Fillable Revised - October 17, 2007 (2:03pm) INSTRUCTIONS --- (Teton County Wyoming Government)

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Revised - October 17, 2007 (2:03pm) INSTRUCTIONS --- (Teton County Wyoming Government)

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BROWSE TETON COUNTY WYOMING GOVERNMENT (WY) FORMS

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Revised - October 17, 2007 (2:03pm)
INSTRUCTIONS --- PLEASE READ CAREFULLY BEFORE COMPLETING FORM
PURSUANT TO WYO. STAT. ANN. §§ 34-1-142 THROUGH 34-1-144, NO INSTRUMENT [UNLESS EXEMPT] MAY BE RECORDED
BY THE COUNTY CLERK UNLESS ACCOMPANIED BY A FULLY COMPLETED AND SWORN STATEMENT OF
CONSIDERATION. It is the responsibility of the BUYER (or the BUYER'S AGENT) to fully complete [please print or type] this Statement
of Consideration and, if necessary, retain a copy of the completed form for their records.
PART A - Enter the names of the Seller and Buyer, their phone numbers, the seller’s current address (if known), the buyer's mailing address,
and the legal description and property address (not a post office box) in the space provided. If more room is necessary, please attach one copy
of the deed or legal description. If an agent or responsible party other than the Buyer or Seller was involved in the sale or filling out the form, enter
the agent's name, phone number and mailing address.
PART B - For items 1 through 5, place a check in the one box which best describes the type of property being transferred. If item 2 is checked,
please check one of the additional boxes listed. An improvement under item 5 is defined as a change in the physical characteristics of land such as
landscaping, corrals, or fencing. Please check ALL of the appropriate boxes under item 6 as well.
PART C - If one of the following exemptions applies, submission of a Statement is NOT required by law. HOWEVER, submission of a Statement
completed through Part C, with signature under Part E, may avoid the necessity of the County Assessor contacting Buyer (or Buyer’s Agent) to
confirm applicability of an exemption. If you choose to provide a Statement, please mark YES and circle the appropriate number to indicate which
exemption applies. If no exemption applies, please complete Part D and Part E.
EXEMPTIONS - The following are exempt from the requirements of Wyo. Stat. Ann. § 34-1-142(a):
1. Any instrument which confirms, corrects, modifies or supplements a previously recorded instrument without added
consideration.
2. A transfer pursuant to mergers, consolidations or reorganizations of business entities.
3. A transfer by a subsidiary corporation to its parent corporation without actual consideration, or in sole consideration of the
cancellation, or surrender of a subsidiary stock.
4. A transfer which constitutes a gift of more than one-half (½) of the actual value.
5. A transfer between husband and wife or parent and child with only nominal consideration therefore.
6. An instrument the effect of which is to transfer property to the same party.
7. A sale for delinquent taxes or assessments or a sale or a transfer pursuant to foreclosure.
8. Transfers of mineral interests with no surface estate.
9. Transfers to establish a chain of title, and are related to the most recent deed associated with performance of a contract.
The prior, related deeds are exempt upon the filing of the most current deed accompanied by a statement of consideration.
10. Transfers pursuant to a court decree of distribution from an estate. A statement of consideration is required when the sale
of real property is a part of estate administration.
11. Transfers pursuant to a court order or decree in divorce proceedings.
12. Transfers of cemetery lots.
13. Transfers by certificate of purchase or sheriff’s deed.
PART D
1. Please answer the questions on lines 1 through 3.
2. For items 4a through 4h, please check the one box which best describes the terms of this real estate sale. If box "4h" applies, please
explain on an additional sheet, if necessary, and attach.
3. Please indicate the date the property was first offered for sale on line 5.
4. The following instructions refer to lines 6 and 7.
a. Enter the DOWN PAYMENT for the assumption or loan.
b. Enter the INTEREST RATE for the assumption or loan.
c. Enter the remaining TERM OF LOAN for the assumption or loan.
d. Enter the POINTS PAID BY SELLER. If no points have been paid, enter "0."
PART E
Part E requires the signature of the person completing the form who affirms that the information contained is true and correct to the best of their
knowledge. It is a misdemeanor for a person to willfully falsify or publicly disclose any information on this statement of consideration. Upon
conviction, an offender is subject to a fine of not more than seven hundred fifty dollars ($750.00), imprisonment for not more than six (6)
months, or both. Wyo. Stat. Ann. § 34-1-144.
Revised - October 17, 2007 (2:03pm)
FOR USE BY COUNTY CLERK ONLY
Reception No. _____________________________________
Recorded : Book _____________ Page __________
Date ___/___/___ Time: ____:____
Type of Instrument: __________________________
Clerk's Signature _____________________________
FOR USE BY COUNTY ASSESSOR ONLY
GEOPIN/ACCOUNT #
__________________________________________
GEOPIN/ACCOUNT #
__________________________________________
GEOPIN/ACCOUNT #
__________________________________________
GEOPIN/ACCOUNT #
__________________________________________
VALIDATION/INVALIDATION CODE (circle one):
0 1 2 3 4 5 6 7 8 9 E
Verified with: 1-Buyer 2-Seller 3-Agent 4-SOC
STATEMENT OF CONSIDERATION (CONFIDENTIAL)
County, Wyoming
PART A (County Clerk: Please Review for Complete Information)
Name of SELLER:
Seller's Phone No.: (_____) _______- _______
Seller’s New Address (if known):
Street or Box No.
City
State____________ ZIP_________
-----------------------------------------------------------------------------------
Name of BUYER:
Buyer's Phone No.: (_____) _______ -______ Ext.________
Buyer's Mailing Address:
Street or Box No.
City__________________________________________________
State ____________ ZIP_________
-----------------------------------------------------------------------------------
Legal Description: [Attached legal description if too lengthy]
Subdivision/Addition _____________________________
Block ____________, Lot ________ OR
Township ______, Range _________, Section(s) ___________
-----------------------------------------------------------------------------------
Physical address (not a P.O. Box) of property transferred:
G Same as BUYER above or:
Street or Road____________________________________________
City_________________________________________________
State ____________ZIP_________
-----------------------------------------------------------------------------------
Agent or reporting party (NA if not applicable):
Name:________________________________________________
Street or Box No.:
City_________________________________________________
State ____________________ ZIP
Agent's Phone No.:
(_____) _______ -__________
-----------------------------------------------------------------------------------
Name of Title Company:
Name of Realtor:
PART B - TYPE OF PROPERTY TRANSFERRED
1. Q Land Only.
2. Q Land and Buildings: Q Residential; Q Commercial;
Q Outbuildings; Q Industrial.
3. Q Building Only. 4. Q Land and Mobile Home.
5. Q Land and Improvements other than structures - (landscaping,
fences, corrals, etc)
6. Present on property: a. Q Well; b. Q Septic;
c. Q City Water/Sewer; d. Q Electric e. Q Natural Gas;
f. Q Telephone; g. Q Cistern Available; h. Q None of the above.
---------------------------------------------------------
PART C - Claim exemption? [See Instructions] Yes No
If YES, circle exemption number and go on to Part E.
1 2 3 4 5 6 7 8 9 10 11 12 13
If NO, complete entire form.
Omit Part D if Exemption Claimed
---------------------------------------------------------------------------
-
PART D - Terms of Sale
1. Date sale price agreed / /
2. Total amount paid or to be paid for the property
$ __________________
3. Does the sale include property other than land or
buildings? G Yes G No
If YES give a brief description and how much you paid for
this other property
4. Financing
a. Q Cash e. Q Contract for deed
b. Q Conventional f. Q Assumption
c. Q FHA or VA g. Q Balloon
d. Q WCDA h. Q Other (Explain)
5. Date offered for sale
6. Down Payment $________________
Interest Rate ________ %
Terms of Loan________ years
Points Paid by Seller __________%
7. Assumptions or Loan Amount $
PART E - I swear or affirm under penalty of Wyo. Stat. Ann. § 34-1-144, this form is, to the best of my knowledge and belief, true and
correct.
Date: ______________________ Signature (Buyer or Buyer’s Agent)______________________________________________
✔
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Revised - October 17, 2007 (2:03pm) INSTRUCTIONS --- (Teton County Wyoming Government)

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Completed 14 February 2021

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