XXX
XXX
XXX
XXX
XXX
XXX
XX
XX
XX
XX
XX
XXX
XX
XX
XXX
REALTY TRANSFER CERTIFICATE
Condential Tax Document: The information contained
in this certicate is condential by Montana law. Unauthorized
disclosure of this information is a criminal offense.
GEOCODE(S) _________________________________________________
_________________________________________________
_________________________________________________
ASSESSMENT CODE: ___________________________________________
PART 1 – DATE OF TRANSFER (SALE)
The Department of Revenue will change the name on ownership records
used for the assessment and taxation of real property when this form is fully
completed and signed by the preparer. (Please read the attached instructions
on page 1 for assistance in completing and ling this form.)
Montana law requires this form be completed and may impose up to
a $500 penalty for failure to le a Realty Transfer Certicate (15-7-304,
15-7-305 and 15-7-310, MCA)
PART 2 – PARTIES Please complete this section in full; if additional space is required, please attach a separate page
Buyer (Grantee)
Name ________________________________________________________
Mailing Address ________________________________________________________
(Permanent) ________________________________________________________
City _______________________________ ST _____ Zip __________
Buyer Principal Residence __Yes __No
Mailing Address ________________________________________________________
For Tax Notice ________________________________________________________
(If different) City _______________________________ ST _____ Zip __________
PART 3 – PROPERTY DESCRIPTION Please complete fully; if additional space is required, please attach a separate page.
PART 4 – DESCRIPTION OF TRANSFER Please complete fully, more than one may apply.
q Sale q Gift q Barter q Nominal or no consideration q Part of 1031 or 1033 exchange
q Transfer is subject to a reserved life estate
Transfer by Operation of Law
q Termination of joint tenancy by
death
q Termination of life estate by
death
q Court order or decree
(except sheriff’s sale)
q Merger, consolidation, or other
business entity reorganization
PART 5 – EXCEPTIONS FROM PROVIDING SALES PRICE INFORMATION Please complete fully, more than one may apply.
PART 6 – SALE PRICE INFORMATION Please complete fully, more than one may apply.
Actual Sale Price $ ________________________
Financing: __Cash __FHA __VA __Contract __Other
Terms: __New loan OR __Assumption of existing loan
Value of personal property included in sale $ _____________
Value of inventory included in sale $ ________________
Value of licenses included in sale $ ________________
Value of good will included in sale $ ________________
Was an SID payoff included in the sale price? ____Yes ____No
Did the buyer assume an SID? ____ Yes ____ No
Amount of SID paid or assumed: $ _______________
Was a mobile home included in the sale? ____ Yes ____ No
PART 7 – WATER RIGHT DISCLOSURE Disclosure is only applicable to the property identied in PART 3 above.
q A. Property is served by a public water
supply, i.e., city, irrigation district, or
water district provides water.
q B. Seller has no water
rights on record with
DNRC to transfer.
q C. Seller is transferring ALL
water rights on record
with DNRC to the Buyer.
q D. Seller is dividing or exempting
(reserving) water rights. Seller
must le Water Right Update form.
X Seller (Grantor) Signature _______________________________________________ Date _______________________________
PART 8 – PREPARER INFORMATION Preparer’s signature is required.
X Signature ____________________________________________ Mailing Address __________________________________________
Name/Title _____________________________________________________ City _____________________State ___________Zip _____________
Daytime Phone ___________________________________________
Clerk and Recorder Use Only
Recording Information: Document No. ________________ Book _______________ Page____________________Date ___________________
Legal Description _______________________________________________________________________________ Attachment
q
_______________________________________________________________________________
Add/Sub _________________________________________________ Block __________________ Lot _____________________
County __________________________________ City/Town __________________________ Section _______ Township _______ Range ________
Seller (Grantor)
Name ________________________________________________________
Mailing Address ________________________________________________________
(Permanent) ________________________________________________________
City _______________________________ ST _____ Zip __________
Seller Principal Residence __Yes __No
____________________________(MM/DD/YYYY)
Main Geocode _______________________________
Assessor Code or Parcel # _____________________
/ / / / / /
Distressed sales:
q Sheriff’s deed q Trustee’s deed q Deed in lieu of foreclosure q Short sale q Other
q Beneciary deed
q Transfer between husband/wife or parent/child for nominal consideration
q Termination of joint tenancy by death
q Transfer to a revocable living trust
q Gift
q Correction, modication, or supplement of previously recorded
instrument, no additional consideration
q Merger, consolidation or reorganization of business entity
q Land currently classied as agricultural land and for continued use for
agricultural purposes (15-7-307, MCA)
q Transfer in contemplation of death without consideration
q Transfer of property of the estate of a decedent
q Transfer pursuant to court decree (except sheriff’s sale)
q Termination of life estate by death
q Transfer by government agency
q Tax deed
q Land currently classied as forestland and for continued use for
producing timber (15-7-307, MCA)
(please print)
Page 3
Department of Revenue Copy
SSN ________ - ______ - ____________
SSN ________ - ______ - ____________
FEIN _______- ______________________
Daytime Phone ______________________
Email Address _______________________
SSN ________ - ______ - ____________
SSN ________ - ______ - ____________
FEIN _______- ______________________
Daytime Phone ______________________
Email Address _______________________
Transfer to Trustee, Custodian, or other
Representative:
Trust FEIN ______ - __________________
Minor SSN ________- _____ - __________
Enter the last 4 digits of the SSN or FEIN