTRUCTIONS ON 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? q YES q NO If yes, check type: q 1, 2, or 3 Family Dwlg. q Condominium (Unit No. Condo Name ) q Apartment: No. of Units q Manufactured (mobile) home q Farm buildings q Other If land is vacant, what is intended use?
6. Conditions of Sale (Check all that apply): q Grantor is Relative q Part Interest Transfer q Land Contract q Trade q Life Estate q Leased Fee q Leasehold q Mineral Rights Reserved q Gift q Grantor is Mortgagee q Other:
7. a)New Mortgage 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 q Conv. q F.H.A. q V.A. q Other: i) If gift, in whole or part, estimated market value of the real property ............................ $
8. 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? q YES q NO. If yes, complete DTE Form 101.
9. Has the grantor indicated that this property qualified for current agricultural use valuation for the preceding or current tax year? q YES q NO. If yes, complete DTE Form 102.
10. Application For 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 grantee’s principal residence by January 1 of next year? q YES q NO. If yes, is the property a multi-unit dwelling? q YES q NO.
11. Is this property leased or otherwise rented to tenants solely for residential purposes? q YES q NO. If yes, new owner must complete and submit a Rental Registration Form to the County Auditor within 60 days (including weekends and holidays) of the date of this transfer to avoid a penalty on their tax bill.
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.
PRINTED NAME OF GRANTEE or REPRESENTATIVE SIGNATURE OF GRANTEE or REPRESENTATIVE DATE
RECEIPT FOR PAYMENT OF CONVEYANCE FEEThe 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 Auditor
Receipt Number
18
COUNTY AUDITOR
FISCA
L OFF
ICER
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CUYAHOGA COUNTY FISCAL OFFICE
REAL PROPERTY CONVEYANCE FEE STATEMENT OF VALUE AND RECEIPTIf exempt by O.R.C. 319.54 (F) (3), Use DTE Form 100 (Ex)
DTE FORM 100 Revised 5/2011
FOR COUNTY FISCAL OFFICER USE ONLY
PERMANENT PARCEL NO.
TypeInstrument
Tax List Year
County Number
Tax Dist. Number
Date
Number
No. of Parcels
DTE Code No.
Neigh. Code
No. of Acres
Land Value
Bldg. Value
Total Value
DTE Use Only
DTE Use Only
DTE Use Only
Consideration
DTE Use Only Valid Sale
l. YES 2. NO
Property Located in Taxing District
Name on Tax Duplicate Tax Duplicate Year PERMANENT PARCEL NO.
Description
AUDITOR’S COMMENTS: q Split q New Plat q New Improvements q Partial Value q C.A.U.V. q Building Removed q Other
q Platted q Unplatted
SUBLOT NO:
GRANTEE OR REPRESENTATIVE MUST COMPLETE ALL QUESTIONS IN THIS SECTIONTYPE OR PRINT ALL INFORMATION SEE INSTRUCTIONS ON REVERSE
1. Grantor’s Name Phone: 2. Grantee’s Name Phone: 2a. Grantee’s Address 3. Address of Property 4. Tax Billing Address Are there buildings on the land? 5. q YES q NO If yes, check type: q 1, 2, or 3 Family Dwlg. q Condominium (Unit No. Condo Name ) q Apartment: No. of Units q Manufactured (mobile) home q Farm buildings q Other If land is vacant, what is intended use?
Conditions of Sale (Check all that apply): 6. q Grantor is Relative q Part Interest Transfer q Land Contract q Trade q Life Estate q Leased Fee q Leasehold q Mineral Rights Reserved q Gift q Grantor is Mortgagee q Other:
7. a)New Mortgage 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 q Conv. q F.H.A. q V.A. q Other: i) If gift, in whole or part, estimated market value of the real property ............................ $
8. 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? q YES q NO. If yes, complete DTE Form 101.
9. Has the grantor indicated that this property qualified for current agricultural use valuation for the preceding or current tax year? q YES q NO. If yes, complete DTE Form 102.
10. Application For 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 grantee’s principal residence by January 1 of next year? q YES q NO. If yes, is the property a multi-unit dwelling? q YES q NO.
11. Is this property leased or otherwise rented to tenants solely for residential purposes? q YES q NO. If yes, new owner must complete and submit a Rental Registration Form to the County Auditor within 60 days (including weekends and holidays) of the date of this transfer to avoid a penalty on their tax bill.
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.
PRINTED NAME OF GRANTEE or REPRESENTATIVE SIGNATURE OF GRANTEE or REPRESENTATIVE DATE
RECEIPT FOR PAYMENT OF CONVEYANCE FEEThe 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 Auditor
Receipt Number
18
COUNTY AUDITOR FOR DTE
DTE
COPY
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CUYAHOGA COUNTY FISCAL OFFICE
REAL PROPERTY CONVEYANCE FEE STATEMENT OF VALUE AND RECEIPTIf exempt by O.R.C. 319.54 (F) (3), Use DTE Form 100 (Ex)
DTE FORM 100 Revised 5/2011
FOR COUNTY FISCAL OFFICER USE ONLY
PERMANENT PARCEL NO.
TypeInstrument
Tax List Year
County Number
Tax Dist. Number
Date
Number
No. of Parcels
DTE Code No.
Neigh. Code
No. of Acres
Land Value
Bldg. Value
Total Value
DTE Use Only
DTE Use Only
DTE Use Only
Consideration
DTE Use Only Valid Sale
l. YES 2. NO
Property Located in Taxing District
Name on Tax Duplicate Tax Duplicate Year PERMANENT PARCEL NO.
Description
AUDITOR’S COMMENTS: q Split q New Plat q New Improvements q Partial Value q C.A.U.V. q Building Removed q Other
q Platted q Unplatted
SUBLOT NO:
GRANTEE OR REPRESENTATIVE MUST COMPLETE ALL QUESTIONS IN THIS SECTIONTYPE OR PRINT ALL INFORMATION SEE INSTRUCTIONS ON 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? q YES q NO If yes, check type: q 1, 2, or 3 Family Dwlg. q Condominium (Unit No. Condo Name ) q Apartment: No. of Units q Manufactured (mobile) home q Farm buildings q Other If land is vacant, what is intended use?
6. Conditions of Sale (Check all that apply): q Grantor is Relative q Part Interest Transfer q Land Contract q Trade q Life Estate q Leased Fee q Leasehold q Mineral Rights Reserved q Gift q Grantor is Mortgagee q Other:
7. a)New Mortgage 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 q Conv. q F.H.A. q V.A. q Other: i) If gift, in whole or part, estimated market value of the real property ............................ $ 8. 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? q YES q NO. If yes, complete DTE Form 101.
9. Has the grantor indicated that this property qualified for current agricultural use valuation for the preceding or current tax year? q YES q NO. If yes, complete DTE Form 102.
10. Application For 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 grantee’s principal residence by January 1 of next year? q YES q NO. If yes, is the property a multi-unit dwelling? q YES q NO.
11. Is this property leased or otherwise rented to tenants solely for residential purposes? q YES q NO. If yes, new owner must complete and submit a Rental Registration Form to the County Auditor within 60 days (including weekends and holidays) of the date of this transfer to avoid a penalty on their tax bill.
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.
PRINTED NAME OF GRANTEE or REPRESENTATIVE SIGNATURE OF GRANTEE or REPRESENTATIVE DATE
RECEIPT FOR PAYMENT OF CONVEYANCE FEEThe 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 Auditor
Receipt Number
18
COPY FOR GRANTEE/GRANTOR
GRAN
TEE'S
COP
Y
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PPN-Box1: undefined_3: DTE1: OffPrint: PrintReset Form: Reset FormType Instrument: Tax List Year: Tax Dist Number: Date: Property Located in: Name on Tax Duplicate: Tax Duplicate Year: Number: No of Parcels: SUBLOT NO: q Other: DTE Code No: Neigh Code: Grantor’s Name: Phone: Grantee’s Name: Phone_2: 2a Grantee’s Address: No of Acres: Address of Property: Tax Billing Address: Condo Name: Land Value: q Other_2: If land is vacant, what is intended use: Bldg Value: q Grantor is Mortgagee q Other: undefined_2: Total Value: undefined_4: undefined_5: undefined_6: undefined_7: DTE Use Only: gName of Mortgagee: q Other: undefined_8: DTE Use Only_2: DTE Use Only_3: Consideration: PRINTED NAME OF GRANTEE or REPRESENTATIVE: DATE: Receipt Number: undefined_9: has been paid by: Land: OffBuildings: OffRB8: OffRB9: OffRB10: OffRB10a: Offresiential11: OffPlatted1: OffUnPlatted1: OffA-Comments1: OffA-Comments2: OffA-Comments3: OffA-Comments4: OffA-Comments5: OffA-Comments6: OffA-Comments7: OffCondtnofSale1: OffCondtnofSale2: OffCondtnofSale3: OffCondtnofSale4: OffCondtnofSale5: OffCondtnofSale6: OffCondtnofSale7: OffCondtnofSale8: OffCondtnofSale9: OffCondtnofSale10: OffOther-6: OffMortageType: OffGrantor8: Off5-Unit No: date: co#: #: name: phone: name2: phone2: address: address2: billing address: 5a: Off5b: Off5c: Off5d: Off5e: Off5f: Off5g: Off5h: Off5i: Off5j: Off5k: Off5l: Off5m: Off5n: Off5o: Off5p: Off5q: Off5r: Off5s: Off5t: Off5u: Off5v: Off5w: Off6: Off7: Off8a: Off8b: OffCUYAHOGA COUNTY FISCAL OFFICER: CUYAHOGA COUNTY FISCAL OFFICERCUYAHOGA COUNTY FISCAL OFFICER2: CUYAHOGA COUNTY FISCAL OFFICER
