Fillable Form 20370106: Statement of Value and Receipt Real (Stark County Government)

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Form 20370106: Statement of Value and Receipt Real (Stark County Government)

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Number
No. of Parcels
DTE Code No.
Neigh. Code
No. of Acres
Land Value
Bldg. Value
Total Value
DTE Use Only
DTE Use Only
DTE Use Only
Consideration
DTE Use Only
Valid sale
1. Yes 2. No
Real Property Conveyance Fee
Statement of Value and Receipt
If exempt by Ohio Revised Code section 319.54(G)(3), use form DTE 100(EX).
TYPE OR PRINT ALL INFORMATION.
DTE 100
Rev. 5/20
Grantee or Representative Must Complete All Questions in This Section. See instructions on reverse.
1. Grantor’s name Phone
2. Grantee’s name Phone
Grantee’s address
3. Address of property
4. Tax billing address
5. Are there buildings on the land? Yes No If yes, check type:
1, 2 or 3 family dwelling Condominium 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. V.A. Other
i) If gift, in whole or part, estimated market value of real property .......................................... $
8. Has the grantor indicated that this property is entitled to receive the senior citizen, disabled person or surviving spouse
homestead exemption for the preceding or current tax year? Yes No If yes, complete form DTE 101.
9.Hasthegrantorindicatedthatthispropertyqualiedforcurrentagriculturalusevaluationfortheprecedingorcurrent
tax year? Yes No If yes, complete form DTE 102.
10.Applicationforowner-occupancy(2.5%onqualiedlevies)reduction.(Notice: Failure to complete this application prohibits
theownerfromreceivingthisreductionuntilanotherproperandtimelyapplicationisled.)Willthispropertybegrantee’s
principal residence by Jan. 1 of next year? Yes No If yes, is the 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.
Signature of grantee or representative Date
Type
instrument
Tax list
year
County
number
Tax. dist.
number
Date
Receipt for Payment of Conveyance Fee
The conveyance fee required by Ohio Revised Code section (R.C.) 319.54(G)(3) and, if applicable, the fee required by R.C. 322, in the total amount
of $ has been paid by and received by the county auditor.
County auditor Date
Receipt Number
20370106
Property located in taxing district
Name on tax duplicate Tax duplicate year
Acct. or permanent parcel no. Map book Page
Description Platted Unplatted
Auditor’s comments: Split New plat New improvements Partial value
C.A.U.V Building removed Other
0.00
0.00
Instructions to Grantee or Representative for Completing
Real Property Conveyance Fee Statement of Value
Complete lines 1 through 10 in box.
WARNING: All questions must be completed to the best of your knowledge to comply with Ohio Revised Code (R.C.) section 319.202.
Personswillfullyfailingtocomplyorfalsifyinginformationareguiltyofamisdemeanoroftherstdegree(R.C.section319.99(B)).Itis
important that the information on this form be accurate as it will be used to determine whether all real property, including this property, is
uniformly assessed for real property tax purposes.
Note: The county auditor has discretionary power under R.C. section 319.202(A) to request additional information in any form of
documentation deemed necessary to verify the accuracy of the information provided by the grantee on the front of the form.
Line 1
List grantor’s name as shown in the deed or other instrument conveying this real property.
Line 2 List grantee’s name as shown in the deed or other instrument conveying this real property and the grantee’s mailing address.
Line 3 List address of property conveyed by street number and name.
Line 4 List complete name and address to which tax bills are to be sent. CAUTION: Each property owner is responsible for paying the
property taxes on time even if no tax bill is received.
Line 5
If there are no buildings on the land conveyed, check “no.” If there are buildings, check “yes” and the appropriate box that describes
thetypeofbuildings.Ifother,describebrieythetypeofbuildings,suchas“ocebuilding.”
Line 6 Showanyspecialconditionofsalethatwouldaecttheconsideration.Ifanyofthespecialconditionsnotedareinvolved,check
theappropriatebox.Brieydescribeotherconditionsinthespaceprovided.
Line 7 a) Enter amount of new mortgage on this property (if any).
b) Enter amount of the balance assumed on an existing mortgage (if any).
c) Enter cash paid for this property (if any).
d) Add lines 7a, 7b and 7c.
e) If any portion of the consideration reported on line 7d was paid for items other than real property, enter the portion of the
consideration paid for those items.
f) Deductline7efromline7dandenterthedierenceonthisline.
g) List mortgagee or mortgagees (the party who advances the funds for a mortgage loan).
h) Check type of mortgage.
i) In the case of a gift, in whole or part, enter the estimated price that the real estate would bring in the open market.
Line 8 If the grantor has indicated that the property to be conveyed will receive the senior citizen, disabled person or surviving spouse
homestead exemption for a proceeding or current tax year under R.C. section 323.152(A), grantor must complete DTE 101 or
submit a statement that complies with the provisions of R.C. section 319.202(A)(2), and the grantee must submit such form to
the county auditor along with this statement.
Line 9 Ifthegrantorhasindicatedthatthepropertytobeconveyedqualiedforcurrentagriculturalusevaluationfortheprecedingor
current tax year under R.C. section 5713.30, the grantor must complete DTE 102 or a statement that complies with R.C. section
319.202(B)(2), and the grantee must submit such form to the county auditor along with this statement.
Line 10
Completeline10(applicationforowner-occupancyreductiononqualiedlevies)onlyiftheparcelisusedforresidentialpurposes.
Toreceivetheowner-occupancyhomesteadtaxreductiononqualiedleviesfornextyear,youmustownandoccupyyourhome
as your principal place of residence (domicile) on Jan. 1 of that year. A homeowner and spouse may receive this reduction on
only one home in Ohio. Failure to complete this application prohibits the owner from receiving this reduction until another proper
andtimelyapplicationisled.
The real property conveyance fee is payable on the amount of money reported on either item 7f or 7i.
DTE 100
Rev. 5/20
Page 2
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Form 20370106: Statement of Value and Receipt Real (Stark County Government)

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Completed 18 July 2020

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