EFTA00089292



*0CD57S1518475*




EFTA00089293

New Hampshire
Department of
Revenue Administration

CD-57-S



*0CD57S1528475*


## REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE SELLER (GRANTOR)

STEP 5 - TAX AMOUNT

a) Full price or consideraton for the real estate



b) Divide Line 5(a) by $100



1070750. 00

10707. 50

c) Tax rate per $100 at time of transfer

d) Subtotal of Seller's tax (Minimum of $20 for all considerations $4,000 or less, per RSA 78-B:1)

| 0.75 |

e) Total tax paid to County on behalf of Seller and Purchaser

8031



16062



Are you claiming tax exemption under RSA 78-B:2?

☐ Yes ☒ No

DO NOT file form CD-57-S for transfers specifically exempted from taxation under RSA 78-B:2, except transfers exempted by RSA 78-B:2, IX. Form CD-57-S must be filed for non-contractual transfers although exempted under RSA 78-b:2, IX.

Under penalties of perjury, I declare that I have examined this return and to the best of my belief it is true, correct and complete.

## STEP 6 - TAXPAYER'S SIGNATURE & INFORMATION(Seller's Signature is Required)

MMDDYYYY

Seller 1 Printed Name

12-13-19

Richard Yospin, Trustee of the Richard Yospin Family Trust

Seller 2 Signature

MMDDYYYY

Seller 2 Printed Name

Witness Signature

MMDDYYYY

Witness Printed Name

12-13-19





12132019




CD-57-S
Rev 3.0 06/2017


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EFTA00089294

New Hampshire
Department of
Revenue Administration

CD-57-S

*0C057S1538475*

## REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE SELLER (GRANTOR)

## STEP 7 - PREPARER'S SIGNATURE & INFORMATION (If prepared by someone other than the Seller)







12132019


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