Vermont Form Pt 172 S – Fill Out and Use This PDF

*Required or Conditionally Required Field

A.

Web request key / Confirmation code

TRANSFEROR’S (Seller’s) INFORMATION

Entity TRANSFEROR Name

Federal ID Number

OR*

OR*

Individual TRANSFEROR Last Name

First Name

Initial

Social Security Number

TRANSFEROR Mailing Address Following Transfer*

Daytime Telephone Number

Line 2 for Mailing Address Following Transfer (if needed)

For Department Use Only

City*

State*

ZIP Code*

Foreign Country (if not United States)*

Email Address

B.

TRANSFEREE’S (Buyer’s) INFORMATION

Entity TRANSFEREE Name

Federal ID Number

OR*

OR*

Individual TRANSFEREE Last Name

First Name

Initial

Social Security Number

TRANSFEREE Mailing Address Following Transfer*

Daytime Telephone Number

Line 2 for Mailing Address Following Transfer (if needed)

For Department Use Only

City*

State*

ZIP Code*

Foreign Country (if not United States)*

Email Address

C.

PROPERTY INFORMATION

Property Physical Location - Number and Street or Road Name*

Land Size (in acres)*

Check if sale did not involve land

City or Town*

SPAN*

Check if property is located in

multiple cities or towns*

D.

HOLDING PERIOD

Date Acquired by Transferor (mm dd yyyy)*

Date of this Closing (mm dd yyyy)*

Time Held*

_________ Years

_________ Months

E.

EXEMPTIONS

E1.

If transfer is exempt from Property Transfer Tax, enter exemption number (see quick reference guide) . E1. _________*

E2.

If sale was between family members, enter corresponding number (see quick reference guide). . . . . . . . E2. _________*

E2a. If Line E2 is “05,” enter description

E2a. _________________________________________*

E3.

Land Gains exemption number (see quick reference guide). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E3. _________*

(continued on next page)

*201722100*

Page 1 of 4

Form PTT-172

5454

* 2 0 1 7 2 2 1 0 0 *

Rev. 10/20

F.

TRANSFER INFORMATION

F1.

How did the Transferor acquire this property? (see quick reference guide) . . . .

. . . . . . . . . . . .

. . . . . . . . F1. _________*

F1a.

If Line F1 is “04,” enter description

F1a. _________________________________________*

F2.

Interest conveyed in this transfer (see quick reference guide) .

. . . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . F2. _________*

F2a.

If Line F2 is “07,” enter percent of interest here

. . . . . . . . . . . . .

. F2a. ________________ . _______% *

F2b.

If Line F2 is “08,” enter description

F2b. _________________________________________*

F3.

Type of building construction at time of transfer (see quick reference guide) . .

. . F3. ________ ________

_______*

F3a.

If Line F3 is “05,” enter number of units transferred . . .

. . . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . F3a. _________*

F3b.

If Line F3 is “06,” enter number of dwelling units transferred

. . . . . . . . . . . .

. . . . . . . F3b. _________*

F3c.

If Line F3 is “20,” enter description

F3c. _________________________________________*

F4.

Was the transferee a tenant prior to this transfer?

. . . . . . . . . . . . . . .

. . . . . F4.

cYes*

cNo*

F5.

Financing

F5. cConventional/Bank*

cOwner Financing*

cOther*

F5c.

If Line F5 is “Other,” enter description

F5c. _________________________________________*

F6.

Do you intend to record this return with the Town/City within 60 days of the closing? . . F6.

cYes*

cNo*

G.

AGRICULTURAL / MANAGED FOREST LAND USE VALUE PROGRAM, 32 V.S.A. CHAPTER 124

G1.

Is all or part of the property being transferred enrolled in the Current Use

cYes*

cNo*

(Use Value Appraisal) Program?

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . .

G1.

G2.

To continue enrollment in the Current Use Program, the new owner must submit a

Current Use Application within 30 days of the recording date. Will the new owner

cYes*

cNo*

be submitting that application?

. . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . .

. . . . . . . .G2.

H.

TRANSFER INFORMATION

H1.

Transferor’s use of property BEFORE transfer (see quick reference guide) . . .

. . . . . . . . . . . .

. . . . . . . . H1. _________*

H1a. If Line H1 is “07,” “08,” or “09,” enter description. . . .

H1a.__________________________________________*

H2.

Transferee’s use of property AFTER transfer (see quick reference guide) . . . .

. . . . . . . . . . . .

. . . . . . . . H2. _________*

H2a. If Line H2 is “07,” “08,” or “09,” enter description. . . .

H2a.__________________________________________*

H3.

Was the property rented BEFORE transfer?

. . . . . . . . . . . . .

. . . . . . . .H3.

cYes*

cNo*

H4.

Will the property be rented AFTER transfer?

. . . . . . . . . . . . .

. . . . . . . .H4.

cYes*

cNo*

H5.

Have development rights been conveyed separately?

. . . . . . . . . . . . . . . . .

H5.

cYes*

cNo*

H6.

Does the transferee hold title to any adjoining property?

. . . . . . . . . . . . . .

. . . . . . . H6.

cYes*

cNo*

H7.

Is the transferee a grantor’s revocable trust?

. . . . . . . . . . . . .

H7.

cYes*

cNo*

I.

REAL ESTATE WITHHOLDING CERTIFICATION

I1.

The transferee certifies that 2.5% VT Income tax has been withheld from the purchase

price and will be remitted to the Vermont Commissioner of Taxes with

. . I1. cYes*

cNo*

Form REW-171 within 30 days of the date of this closing

I2.

If Line I1 is “No,” enter the withholding exemption number (see quick reference guide)

I2. _________*

I2a. If Line I2 is “04,” enter Commissioner’s Certificate number

I2a. ___________________________*

J.

TAX CALCULATION

Tax on Special Rate Property

J1.

Portion of value eligible for special principal

residence rate (see instructions) . . . .

. . . . J1.

__________________________*

J2.

If transfer happened prior to July 1, 2011,

enter the portion of value eligible for a

special rate. (see instructions)

. . . . J2.

__________________________*

J3.

Total special rate value (Add Lines J1 & J2) .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

.J3. ___________________________*

J4.

Tax due on portion of value eligible for special rate

(Multiply Line J3 by the tax rate of 0.005). . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

J4. ___________________________*

J5.

Only If Line E1 is “99”:

Enter any portion of value in excess

of $110,000 but below $200,000. . . .

. . . J5.

__________________________*

J6.

Tax due on exemption 99 for portion of value less than $200,000

(Multiply Line J5 by the tax rate of 0.0125 for exemption 99 only)

.J6. ___________________________*

J7.

Total due on portion of value eligible for special rates. (Add Lines J4 and J6) . . .

.J7. ___________________________*

Tax on General Rate Property

J8.

Value paid or transferred as defined

in 32 V.S.A. § 9601(6)

J8.

__________________________*

J9.

Value paid or transferred for personal

property

. . . J9.

__________________________*

J10.

Value paid or transferred for real property

(Subtract Line J9 from Line J8) . .

. . . . J10.

__________________________*

J11.

Enter amount from Line J3 above . .

. . . J11.

__________________________*

J12.

Enter amount from Line J5 above

. . . . J12.

__________________________*

J13.

Subtract Lines J11 and J12 from

Line J10

J13.

__________________________*

J14.

Tax due on portion of value subject to the General Rate (Multiply Line J13

by the tax rate of 0.0145 which includes a 0.002 surcharge for the Clean

Water Fund, 32 V.S.A. § 9602a) . .

. . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

J14. ___________________________*

Total Tax Due

J15.

Total Tax Due (Add Lines J7 and J14)

. . . . . . . . . . . . . . . . . . . . . . . .

J15. ___________________________*

Prepared by (print or type) ____________________________________________ *

Preparer’s Address _________________________________________________ *

Preparer’s Email Address ______________________________________________ *

__________________________________________________________________

Preparer’s Telephone __________________________________________________ *

Book Number*

Page Number*

Grand List year*

City or Town*

Parcel ID Number

Date of Record*

Grand List Value

Grand List Category*

SPAN*

Comments, additional information, etc.

cDuplicate Return Suspected

cPortion of the Property Sold

cOriginal Return Waiting on Deed

ACKNOWLEDGMENT

Return received.

SIGNED__________________________________________________________________ , Clerk

DATE ______________________________________________