State: NY

Columbia County Transfer Tax

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COLUMBIA COUNTY SUPPLEMENTAL REAL ESTATE TRANSFER TAX REETURN	Recording Office Stamp here
Schedule A—Information relating to conveyance

Location and description of property to be conveyed
Tax map designation			Address	City/Village	Town	County
Section	Block	Lot

Type of property conveyed	Date of Conveyance	Date of Contract
One Family Residence
Other

Schedule B—Real estate transfer tax return
Part I. Apportionment
Portion of property outside of Columbia County:Yes NoIf no, proceed to II. below
If yes: Taxable on % share of assessed value within Columbia County, calculated as follows:
a. Total Assessed Value:	a. $
b. Assessed Value in Columbia County:	b. $
c. % of Assessed Value in columbia County [b. ÷ a. x 100]	c. $
d. Columbia County portion of consideration upon which Tax is due [consideration x c. %]	d. $
Part II. Computation of Tax Due
a. Amount of full consideration if entire parcel is within county OR d. above if applicable	a. $
b. If a total exemption is claimed on the TP-584 check here and enter $0 on this line	b. $
c. Taxable consideration (for one family residence, first $150,000 of consideration is exempt)	c. $
d. Tax: $1 for each $500, or part thereof, of consideration on line a., b., or c. as applicable	d. $

Signature (both the grantor(s) and grantee(s) must sign)

The undersigned certify that the above information in Schedules A and B, including any return, certification, schedule or attachment, is to the best of his/her knowledge, true and complete, and authorize the person(s) submitting such form on their behalf to receive a copy for purposes of recording the deed or other instrument effecting the conveyance. The contents hereof shall not be otherwise disclosed.

Grantor

Title

Grantor

Title

Grantee

Title

Grantee

Title

For Recording Officer's Use

Amount received

Date received

Transaction number

TRANSFER TAX AND RELATED DOCS NY04: COLUMBIA COUNTY SUPPLEMENTAL REAL ESTATE TRANSFER TAX REETURN

Grantor/Transferor Individual Corporation Partnership Estate/Trust Other	Name (if individual; last, first, middle initial)			Social Security Number
	Mailing Address			Social Security Number
	City	State	Zip	Federal Employer Identification Number
Grantor/Transferee Individual Corporation Partnership Estate/Trust Other	Name (if individual; last, first, middle initial)			Social Security Number
	Mailing Address			Social Security Number
	City	State	Zip	Federal Employer Identification Number