Fill and Sign the Cd 57 S Print New Hampshire Department of Revenue Form

FORM CD-57 NEW HAMPSHIRE DEP ARTMENT OF REVENUE ADMINISTRA TION REAL EST ATE TRANSFER T AX DECLAR ATION OF CONSIDER ATION (RSA 78-B:10) PURCHASER, GRANTEE, ASSIGNEE, TRANSFEREE (buyer): 1. IDENTITY: NAME (S) (LAST, FIRST, M-INTL.) AND SOCIAL SECURITY NUMBER (S) OR ENTITY NAME (S) AND FEDERAL IDENTIFICATION NUMBER (S) 2. NUMBER AND STREET CITY OR TOWNSTATE AND ZIP CODE SELLER, GRANTOR, ASSIGNOR, TRANSFER0R: 3. IDENTITY: NAME (S) (LAST, FIRST, M-INTL.) AND SOCIAL SECURITY NUMBER (S) OR ENTITY NAME (S) AND FEDERAL IDENTIFICATION NUMBER (S) 4. NUMBER AND STREET CITY OR TOWNSTATE AND ZIP CODE PROPERTY: 5. CITY/TOWN COUNTYBOOK NOPAGE NO BRIEF DESCRIPTION: (SUCH AS MAP AND LOT NUMBERS; LOCATED AT 17 ELM STREET, AUBURN, OR 10 ACRES, FARM HOUSE AND BARN KNOWN AS SMITH FARM, MILL ROAD, MILTON.) 6. DATE OF TRANSFER: MONTH (use numerals) DAY YEAR PLEASE PRINT OR TYPE INFORMATION BELOWsee reverse for instructions Mail T o: NH DEPT OF REVENUE ADMINISTRA TION 45 CHENELL DRIVE PO BOX 1324 CONCORD NH 03302-1324Tel. (603) 271-3701 CD-57 Rev 12/98 PRICE OR CONSIDERATION MEANS THE AMOUNT OF MONE Y, OR OTHER PROPERTY AND SERVICES, OR PROPERTY OR SERVICES VALUED IN MONEY WHICH IS GIVEN IN EXCHANGE FOR REAL ESTATE, AND MEASURED AT A TIME IMMEDIATELY AFTER THE TRANSFER OF THE REAL ESTATE. PRICE OR CONSIDERATION: 7. THE UNDERSIGNED BUYER (S) AND SELLER (S) AGREE AND AFFIRM THAT THE FULL PRICE OR CONSIDERATION PAID FOR THE REAL ESTATE TRANSFERRED BY THIS DEED OR INSTRUMENT IS......$ THE TAX DUE UPON THIS TRANSFER IS CALCULATED AT..................$ PER $100.00 OR ANY PART THEREOF TAX DUE ..............................................................................................$ (computed to the nearest dollar) 8. SPECIAL CIRCUMSTANCES: SIGNATURES: BUYER (S): WITNESS: DATE: SELLER (S): WITNESS: DATE: Were there special circumstances in the transfer which suggest that the full price or consideration of the property was either more or less than it's fair market value? NO YES, if yes, please explain. FORM CD-57 Instructions NEW HAMPSHIRE DEPARTMENT OF REVENUE ADMINISTRA TION REAL EST ATE TRANSFER TAX DECLAR ATION OF CONSIDER ATION (RSA 78-B) GENERAL INSTRUCTIONS The tax is paid at the Register of Deeds office for the county where the property is located. DO NOT send the tax payment with this Declaration. The purchaser, grantee, assignee, or transferee must file the Declaration. A Declaration must befiled for all transfers except : (1) Transfers involving only utility easements. (2) Transfers exempted from the tax by RSA 78-B:2 except : (a) RSA 78-B:2 IX - noncontractual (b) RSA 78-B:2 XIV - transfers resulting from merger, consolidation, or other tax-free reorganization as defined under US IRS Code of 1986, Sections368, as amended. (c) RSA 78-B:2 XVII - transfers between entities having transferrable interestswhere the form of organization changes and the owners and ownershippercentages of the transferor and transferee are identical. NOTE : Declarations are required under circumstances shown in [2 (a), (b) and (c)] above. The Declaration must be filed with the Department of Revenue Administration no later than 30days from the recording of the deed (or other instrument ) at the Register of Deeds office, or nolater than 30 days form the date of the transfer, whichever is later. The Declaration should be mailed to: Department of Revenue Administration Documents Processing Division45 Chenell DrivePO Box 1324Concord, NH 03302-1324 Willful failure to file the Declaration is a misdemeanor and shall be subject to a penalty of 100% ofthe amount of additional taxes determined to be due. Specific questions relating to this form or the Real Estate Transfer Tax should be referred to: NH Department of Revenue Administration Collection Division45 Chenell DriveConcord, NH 03301Telephone: (603) 271-3701 TTY/TDD Relay Services for the deaf and speech impaired: 1-800-735-2964 QUESTIONS: PENALTY: WHERE TOFILE: WHEN TOFILE: WHOMUSTFILE: PAYMENTOF THE TAX: CD-57 Instructions Rev 12/98