Fillable DTT AFFIDAVIT County of San Mateo TRANSFER TAX (San Mateo County Law Library)

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DTT AFFIDAVIT County of San Mateo TRANSFER TAX (San Mateo County Law Library)

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County of San Mateo
TRANSFER TAX AFFIDAVIT
NOTICE: Any material misrepresentation of fact in
this affidavit is a misdemeanor under section
2.93.120 of the San Mateo County real property tax
code. Any person who makes such a representation
is subject to prosecution for such offense.
The Assessor-Clerk-Recorder reserves the right to
report potentially fraudulent recordings to the
District Attorney’s Real Estate Fraud Unit.
Per San Mateo County Ordinance Code 2.93.050
DTT AFFIDAVIT
This form must accompany any document that
requires a Documentary Transfer Tax
declaration, including but not limited to;
Agreement for Sale; Assignment of Lease;
Deed in Lieu of Foreclosure; Easement; Grant
Deed; Land Contract; Lease; Memorandum of
Lease;
— —
1. LOCATION OF PROPERTY: Assessor’s Parcel Number: City:
Street Address: Document To Be Recorded:
2. IS THIS A FORECLOSURE OR TRUSTEE SALE?
□ Yes □ No (If yes, complete this section.)
□ Yes □ No
a. Is the transferee the Beneficiary or Mortgagee?
□ Yes □ No
b. Please provide. Name of Trustee:
Date of original Deed of Trust:
3. IS THIS A LEASE?
□ Yes □ No (If yes or no, complete this section.)
a. Is remaining term of lease, including renewal options, greater than 35 years?
b. If NO, submit a copy of the lease, or summary, or terms.
c. If YES, enter the value of the lease interest on line 9a. (For tax calculations.)
4.
IS
THIS A GIFT IN WHOLE OR IN PART?
□ Yes □ No (If yes, give a complete explanation.)
Name of the Donor:
Name of the Donee:
Please be aware that certain gifts in excess of $15,000 per calendar year may trigger a Federal Gift Tax. In such
cases, the Transferor/Donor may be required to fill out a Form 709 (Federal Gift Tax Return) with the Internal
Revenue Service. Please also be aware that the information stated on this document may be given to and used by
governmental agencies, including the Internal Revenue Service.
I, as the Transferor/Donor declare under penalty of perjury that I have read the above paragraph and
acknowledge that a Federal Gift Tax may be triggered.
5. ARE YOU ADDING OR REMOVING A CO-OWNER FOR REFINANCING PURPOSES?
□ Yes □ No
If yes, initial to the right to indicate your agreement with the statement below and sign on reverse.
Initial here:
The proportional ownership interest will revert back to its original holding within one (1) month from the date of
recording; otherwise I will pay the applicable transfer tax.
THIS DOCUMENT IS NOT SUBJECT TO PUBLIC INSPECTION.
Page 1 of 2
Continued on Reverse

( )
SIGNATURE ON REVERSE STILL REQUIRED.
Signature of Donor: Print Donor Name:
Donor Phone:
TRANSFER TAX AFFIDAVIT, pg. 2
Entity ownership documentation is required if you are a:
Corporation—A copy of the Articles of Incorporation amendments and any other documents showing the
shares issued and share ownership; or
LLC—A copy of the Operating Agreement, amendments, and any other documentation showing the partners
and ownership \percentage; or
Partnership— A copy of the Partner Agreement, amendments and any other documents showing the part-
ners and ownership percentage.
For all legal entities, provide the names of individuals and specific percentages held by each individual prior to and following the transfer.
6. ARE YOU MOVING TITLE INTO OR OUT OF A TRUST?
□ Yes □ No / □ Into □ Out of
e. If this transaction changes who is on title or the proportional interest of how title is held, further explanation is required and may
require additional time to review.
b. Date of Trust:
c.
Name of Trustor(s):
d. Name(s) of Currently Active Trustee(s):
a.
Name of Trust:
Attach additional page(s) if necessary.
7. DO YOU CONTEND THAT NO TRANSFER TAX IS DUE FOR A REASON NOT EXPLAINED IN #1-6?
a. The nature of the transaction is:
b. The reason (exemption) you claim no tax is due:
□ Yes □ No
(If yes, give a complete explanation.)
8. IS THIS A TRANSFER BETWEEN LEGAL ENTITIES?
IF YES, TRANSFERS INVOLVING LEGAL ENTITIES MUST PR0VIDE, PREFERRABLY ONE (1) WEEK IN ADVANCE
, APPLICABLE DOCU-
MENTATION. SOME EXAMPLES ARE LISTED BELOW. THIS TYPE OF TRANSACTION WILL REQUIRE 1-3 BUSINESS DAYS TO REVIEW.
9. TAXABLE TRANSACTIONS: Complete the following and calculate the tax below. Tax is calculated as $0.55 per $500 of line 9D.
Example, $100,000 value/$500 increments = 200. 200 increments x
$0.55 = $110 in tax due. You ma
y also use $1.10
A) Consideration paid or value. $
B) □ Full cash value. □ Less liens.
C) If less liens, loan amount assumed.
$
D) Total consideration or value less liens. (Line A minus line C.)
$
E) Tax due.
$
I DECLARE OR AFFIRM UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT.
Are you the □ Transferee, □ Transferor, □ Both, or □ Representative with full knowledge of foregoing. Signature still required.
Signature of Transferor:

( )
Phone Number of Transferee:
Signature of Transferee: Print Name:
Page 2 of 2
REC-SMC-012011-REV_3 (10/2016)
Address of Transferee:
Address of Transferor:
Print Name

Place of Execution: (City
, County, State where executed.)
( )
Phone Number of Transferor:
Date of Execution
/ □ Revocable □ Irrevocable
□ Yes □ No
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DTT AFFIDAVIT County of San Mateo TRANSFER TAX (San Mateo County Law Library)

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Completed 15 December 2020

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