Effective On or Before 07/01/16 Page 1 57-006a (03/15/16)
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REAL ESTATE TRANSFER - DECLARATION OF VALUE
Please read the instructions comprised in form 57-011 before completing and filing this form.
Part I - TO BE COMPLETED BY BUYER, SELLER OR AGENT
Date of Instrument (MMDDYYYY)
Enter the number matching your selection in the box at the end of the line: Deed (1) Contract (2)
Seller: Phone Number:
Seller Address: City:
State: ZIP: email:
Buyer: Phone Number:
Buyer Address: City:
State: ZIP: email:
Address of Property Conveyed:
City: State: ZIP:
Legal Description:
Enter the number corresponding to your selection in the box at the end of the line, if applicable.
Type of Sale: Sale between related parties/family (1); Sale of partial interest (2); Trade (3); Quit Claim Deed (4); Auction (5)
Was this a sale of agricultural land to: Corporation (1); Trust (2); Alien (3); Non-resident Alien (4); Limited Partnership (5)
DECLARATION OF VALUE STATEMENT
1. Total Amount Paid ....................................................................
2. Amount Paid for Personal Property ..........................................
3. Amount Paid for Real Property .................................................
I hereby declare that the information contained in Part I of this form is true and correct.
Printed Name: Phone Number:
Signature: Buyer or Seller or Agent or Attorney
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Real Estate Transfer Declaration of Value, Page 2
Effective on or before 07/01/16 Page 2 57-006b (03/15/16)
Part II - TO BE COMPLETED BY THE ASSESSOR
Assessed values must be as of January 1 of the year in which the sale occurred.
SECTION A: SINGLE CLASSIFICATION
Primary Classification: Residential (4); Commercial (5); Industrial (2); Agricultural (1); Multi-residential (7)
City/Township: Occupancy:
Primary Parcel Number: Year Built:
Class
Land
Building
Dwelling
Res
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Com
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Ind
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Ag
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MultiRes
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.00
Subtotal ..........................
SECTION B: DUAL CLASSIFICATION
Primary Classification: Commercial (5); Industrial (2); Multi-residential (7)
City/Township: Occupancy:
Primary Parcel Number: Year Built:
Class
Land
Building
Dwelling
Com
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.00
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.00
Ind
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.00
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.00
MultiRes
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.00
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.00
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.00
Subtotal ....................................................................
Total: Add Subtotal amounts from Sections A and B ....................
Enter amount from line 3, page 1 ...............................................
Ratio: Divide Total amount by the amount on line 3, page 1 ........................... : %
NUTC
Jurisdiction
Comments:
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Effective on or before 07/01/16 Page 1 57-011a (03/15/16)
Real Estate Transfer Declaration of Value Instructions
Visit the Department website at https://tax.iowa.gov for more information.
FILING INSTRUCTIONS: Iowa law requires that a “Declaration of Value” statement reflecting the full
consideration paid in certain nonexempt real estate conveyances be submitted to the county recorder at the
time a deed, contract, instrument, or other writing is presented for recording. The blank area at the top of
page 1 of form 57-006, Real Estate Transfer- Declaration of Value, is for use by the county recorder. In this
area the recorder will provide the following information: Date of Recording, Book and Page Number or
Instrument Number, County, or Real Estate Transfer Tax. Part I of the form is the prescribed “Declaration of
Value” statement that must be completed by the buyer or seller or either’s agent for nonexempt transactions.
Part II of the form is to be completed only by the assessor.
IMPORTANT: This form does not have to be completed for any document presented for recording which
clearly indicates on such document that it is an exempt transaction. Refer to Iowa Administrative Code 701-
79.5. If the transaction is exempt, but the reason for exemption is not stated on the actual document
presented for recording, Part I of this form must be completed. If this form is not completed accurately and
completely for nonexempt transactions by the buyer or seller or either’s agent, the county recorder is
required by law to refuse to record the contract, deed or other instrument conveying the affected property.
TYPE OF SALE: Enter the number corresponding to your selection in the box at the end of the line on
page 1, if applicable. For purposes of indicating a “Sale Between Family Members” only the following
relationships are to be considered:
Mother
Daughter
Sister
Sister-in-law
Stepsister
Mother-in-law
Daughter-in-law
Niece
Foster child
Foster parent
Foster brother
Foster sister
Father
Son
Brother
Brother-in-law
Stepbrother
Father-in-law
Son-in-law
Nephew
Grandson
Granddaughter
Grandfather
Grandmother
Stepmother
Stepfather
Stepson
Stepdaughter
Uncle
Aunt
DECLARATION OF VALUE STATEMENT:
Line 1. Total Amount Paid: Enter the entire and full purchase price of the property transferred, including
down payment.
Note: Reporting of personal property should conform to the transfer document and any related income tax
filings.
Line 2. Amount Paid for Personal Property: Enter the amount of the purchase price that was paid for
personal property. For residential sales, personal property includes items that are not attached (“built in”) to
the home that are normally removed by the owner, when he or she vacates. This includes, but is not limited
to, items such as washers, dryers, drapes, stoves, refrigerators, and portable dishwashers. Personal
property for commercial or industrial sales includes inventories, as well as equipment and fixtures classified
and assessed as personal property. Reporting of personal property should conform to the transfer document
and any related income tax filings.
Line 3. Amount Paid for Real Property Only: Subtract Line 2 from Line 1 and enter the difference here.
Real Estate Transfer Declaration of Value Instructions, Page 2
Effective on or before 07/01/16 Page 2 57-011b (03/15/16)
IMPORTANT: If this transaction is exempt from the transfer tax, you may not be required to complete
this form. Exemption numbers 1, 6, 14, or 15 require a Declaration of Value form to be completed.
Exceptions Iowa Code 428A.2
1. (DOV required) Any executory contract for the
sale of land under which the vendee is entitled to
or does take possession thereof, or any
assignment or cancellation thereof.
2. Any instrument of mortgage, assignment,
extension, partial release, or satisfaction thereof.
3. Any will.
4. Any plat.
5. Any lease.
6. (DOV required for federal agency or
instrumentality) Any deed, instrument, or writing
in which the United States or any agency or
instrumentality thereof or the state of Iowa or any
agency, instrumentality, or governmental or
political subdivision thereof is the grantor,
assignor, transferor, or conveyor; and any deed,
instrument or writing in which any of such unit of
government is the grantee or assignee where
there is no consideration.
7. Deeds for cemetery lots.
8. Deeds which secure a debt or other obligation,
except those included in the sale of real property.
9. Deeds for the release of a security interest in
property excepting those pertaining to the sale of
real estate.
10. Deeds which, without additional consideration,
confirm, correct, modify or supplement a deed
previously recorded.
11. Deeds between husband and wife, or parent
and child, without actual consideration. A
cancellation of indebtedness alone which is
secured by the property being transferred and
which is not greater than the fair market value of
the property being transferred is not actual
consideration within the meaning of this
subsection.
12. Tax deeds.
13. Deeds of partition where the interest conveyed
is without consideration. However, if any of the
parties take shares greater in value than their
undivided interest a tax is due on the greater
values, computed at the rate set out in section
428A.1.
14. (DOV required)The making or delivering of
instruments of transfer resulting from a corporate
merger, consolidation, or reorganization or a
merger, consolidation, or reorganization of a limited
liability company under the laws of the United States
or any state thereof, where such instrument states
such fact on the face thereof.
15. (DOV required) Deeds between a family
corporation, partnership, limited partnership, limited
liability partnership, or limited liability company and its
stockholders, partners, or members for the purpose of
transferring real property in an incorporation or
corporate dissolution or the organization or dissolution
of a partnership, limited partnership, limited liability
partnership, or limited liability company under the
laws of this state, where the deeds are given for no
actual consideration other than for shares or for debt
securities of the corporation, partnership, limited
partnership, limited liability partnership, or limited
liability company. For purposes of this subsection, a
family corporation, partnership, limited partnership,
limited liability partnership, or limited liability company
is a corporation, partnership, limited partnership,
limited liability partnership, or limited liability company
where the majority of the voting stock of the
corporation, or of the ownership shares of the
partnership, limited partnership, limited liability
partnership, or limited liability company is held by and
the majority of the stockholders, partners, or members
are persons related to each other as spouse, parent,
grandparent, lineal ascendants of grandparents or
their spouses and other lineal descendants of the
grandparents or their spouses, or persons acting in a
fiduciary capacity for persons so related and where all
of its stockholders, partners, or members are natural
persons or persons acting in a fiduciary capacity for
the benefit of natural persons.
16. Deeds for the transfer of property or the transfer of
an interest in property when the deed is executed
between former spouses pursuant to a decree of
dissolution of marriage.
17. Deeds transferring easements.
18. Deeds giving back real property to lienholders in
lieu of forfeitures or foreclosures.
19. Deeds executed by public officials in the
performance of their official duties.
20. Deeds transferring distributions of assets to heirs
at law or devisees under a will.
21. Deeds in which the consideration is five hundred
dollars or less.