Real Property Conveyance Fee - 1315 E 114th St, Cleveland, OH 44106.pdf

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Real Property Conveyance Fee
Statement of Value and Receipt

If exempt by Ohio Revised Code section 319.54(G)(3), use form DTE 100(EX).
TYPE OR PRINT ALL INFORMATION.

Type instrument Tax list year County number 18 Tax. dist. number Date

Property located in taxing district
Name on tax duplicate Tax duplicate year
Acct. or permanent parcel no. 120.04.119 Map book Page
Description Platted Unplatted

Auditor’s comments: Split New plat New improvements Partial value
C.A.U.V Building removed Other

Grantee or Representative Must Complete All Questions in This Section. See Instructions on reverse.

1. Grantor’s name Phone - 419.299.8468
2. Grantee’s name Phone - 419.299.8468
Grantee’s address City State OH Zip 44106
3. Address of property City State OH Zip
4. Tax billing address City State OH Zip

5. Are there buildings on the land? Yes No If yes, check type:
   1, 2 or 3 family dwelling Condominium Apartment: No. of units
   Manufactured (mobile) home Farm buildings Other
If land is vacant, what is intended use?

6. Conditions of sale (check all that apply) Grantor is relative Part interest transfer Land contract
Trade Life estate Leased fee Leasehold Mineral rights reserved Gift
Grantor is mortgagee Other

7. a) New mortgage amount (if any) $___
b) Balance assumed (if any) $___
c) Cash (if any) $92319.51
d) Total consideration (add lines 7a, 7b and 7c) $___
e) Portion, if any, of total consideration paid for items other than real property $___
f) Consideration for real property on which fee is to be paid (7d minus 7e) $___
g) Name of mortgagee ___
h) Type of mortgage Conv. F.H.A. V.A. Other ___
i) If gift, in whole or part, estimated market value of real property $___

8. Has the grantor indicated that this property is entitled to receive the senior citizen, disabled person or surviving spouse homestead exemption for the preceding or current tax year? Yes No If yes, complete form DTE 101.

9. Has the grantor indicated that this property qualified for current agricultural use valuation for the preceding or current tax year? Yes No If yes, complete form DTE 102.

10. Application for owner-occupancy (2.5% on qualified levies) reduction. (Notice: Failure to complete this application prohibits the owner from receiving this reduction until another proper and timely application is filed.) Will this property be grantee’s principal residence by Jan. 1 of next year? Yes No If yes, is the property a multi-unit dwelling? Yes No

I declare under penalties of perjury that this statement has been examined by me and to the best of my knowledge and belief it is a true, correct and complete statement.

Signature of grantee or representative Date 01-06-23

Receipt for Payment of Conveyance Fee

The conveyance fee required by Ohio Revised Code section (R.C.) 319.54(G)(3) and, if applicable, the fee required by R.C. 322. in the total amount of $___ has been paid by ___ and received by the CUYAHOGA county auditor.
County auditor Date