REV-183 - Realty Transfer Tax Statement of Value

Enter the name, address and telephone number of party
completing this form.
Date of Acceptance
Enter the date the document was
delivered to and accepted by the grantee/lessee.
Enter the full names and addresses of all grantor(s)/lessor(s)
and all grantee(s)/lessee(s). Attach additional sheets if
This section identifies the real estate to be transferred. Com-
plete fully, including the tax parcel number where applicable
and the county where the statement is to be filed.
Indicate by checking YES or NO, whether the document rep-
resents two or more transactions accomplished by an assign-
ment of the agreement of sale or by the use of a relocation
arrangement. Complete for all transactions:
1. Actual Cash Consideration – Enter the amount of cash
or cash equivalent that the grantor received for the
transfer of the real estate.
2. Other Consideration – Enter the total amount of non-
cash consideration that the grantor received for the
transfer of the real estate, such as property and securi-
ties. Include mortgages and liens existing before the
transfer and not removed thereby, and the agreed con-
sideration for the construction of improvements.
3. Total Consideration – Enter the sum of Lines 1 and 2.
This will be the total consideration for the purchase of the
real estate.
4. County Assessed Value - Enter the actual assessed
value of the entire real estate, per records of the county
assessment office. Do not reduce the assessed value by
the grantors fractional interest in the real estate.
5. Common Level Ratio Factor – Enter the common level
ratio factor for the county in which the real estate is
located. An explanation of this factor is provided below.
6. Computed Value – Enter the product of Lines 4 and 5.
Complete only for transactions claiming an exemption. For
exemptions refer to Title 61 §91.193 of the Pennsylvania Code.
1a. Amount of Exemption Claimed – Enter the dollar
amount of the value claimed as exempt.
1b. Percentage of Grantor’s Interest in Real Estate
Enter the percentage of grantors ownership interest in
the real estate listed in Part C.
1c. Percentage of Grantor’s Interest Conveyed Enter
the fraction or percentage of grantor’s interest in the real
estate on Line 1b that the grantor conveyed to the
grantee. For example, if you indicated on Line 1b that
grantor owns a 50 percent tenant-in-common interest in
the real estate and grantor is conveying his entire 50
percent interest to the grantee, then you would enter
100 percent on this line.
2. Check Appropriate Box for Exemption Claimed -
Boxes are provided for the most common Pennsylvania
realty exemptions. Each is explained in order of appear-
ance on the Realty Transfer Statement of Value form.
Will or Intestate Succession – A transfer by will for no or
nominal consideration, or under the intestate succession
laws, is exempt from tax. Provide the name of the decedent
and estate file number in the space provided.
Transfer to a Trust – A transfer for no or nominal consid-
eration to a trust is exempt from tax when the transfer of the
same property would be exempt from tax if the transfer were
made directly by the grantor to all the possible (including
contingent) beneficiaries. Attach a complete copy of the trust
agreement and identify the grantors relationship to each
Transfer from a Trust – Enter the date the real estate was
conveyed to the trust by the prior deed. If the trust was
amended after that date, attach a complete copy of the orig-
inal trust and all amendments to the trust.
Transfer Between Principal and Agent/Straw Party –A
transfer between an agent/straw party and principal for no or
nominal consideration is exempt. Attach a complete copy of
the agency/straw party agreement.
Transfer to the Commonwealth, the U.S. and Instru-
mentalities by Gift, Dedication, Condemnation or in
Lieu of Condemnation – If the transfer is by condemnation
or in lieu of condemnation, attach a copy of the resolution.
Transfer from Mortgagor to Holder of a Mortgage in
Default – A transfer from a mortgagor to a holder of a mort-
gage in default, whether pursuant to a foreclosure or in lieu
thereof, is exempt. Provide a copy of the mortgage and note,
and any documentation evidencing the assignment thereof.
Corrective or Confirmatory Deed – A deed for no or nom-
inal consideration that corrects or confirms a previously
recorded deed but does not extend or limit the title or inter-
est under the prior deed is exempt from tax. Attach a com-
plete copy of the prior deed being corrected or confirmed.
Statutory Corporate Consolidation, Merger or Division
A document that evidences the transfer of real estate pur-
suant to the statutory consolidation or merger of two or more
corporations (15 Pa. C.S. §1921-1932 or 15 Pa. C.S. §5921-
5930) – or the statutory division of a nonprofit corporation
(15 Pa. C.S. §5951-5957) – is exempt from tax. Attach a
copy of the articles of consolidation, merger or division.
Other When claiming an exemption other than those list-
ed, you must specify what exemption is claimed. When pos-
sible, provide the applicable statutory and regulatory
citation. Attach additional pages, if necessary. Attach a copy
of supporting documentation.
This is a property valuation factor provided by the PA Depart-
ment of Revenue by which the county assessed value is mul-
tiplied to determine the taxable value of real estate for all
non-arm’s-length transactions, leases and acquired compa-
nies. The factor is based on the common level ratio estab-
lished by the State Tax Equalization Board. The common
level ratio is a ratio of assessed values to current fair market
values as reflected by actual sales of real estate in each
county. A statewide list of the factors is available at the
Recorder of Deeds’ office in each county and on the depart-
ment’s website at
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