HomeMy WebLinkAboutCONVEYANCE TAX FORM DESAUTELS 257 CHESTERFIELD (TOM)Declaration: I declare under penalty of law that I have examined this return (including any accompanying schedules and statements) and, to the best of my knowledge and belief, it is true, complete, and correct. I understand the penalty for willfully delivering a false return to the Department of Revenue Services (DRS) is a fine of not more than $5,000, or imprisonment for not more than five years, or both. The declaration of a paid preparer other than the taxpayer is based on all information of which the preparer has any knowledge.
Name of person signing the return (type or print) Signature Date
Name of grantor’s representative (type or print) Connecticut juris number if applicable Telephone number
Indicate who is signing this return: Grantor Grantor’s attorney Grantor’s authorized agent
Department of Revenue Services
State of ConnecticutPO Box 5035 Hartford CT 06102-5035
OP236 0417W 01 9999
OP-236
Connecticut Real Estate Conveyance Tax Return (Rev. 04/17)
Complete Form OP-236 in blue or black ink only.
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FEIN
SSN
4. Grantor/seller #1 (last name, first name, middle initial) Taxpayer Identification Number
Grantor/seller address (street and number) after conveyance City/town State ZIP code
FEIN
SSN
10. Grantee/buyer (last name, first name, middle initial) Taxpayer Identification Number
Grantee/buyer address (street and number) after conveyance City/town State ZIP code
1. Town 2. Location of property conveyed (number and street)Amended return
3. Are there more than two grantors/sellers? Yes If Yes, attach OP-236 Schedule A - Grantors, Supplemental Information for Real Estate Conveyance Tax Return.
FEIN
SSN
5. Grantor/seller #2 (last name, first name, middle initial) Taxpayer Identification Number
Grantor/seller address (street and number) after conveyance City/town State ZIP code
9. Is there more than one grantee/buyer or, is the grantee a partnership, S corporation, LLC, estate, or trust? Yes If Yes, attach OP-236 Schedule B - Grantees, Supplemental Information for Real Estate Conveyance Tax Return.
15. Consideration for unimproved land x 0.0075 =
16. Total consideration for residential dwelling
16a. Portion of Line 16 that is $800,000 or less x 0.0075 =
16b. Portion of Line 16 that exceeds $800,000 x 0.0125 =
17. Residential property other than residential dwelling x 0.0075 =
18. Nonresidential property other than unimproved land x 0.0125 =
19. Property conveyed by a delinquent mortgagor x 0.0075 =
20. Total State of Connecticut tax due: Add Lines 15, 16a through 19.
Computation of Tax - Enter consideration for conveyance on the appropriate line. See Instructions.
11. Date conveyed (MM - DD - YYYY) 12. Date recorded (MM - DD - YYYY) 13. Type of instrument:
Warranty Quitclaim Easement Other
14. The grantor claims no tax is due because (See instructions.): Conveyance was for no consideration or consideration was less than $2,000.
Conveyance is exempt under Conn. Gen. Stat. §12-498. Enter exemption code:
If exemption code is 01 or 09, enter citation or docket number:
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Vol. Pg.
For Town Clerk Use Only
Town Code Land Record
6. Is the grantor a partnership, S corporation, LLC, estate, or trust? Yes If Yes, attach OP-236 Schedule A - Grantors 7. Was more than one deed filed with this conveyance? Yes
8. If this conveyance is for no consideration or less than Federal only State only Both fed. & state None adequate consideration, which gift tax returns will be filed?
OP-236
Connecticut Real Estate Conveyance Tax Return(Rev. 04/17)
Town Clerk Copy
4. Grantor/seller #1 (last name, first name, middle initial)
Grantor/seller address (street and number) after conveyance City/town State ZIP code
10. Grantee/buyer (last name, first name, middle initial)
Grantee/buyer address (street and number) after conveyance City/town State ZIP code
3. Are there more than two grantors/sellers? Yes
5. Grantor/seller #2 (last name, first name, middle initial)
Grantor/seller address (street and number) after conveyance City/town State ZIP code
15. Consideration for unimproved land x 0.0075 =
16. Total consideration for residential dwelling
16a. Portion of Line 16 that is $800,000 or less x 0.0075 =
16b. Portion of Line 16 that exceeds $800,000 x 0.0125 =
17. Residential property other than residential dwelling x 0.0075 =
18. Nonresidential property other than unimproved land x 0.0125 =
19. Property conveyed by a delinquent mortgagor x 0.0075 =
20. Total State of Connecticut tax due: Add Lines 15, 16a through 19.
Computation of Tax - Enter consideration for conveyance on the appropriate line. See Instructions.
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-
-
1. Town 2. Location of property conveyed (number and street)Amended return
Vol. Pg.
For Town Clerk Use Only
Town Code Land Record
9. Is there more than one grantee/buyer or, is the grantee a partnership, S corporation, LLC, estate, or trust? Yes
11. Date conveyed (MM - DD - YYYY) 12. Date recorded (MM - DD - YYYY) 13. Type of instrument:
Warranty Quitclaim Easement Other
14. The grantor claims no tax is due because (See instructions.): Conveyance was for no consideration or consideration was less than $2,000.
Conveyance is exempt under Conn. Gen. Stat. §12-498. Enter exemption code:
If exemption code is 01 or 09, enter citation or docket number:
6. Is the grantor a partnership, S corporation, LLC, estate, or trust? Yes 7. Was more than one deed filed with this conveyance? Yes
8. If this conveyance is for no consideration or less than Federal only State only Both fed. & state None adequate consideration, which gift tax returns will be filed?