DTE 101
Rev. 6/16
STATEMENT OF CONVEYANCE HOMESTEAD PROPERTY
To be attached to Conveyance Fee Forms, DTE 100, 100(EX), 100M & 100M(EX)
Grantor’s (Seller’s) Name _______________________________________________________
Grantor’s Address _____________________________________________________________
Grantee’s (Buyer’s) Name _______________________________________________________
Taxing District _________________________________
Parcel, Account or Registration No. _______________________________________________
The grantor and the grantee have considered and accounted for the total estimated amount of
such reduction(s) to the satisfaction of both the grantee and the grantor.
___________________________________
Signature of Grantor or Representative
Sworn to or affirmed in my presence,
this _____ day of ___________________________ ________ (year).
___________________________________
Notary Public
Endorsement by County Auditor:
Upon presentation of this instrument, the County Auditor shall indorse it, return it to the grantee
or his representative, and provide a copy of the indorsed instrument to the grantor or his
representative, evidencing delivery to the County Auditor.
County Auditor: ___________________________________
Date: ___________________________________
Complete This Section Only If Real Estate Is Transferred
The grantor of the property referred to above states that the property has or will receive the senior
citizen, disabled persons, or surviving spouse homestead exemption under Ohio Revised Code
section 323.152(A) for the preceding or current tax year. The estimated amount of such reduction
that will be reflected in the grantee’s taxes is:
Preceding Tax Year $_________________ Current Tax Year $_________________
Complete This Section Only If Manufactured or Mobile Home Is Transferred
The grantor of the manufactured or mobile home referred to above states that the home received the
senior citizen, disabled persons or surviving spouse homestead exemption under Ohio Revised Code
section 4503.065 for the current tax year. The estimated amount of such reduction that will be
reflected in the grantee’s taxes is $_________________
