City of Harvey Real Estate Transfer Declaration & Application (with Certificate for Exemption) Instructions

Enter the total number of apartment units in the building. Fill only if 'Apartment Building' is 'Yes'.

Check this box if the buyer is submitting the application.

Check this box if the seller is submitting the application.

Check this box if you are applying for an Exempt Transfer Stamp for a transfer with $0.00 to $1,000.00 monetary exchange.

Check this box if you are applying for a Full Consideration Transfer Stamp for a transfer with monetary exchange over $1,000.00.

Enter the name of the person who approved this document.

Enter the full name of the person making this certificate statement (declarant).

Enter the name of the party transferring the property as shown on the deed.

Enter the name of the party receiving the property as shown on the deed.

Enter the date the deed is dated.

Enter the date shown on the deed for the property transfer.

Enter the type of deed being used for the transfer (e.g., warranty deed, quit claim deed).

Check this box if the deed transfers property to/from a governmental body (including between governmental bodies) or to/from an organization operated exclusively for charitable, religious, or educational purposes.

Check this box if the deed is given to secure a debt or other obligation.

Check this box if the deed confirms, corrects, modifies, or supplements a previously recorded deed and there is no additional consideration.

Check this box if the actual consideration for the deed is less than $100.

Check this box if the document is a tax deed.

Check this box if the deed releases property that served as security for a debt or other obligation.

Check this box if the deed is a deed of partition.

Check this box if the deed is made pursuant to a merger, consolidation, or transfer/sale of substantially all corporate assets under a plan of reorganization.

Check this box if a subsidiary corporation deeds property to its parent corporation for no consideration other than cancellation or surrender of the subsidiary’s stock.

Check this box if the deed involves an actual exchange of real estate (noting that any money difference paid from one party to the other is not exempt).

Check this box if the transfer is subject to a documentary stamp tax imposed by the U.S. government (even though the declaration must still be filed).

Enter a detailed explanation describing why the deed or transfer qualifies for the selected exemption from the City of Harvey real estate transfer tax. Fill only if 'a) Governmental or charitable/religious/educational deed', 'b) Deed securing debt or other obligation', 'c) Confirm/correct/modify/supplement prior recorded deed (no additional consideration)', 'd) Consideration less than $100', 'e) Tax deed', 'f) Release of property securing a debt/obligation', 'g) Deed of partition', 'h) Merger/consolidation/reorganization transfer of substantially all assets', 'i) Subsidiary-to-parent deed (no consideration other than stock cancellation/surrender)', 'j) Exchange of real estate (cash difference not exempt)', 'k) Transfer subject to U.S. documentary stamp tax' is selected (any).

Enter the full actual consideration (purchase price/total consideration) for the property transfer as shown on Line 11 of the IL PTAX-203 form.

Enter the full legal name of the grantee/buyer.

Enter the grantee/buyer's current street address.

Enter the city, state, and ZIP code for the grantee/buyer's current address.

Enter the grantee/buyer's email address.

Enter the grantee/buyer's telephone number.

Enter the date the grantee/buyer signed the form.

Enter the full legal name of the grantor/seller.

Enter the grantor/seller’s current street address.

Enter the city, state, and ZIP code for the grantor/seller’s address.

Enter the grantor/seller’s email address.

Enter the grantor/seller’s telephone number.

Enter the date the grantor/seller signed this declaration.

Check this box if the property’s intended primary use is commercial.

Check this box if the property’s intended primary use is as an apartment building.

Check this box if the property’s intended primary use is residential.

Check this box if the seller wants to keep water service active until the scheduled closing date.

Check this box if the seller does not want to keep water service active until the scheduled closing date.

Check this box if the property will be occupied by the owner.

Check this box if the property will not be occupied by the owner.

Check this box if the petitioner is the seller and has made the buyer aware that water service must be established in the buyer’s name within 30 days after the transfer stamp is issued (or within 30 days of issuance if closing is delayed) to avoid disconnection.

Enter the street number for the property address.

Enter the street name for the property address.

Enter the first line of the property’s street address (e.g., house number and street name).

Enter any additional property address information, such as apartment, suite, unit, or floor.

Enter the permanent property index number (PIN) for the property, using a colon to separate multiple PINs if applicable.

Enter the date the property closing is scheduled to occur.

Enter the date on which the form is signed.

Enter the total full consideration (sale/transfer price) amount used to calculate the City of Harvey transfer tax.

Enter the result of dividing the full consideration price by 1,000 (the number of $1,000 units to be taxed).

Enter the calculated transfer tax due after multiplying the quotient by $5.00.