PETER ALDANA COUNTY OF RIVERSIDE ASSESSOR-COUNTY CLERK-RECORDER Recorder P.O. Box 751 Riverside, CA 92502-0751 (951) 486-7000 Website: www.riversideacr.com DOCUMENTARY TRANSFER TAX AFFIDAVIT WARNING ANY PERSON WHO MAKES ANY MATERIAL MISREPRESENTATION OF FACT FOR THE PURPOSE OF AVOIDING ALL OR ANY PART OF THE DOCUMENTARY TRANSFER TAX IS GUILTY OF A MISDEMEANOR UNDER SECTION 5 OF ORDINANCE 516 OF THE COUNTY OF RIVERSIDE AND IS SUBJECT TO PROSECUTION FOR SUCH OFFENSE. ASSESSOR'S PARCEL NO. Property Address: -- -- I declare that the documentary transfer tax for this transaction is: $ . If this transaction is exempt from Documentary Transfer Tax, the reason must be identified below. I CLAIM THAT THIS TRANSACTION IS EXEMPT FROM DOCUMENTARY TRANSFER TAX BECAUSE: (The Sections listed below are taken from the Revenue and Taxation Code with the exception of items 9 and 10 which are taken from Riverside County Ordinance 516). Please check one or explain in "Other". 1. 2. 3. 4. 5. 6. 7. ____Section 11911. The consideration or value of the property, exclusive of any liens and encumbrances is $100.00 or less and there is no additional consideration received by the grantor. ____Section 11911. The conveyance transfers to a revocable living trust by the grantor or from a revocable living trust to a beneficiary. ____Section 11921. The conveyance was given to secure a debt. ____Section 11922. The conveyance is to a governmental entity or political subdivision. ____Section 11925. The transfer is between individuals and a legal entity or partnership, or between legal entities and does not change the proportional interests held. ____Section 11926. The conveyance is to a grantee who is the foreclosing beneficiary and the consideration paid by the foreclosing beneficiary does not exceed the unpaid debt. ____Section 11927. The conveyance relates to a dissolution of marriage or legal separation. (A spouse must sign a written recital in order to claim this exemption. This form may be used for that purpose.) *Please be aware that information stated on this document may be given to and used by governmental agencies, including the Internal Revenue Service. Also, certain gifts in excess of the annual Federal gift tax exemption may trigger a Federal Gift Tax. In such cases, the Transferor (donor/grantor) may be required to file Form 709 (Federal Gift Tax Return) with the Internal Revenue Service. 8. ____Section 11930. The conveyance is an inter vivos gift* or a transfer by death. 9. ____Section 8. The easement is not perpetual, permanent, or for life. 10. ____Section 9. The document is a lease for a term of less than (35) years (including written options.) 11. ____Other (Include explanation and legal authority) ________________________________________ ___________________________________________________________________________________________ I DECLARE UNDER PENALTY OF PERJURY THAT THE FOREGOING IS TRUE AND CORRECT. Executed this day of , 20______ at City Signature of Affiant Name of Firm (if applicable) Printed Name of Affiant Address of Affiant (including City, State, and Zip Code) Telephone Number of Affiant (including area code) State . This form is subject to the California Public Records Act (Government Code 6250 et. seq.) For Recorder's Use: Affix PCOR Label Here ACR 521 (Rev. 11/2014) Available in Alternate Formats American LegalNet, Inc. www.FormsWorkFlow.com