PTA-Knight.pdf

Page 1

Michigan Department of Treasury 

- 

2766 (Rev. 05-16) 

L-4260 

P roperty Transfer Affidavit 

This form is issued under authority of P.A. 415 of 1994. Filing is mandatory. 

This form must be filed whenever real estate or some types of personal property are transferred (even if you are not recording a deed). The completed 

Affidavit must be filed by the new owner 

with the assessor for the city or township where the property is located within 45 days of the transfer. 

The information on this form is NOT CONFIDENTIAL. 

1. Street Address of Property 

2. County 

3. Dateyof Transfer (or land contract signed) 

1762 54TH ST 

ALLEGAN 

eel 

30 Jo 

4. Location of Real Estate (Check appropriate field and enter name in the space below.) 

5. Purchase Price of Real Estate 

oiy 

[X] Township 

[[] vitage 

F 95 000 

8. Seller's (Traneferor) Name 

9. Buyer's (Transferee) Telephone Number 

269. 223. 42 Hp 

Items 10 - 15 are optional, However, by completing them you may avoid further correspondsiice. 

10. Type of Transfer. Transfers include, but are not limited to, deeds, land contracts, transfers involving trusts or wills, certain long-term leases and business interest. See 

03-04-021-001-10 

[ 

list. 

Land Contract 

Od Lease 

O Deed 

O Other (specify) 

11. Was property purchased from a finan 

stitution? | 12. Is the transfer between related persons? 

13. Amount of Down Payment 

[Jes 

o 

[J ves 

[Ho 

3 4, oo® 

14. If you financed the purchase, did you pay market rate of interest? 

“5. Amount Financed (Borrowed) 

O Yes 

O No 

EXEMPTIONS 

Certain types of transfers are exempt from uncapping. If you believe this transfer is exempt, indicate below the type of exemption you are claiming. 

If 

you claim an exemption, your assessor may request more information to support your claim. 

Transfer from one spouse to the other spouse 

= Change in ownership solely to exclude or include a spouse 

O Transfer between certain family members *(see page 2) 

El] Transfer of that portion of a property subject to a life lease or life estate (until the life lease or life estate expires) 

O Transfer between certain family members of that portion of a property after the expiration or termination of a life estate or life lease retained 

by transferor ** (see page 2) 

O Transfer to effect the foreclosure or forfeiture of real property 

1] Transfer by redemption from a tax sale 

O Transfer into a trust where the settlor or the settlor’s spouse conveys property to the trust and is also the sole beneficiary of the trust 

OJ Transfer resulting from a court order unless the order specifies a monetary payment 

J Transfer creating or ending a joint tenancy if at least one person is an original owner of the property (or his/her spouse) 

=| Transfer to establish or release a security interest (collateral) 

OJ Transfer of real estate through normal public trading of stock 

| Transfer between entities under common control or among members of an affiliated group 

B Transfer resulting from transactions that qualify as a tax-free reorganization under Section 368 of the Internal Revenue Code. 

J Transfer of qualified agricultural property when the property remains qualified agricultural property and affidavit has been filed. 

J Transfer of qualified forest property when the property remains qualified forest property and affidavit has been filed. 

O Transfer of land with qualified conservation easement (land only - not improvements) 

O Other, specify: 

CLYDE 

PATRICK O KELLY 

7. Property Identification Number (PIN). If you don't have a PIN, attach legal description. 

8. Buyer's (Transferee) Name and Mailing Address 

BIN, This number ranges from 10 to 25 digits. 

It usually includes hyphens and sometimes includes 

t7¢ Sh SY AN F 

letters. 

It is on the property tax bill and on the assessment notice. 

Mare) Cmahd 

Fenn le, pr 48% 

CERTIFICATION 

| certify that the information above is true and complete to the best of my knowledge. 

i 

er L108 Rais wif 

Name and title, if signer is other than the owner 

Daytime Phone Number 

E-mail Address