Information provided is for the use of the Clerk’s Office, State Department of Assessments and Taxation, and County Finance Office Only. (Type or Print in Black Ink Only All Copies Must Be Legible) 1 2 3 Type(s) of Instruments ( Check Box if addendum Intake Form is Attached.) Mortgage Lease Unimproved Sale Arms-Length [2] Deed Deed of Trust Conveyance Type Check Box Tax Exemptions (if applicable) Cite or Explain Authority Improved Sale Arms-Length [1] Other _________ _______________ Other _________ _______________ Multiple Accounts Arms-Length [3] Not an ArmsLength Sale [9] Recordation State Transfer County Transfer 4 Consideration Amount Space Reserved for Circuit Court Clerk Recording Validation State of Maryland Land Instrument Intake Sheet Baltimore City County: Finance Office Use Only Transfer and Recordation Tax Consideration Purchase Price/Consideration Any New Mortgage $ Transfer Tax Consideration $ Balance of Existing Mortgage Other: $ $ Other: $ Full Cash Value: Consideration and Tax Calculations $ $ X( )% = Less Exemption Amount Total Transfer Tax = Recordation Tax Consideration X( ) per $500 = TOTAL DUE $ $ $ $ $ $ 5 Amount of Fees Doc. 1 $ Surcharge $ $ State Recordation Tax Fees $ $ $ State Transfer Tax $ $ $ Other $ Tax Bill: $ $ Other Description of Property SDAT requires submission of all applicable information. A maximum of 40 characters will be indexed in accordance with the priority cited in Real Property Article Section 3-104(g)(3)(i). $ County Transfer Tax 6 Agent: Doc. 2 Recording Charge $ District Property Tax ID No. (1) Grantor Liber/Folio Subdivision Name C.B. Credit: Ag. Tax/Other: Map Lot (3a) Block (3b) Parcel No. Sect/AR (3c) Var. LOG (5) SqFt/Acreage (4) Plat Ref. Location/Address of Property Being Conveyed (2) Other Property Identifiers (if applicable) Residential or Non-Residential Partial Conveyance? Yes No Water Meter Account No. Fee Simple or Ground Rent Amount: Description/Amt. of SqFt/Acreage Transferred: If Partial Conveyance, List Improvements Conveyed: 7 Doc. 1 – Grantor(s) Name(s) Doc. 1 – Owner(s) of Record, if Different from Grantor(s) Doc. 2 – Owner(s) of Record, if Different from Grantor(s) Doc. 1 – Grantee(s) Name(s) Transferred From Doc. 2 – Grantor(s) Name(s) Doc. 2 – Grantee(s) Name(s) 8 Transferred To 10 Doc. 1 – Additional Names to be Indexed (Optional) Other Names to Be Indexed Contact/Mail Information Doc. 2 – Additional Names to be Indexed (Optional) Return to Contact Person Instrument Submitted By or Contact Person Name: Firm Hold for Pickup Address: Phone: ( 11 ) Return Address Provided IMPORTANT: BOTH THE ORIGINAL DEED AND A PHOTCOPY MUST ACCOMPANY EACH TRANSFER Yes No Will the property being conveyed be the grantee’s principal residence? Yes No Does transfer include personal property? If yes, identify: Yes Assessment Information Space Reserved for County Validation 9 New Owner’s (Grantee) Mailing Address No Was property surveyed? If yes, attach copy of survey (if recorded, no copy required). Terminal Verification Transfer Number Year Land Buildings Total 20 Assessment Use Only – Do Not Write Below This Line Agricultural Verification Whole Part Date Received: Deed Reference: 20 Geo. Zoning Use Town Cd. Map Grid Parcel Ex. St. Tran. Process Verification Assigned Property No.: Sub Plat Section Ex. Cd. Block Lot Occ. Cd. REMARKS: Distribution: White – Clerk’s Office Pink – Office of Finance Canary – SDAT Goldenrod – Preparer AOC-CC-300 (5/2007) American LegalNet, Inc. www.FormsWorkflow.com