State: OH

Reconveyance Form

DOWNLOADS

Reconveyance Form

Download PDF
FRANK RUSSO, CUYAHOGA COUNTY AUDITOR
DTE FORM 100
Revised 12/98 		REAL PROPERTY CONVEYANCE FEE STATEMENT OF VALUE AND RECEIPTPERMANENT PARCEL NO.
If exempt by O.R.C. 319.54 (F) (3), Use DTE Form 100 (Ex)
PERMANENT PARCEL NO.    


    

FOR COUNTY AUDITOR'S USE ONLY

Type
Instrument  		 Tax List
Year		 County
Number       18 		Tax Dist.
Number 		Date


Property  Located  in                                  __________________________                                        Taxi ng District

Name on Tax Duplicate________________________________________ Tax Duplicate Year________________

Description PERMANENT PARCEL NO.    


    
Platted         Unplatted
       SUBLOT NO: ________________

AUDITOR'S COMMENTS:   Split            NewPiat   New Improvemen           Partial Value
                                                C.A.U.V.     Building Removed         Other___________________

                       GRANTEE OR  REPRESENTATIVE MUST COMPLETE ALL QUESTIONS IN THIS SECTION
TYPE OR  PRINT ALL INFORMATION                                                                        SEE INSTRUCTIONS ON  REVERSE

I. 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? YES    NO  If yes, check  type:
I , 2, or 3 Family  Dwlg.   Condominium (Unit  No.___ Condo Na______ )  Apartment: No. of Units
Manufactured  (mobile) home      Farm  buildings   Other__________________________________
If land is vacant,  what is intended use? ___________________________________________________________
6. Conditions of Sale (Check' all that apply): Grantor is Relative     Part Interest Transfer    Land Contract Trade   Life Estate Leased Fee Leasehold  Mineral  Rights  Reserved Gift 
 Grantor is Mortgagee    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    Conv.         F.H.A.      VA.       Other:                                    
i) If gift, in whole or part, estimated market val ue of the real property ............................. $                            .
8. Has the grantor indicated th at this  property is entitled to receive the senior  citizen, disabled person,  or survivi n g spouse homestead exemption for the preceding or current tax year? 
YES NO.  If yes, complete DTE Form  I 01.
9. Has the grantor indicated  that this property qualified for current agricu l tural  use valuati on for the preceding or current tax year? YES NO.  If yes, compl ete DTE Form  I 02.
10. Application For 21h% Reducti on (NOTICE:  fail ure to complete this application prohibits the owner  from receivi ng this reduction  un til another proper and timel y application is filed):  Will this property  be grantee's  pri ncipal residence by January I  of next year?     YES   NO.
If yes, is t he property  a multi-unit dwelling? YES   NO.

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.

______________________________                                                  ____________________________________________
                        DATE                                                                                SIGNATURE OF GRANTEE or REPRESENTATIVE
Number


No. of Parcels


DTE CodeNo.


Neigh. Code


No. of Acres
Land Value


Bldg. Value


Total Value
DTEUseOnly
DTE Use Only
DTEUseOnly


Consideration
DTEUse Only
Valid Sale

I. YES        2.NO


______________________
       Receipt Number

                                                                        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 FRANK RUSSO.

OH Reconveyance Form