REV-1728 - Realty Transfer Tax Declaration of Acquisition
A. CORRESPONDENT – All inquiries may be directed to the following person:
Name Telephone Number
Street Address City State Zip Code
B. TRANSFER DATA
1. Company Name Employer Identification Number (EIN)
Street Address City State Zip Code
2. Date on which the company became an acquired company: 3. County in which this Declaration of Acquisition is being recorded:
4. List all other counties in which a Declaration of Acquisition must be recorded:
C. PROPERTY LOCATION D. PROPERTY VALUATION
REV-1728 EX (8-04)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
PO BOX 280603
HARRISBURG, PA 17128-0603
RECORDER’S USE ONLY
State Tax Paid
Book Number
Page Number
Date Recorded
REALTY TRANSFER TAX
DECLARATION OF ACQUISITION
See Reverse for Instructions
(Must be filed in Duplicate)
A Corporation or Association that qualifies as a “Real Estate Company” must file a Declaration of Acquisition form within thirty (30) days after becom-
ing an “Acquired Company” as defined in 72 P.S. §8102-C.5 in every county in which the corporation or association owns real estate.
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School District Political Subdivision Tax Parcel Number
1. County Assessed
Value
2. Common Level
Ratio Factor
4. Total Fair
Market Value
3. Fair Market Value
Under penalties of law, I declare that I have examined this Declaration, including accompanying information, and to the best
of my knowledge and belief, it is true, correct and complete.
Signature of Correspondent or Responsible Party Date
▼ RECORDER’S USE ONLY ▼
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