New Hampshire real estate transfer tax form for a $1.07 million sale, Dec 2019

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

1070751. 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¶

Page 2 of 3¶

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¶

Page 3 of 3¶