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Statement of Value Form

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STATEMENT OF VALUE FORM

Property Identification

Property Address:

Assessor's Parcel Number (APN) / Parcel No.:    Tax Map / Lot:

Party Identification

Phone:    Email:

Phone:    Email:

Transaction Information

Sale / Transfer Date:

Type of Deed / Instrument:

Earnest Money / Deposit Delivered:    Date Delivered:

Cash / All cash    Purchase money mortgage    Seller financing / Carryback    Loan assumption    Other

If Other or additional financing details, describe:

Consideration Adjustments and Personal Property

Does the total consideration include personal property, fixtures, equipment or other non-real estate items?   Yes   No

Exemptions / Reason for Transfer

Transfer Reason (check applicable): Arms-length sale    Gift / Nominal consideration    Foreclosure / Trustee sale    Inheritance / Probate    1031 Exchange / Like-kind exchange    Other

Property Condition / Disclosures

Lead-based paint known?   Yes   No

Structural damage or material defects known?   Yes   No

Environmental contamination (underground tanks, hazardous materials) known?   Yes   No

Administrative Information

Prepared by / Escrow Officer / Agent Name:

Company / Firm:    Phone:

Filing / Recording information (if recorded): Recording Date:

Certification

I declare under penalty of perjury under the laws applicable to this jurisdiction that the information contained in this Statement of Value is true, correct, and complete to the best of my knowledge. I understand that this statement may be relied upon by assessors, revenue collectors and other public officials for valuation and tax purposes, and that materially false statements may subject the signer to civil or criminal penalties.

Signer Capacity (indicate role of signer):

Seller / Grantor — Print Name:

By:

Date:

Buyer / Grantee — Print Name:

By:

Date:

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What a Statement of Value Form Is and When It’s Used

The Statement of Value Form is a written record used to declare the fair market value or agreed monetary amount for property, goods, services, or an asset for purposes such as sale, transfer, insurance, or accounting. It identifies the parties, describes the asset, states the valuation method and effective date, and references supporting evidence. Properly completed forms create a clear audit trail for counterparties, insurers, and tax or regulatory reviewers. In many transactions the form accompanies contracts, claims, or filings and may require signatures or notarization to meet local rules.

Why a Statement of Value Form Matters

A Statement of Value Form reduces ambiguity in commercial and insurance transactions, supports tax and accounting positions, and documents agreed amounts for dispute resolution or regulatory review.

Why a Statement of Value Form Matters

Who Typically Prepares or Signs This Form

Typical users include parties documenting asset transfers, insurers, lenders, and accountants who need clear valuation records.

  • Real estate agents and brokers preparing sale disclosures and purchase documentation.
  • Business owners and buyers documenting asset values for purchase agreements or due diligence.
  • Insurance adjusters and claims specialists verifying declared value for coverage and settlement.

Use the form when you need a written valuation reference that complements contracts, insurance files, tax records, or dispute resolution.

Essential Elements of a Professional Statement of Value Form

A thorough Statement of Value Form identifies parties, describes the asset, explains valuation methodology, specifies the effective date, lists supporting attachments, and captures signatures and authentication to reduce downstream disputes.

Parties

List full legal names and contact information for the owner, recipient, and preparer. Identify roles and authorized representatives to establish who has authority to sign and accept the stated value.

Asset Description

Provide a clear, itemized description of the property or asset, including serial numbers, model, location, condition, and any encumbrances that materially affect current market value.

Valuation Basis

State the valuation method used—comparable sales, appraisal, replacement cost, income capitalization—with calculations, assumptions, and the identity of any appraiser or valuation source with dates and credentials.

Effective Date

Record the effective valuation date in MM/DD/YYYY format. The effective date determines the period the value represents and affects tax, insurance, and contractual obligations.

Supporting Documents

Attach appraisals, invoices, purchase agreements, inspection reports, photographs, and any regulatory filings that substantiate the stated value; list each attachment including dates and author credentials.

Signatures

Provide signature lines for preparer, owner, and recipient, each with printed name, title, date signed, and contact details. Notarization or witness blocks included where required by state law.

Step-by-Step Completion and Validation Checklist

Follow these steps to complete and validate a Statement of Value Form before sharing it with counterparties, insurers, or filing authorities.

  • 01
    Gather Details: Collect asset identifiers, contracts, and supporting documents.
  • 02
    Determine Value: Choose method and run calculations or obtain appraisal.
  • 03
    Complete Form: Enter fields, attach evidence, and check for consistency.
  • 04
    Authenticate: Sign, date, and notarize if state law requires.

Configuring an Online Workflow for the Form

Configure an online workflow to automate field population, routing, and storage for the Statement of Value Form using form templates and conditional logic.

Field Configuration
Auto-fill fields Use templates or CSV import to pre-populate.
Conditional fields Show valuation details only when asset type matches.
Signer order Set role-based sequential or parallel signing.
Storage Save final PDF and JSON metadata to secure archive.

Typical Routing and Delivery Flow

Typical routing paths show how a completed Statement of Value Form moves from preparer to approver, signers, and final storage or insurer.

  • Upload Document: Start with the template and attach evidence.
  • Add Signers: Assign roles and set authentication methods.
  • Send for Signature: Dispatch via email or secure link.
  • Archive: Store signed PDF with audit trail.

Platform and Integration Considerations

For eSubmission, ensure the platform supports PDF/DOCX import, audit trails, and signer authentication methods matching legal needs.

  • File Formats: Supports PDF, DOCX, and Excel.
  • Integrations: Salesforce, NetSuite, Google Workspace available.
  • Security: TLS 1.2/1.3 and AES-256 encryption.

Key Dates and Timing Considerations

Key dates for the Statement of Value Form depend on transaction type; these common deadlines guide filing, reporting, and insurer notification.

Effective Valuation Date:

Set on the form; determines applicable reporting period.

Delivery to Counterparty:

Provide within agreed contract timeframe or at closing.

Insurance Claim Filing:

Submit declared value with claim within insurer's policy deadlines.

Tax Reporting Reference:

Retain for tax preparer before filing returns; affects backup withholding.

Record Retention Start:

Retention begins at creation or termination date per regulation.

How This Form Differs from an Appraisal

Compare Statement of Value Forms with related documents to clarify purpose and legal implications across common document types.

Document Statement of Value Appraisal
Purpose declare agreed value independent certified valuation
Authority contracting parties licensed appraiser
Evidence invoices, photos certified report
Notarization sometimes required rarely notarized

eSignature Provider Pricing and Capability Snapshot

This vendor comparison summarizes starting prices and key features relevant when choosing an eSignature provider for completing and distributing Statement of Value Forms.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Required Data Elements at a Glance

Full Legal Name: Exact as on ID or paperwork
Taxpayer ID / TIN: Provide accurate EIN or SSN
Valuation Amount: Numeric dollars and cents
Effective Date: Enter as MM/DD/YYYY date
Supporting Documents: List attachments and dates
Authorized Signer: Name, title, and contact

Common Preparation Mistakes to Avoid

  • Incomplete asset identifiers leading to ambiguity in enforced valuations and delays during due diligence reviews by buyers, insurers, or auditors.
  • Using vague valuation language such as 'fair value' without method or calculation, which complicates tax positions and insurer assessments.
  • Failing to attach supporting documents like appraisals or invoices, removing audit trail evidence and increasing the risk of rejection by reviewers.
  • Mismatched signer names, missing dates, or absent notarization where required can render the statement non-actionable in legal or insurance disputes.

Potential Consequences of Errors or Omissions

Tax Penalties: IRC §6721 penalties may apply
Backup Withholding: 24% rate may be triggered
Claim Denial: Insurer may deny coverage
Contract Dispute: Value disputes risk litigation
Administrative Fines: State agencies can impose fees
Document Invalidity: Missing notarization or signature may void

Frequently Asked Questions and Practical Answers

Answers to common questions about preparing, signing, and filing a Statement of Value Form, including validation, notarization, and digital submission considerations.


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