Confidential Document
This form provides essential market information to the county assessor to ensure accurate, fair and
uniform assessments for all property. This document is not recorded, is kept confidential, and is not
available for public inspection.
This declaration must be completed and signed by either the grantor (seller) or grantee (buyer).
Questions 1, 2, 3, and 4 may be completed (prefilled) by a third party, such as a title company or closing
agent, familiar with details of the transaction. The signatory should confirm accuracy before signing.
This form is required when conveyance documents are presented for recording. If this form is not
completed and submitted, the county assessor may send notice. If the completed and signed form is not
returned to the assessor within 30 days of notice, the assessor may impose a penalty of $25.00 or 0.025%
(0.00025) of the sale price, whichever is greater.
Additional information as to the purpose, requirements, and level of confidentiality regarding this form
are outlined in Colorado Revised Statutes, sections 39-14-102, 39-5-121.5, and 39-13-102.
1. Physical Address and/or legal description of the real property sold: Please do not use P.O. Box numbers.
2. Type of property purchased:  Single Family Residential  Townhome  Condominium  Multi-Unit Residential
 Commercial  Industrial  Agricultural  Mixed Use  Vacant Land  Other
Date of closing: mm/dd/yyyy
Date of contract: mm/dd/yyyy
4. $
Total Sale Price: include all real and personal property
Contracted price (if different from final sale price)
List any personal property included in the transaction that materially impacts the total sale price.
Personal property may include, but is not limited to: machinery or equipment, vehicles, exceptional appliances, electronic
devices, furniture, or anything that would not typically transfer with the real property (attach additional pages if necessary).
Description Approximate Value
Personal Property Total:
If no personal property is listed, the entire purchase price will be assumed to be for the real property.
6. Did the total sale price include a trade or exchange of additional real or personal property?  No  Yes
If Yes, approximate value of the goods or services as of the date of closing:
If Yes, does this transaction involve a trade under IRS Code Section 1031?
 No  Yes
7. Was 100% interest in the real property purchased?  No  Yes
Mark "No" if only a partial interest is being purchased.
If No, interest purchased %
Is this a transaction between related parties or acquaintances? This includes persons connected by blood or marriage, or
business affiliates, or those acquainted prior to the transaction.
 No  Yes
Please mark type of sale:
 Builder (new construction)  Public (MLS or Broker Representation)
Private (For Sale By Owner)  Other (describe)
10. Mark any of the following that apply to the condition of the improvements at the time of purchase.
 New  Excellent  Good Average  Fair  Poor  Salvage
11. Type of financing: (mark all that apply)
None (all cash or cash equivalent)
New/Mortgage Lender (government-backed or conventional bank loan)
New/Private Third Party (nonconventional lender, e.g., relative, friend, or acquaintance)
Seller (buyer obtained a mortgage directly from the seller)
Assumed (buyer assumed an existing mortgage)
Combination or Other: Please explain
12. Total amount financed $
13. Terms:
Variable; Starting interest rate
Fixed; Interest rate
Length of tim
Balloon payment?
 No  Yes
If yes, amount
$ Due date
Mark any that apply:
Seller assisted down payments
Seller concessions
Special terms or financing
If marked, please specify terms:
15. Was an independent appraisal obtained in conjunction with this transaction?  No  Yes
For properties OTHER THAN
Residential (Residential is defined as: single family detached, townhomes, apartments and
condominiums), please complete questions 16-18, if applicable.
Did the purchase price include a franchise or license fee?
 No  Yes
If yes, franchise or license fee value $
Did the purchase price involve an installment land contract?
 No  Yes
If yes, date of contract
18. If this is vacant land, was an on-site inspection conducted by the buyer prior to the closing?  No  Yes
Please include any additional information concerning the transaction and price paid that you feel is important:
Signature of Grantee (Buyer)
Date mm/dd/yyyy Printed name of Grantee
Signature of Grantor (Seller)
Date: mm/dd/yyyy Printed name of Grantor
Buyer Mailing Address: Future correspondence (tax bills, property valuations, etc.) regarding this property should be mailed to:
Address (mailing) City State Zip Code
Daytime Phone
Email address
Contact information is kept confidential, for County Assessor and Treasurer use only, to contact buyer with questions regarding
this form, property valuation, or property tax information.
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