REAL PROPERTY CERTIFICATE OF VALUE ST LOUIS COUNTY Type or print all information. All questions must be answered by grantee. 1. Grantor: 2. Grantee: 3. DATE ____/____/____ Address of Property: DAILY ____________ Locator(s): 4. 5. 6. Is this newly constructed residential property? Yes Intended use of property? Present use , Renovation . If "Yes", date of occupancy: , New Development Did the transaction transfer title in any of the following ways: A. B. C. D. E. F. G. H. I. J. K. L. M. N. 7. , No / / , Short term Investment To or from any governmental or political agency?............................................................................. For the purpose of correcting a previously recorded deed?.............................................................. For the purpose of releasing security for a debt?.............................................................................. Sale for delinquent taxes?................................................................................................................. Sale of cemetery lot?......................................................................................................................... Transfer of severed mineral interests?............................................................................................... By order of any court?....................................................................................................................... By deed between husband & wife, parent & child, without actual consideration; to or from a family corporation or partnership or trust for no consideration?...................................................... By deed of partition?.......................................................................................................................... By deed made pursuant to merger, consolidation, sale or transfer of the assets of a corporation pursuant to a plan filed with the Missouri Secretary of State?....................................... By executory contract for deed?........................................................................................................ By deed of distribution conveying property to heirs? ........................................................................ By lease or easement?...................................................................................................................... By deed which conveys property held in name of partnership to any partner or partner's spouse?............................................................................................................................................. If any of the above are marked yes, go to item 10. Did this transaction involve any of the following: A. A transaction between relatives or related corporations?................................................................... B. A compulsory transaction in lieu of foreclosure, divorce, court order, condemnation, probate? C. A transaction with one of the following types of deed: Quit Claim Deed, Trustee's Deed, Deed conveying less than full fee simple interest in property?.......................................................... - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes - Yes If a, b, or c was answered yes, explain: 8. 9. 10. Full consideration, including the amount of all assumed mortgages and liens, excluding personal property: Mortgage(s): $ Cash: $ Total: $ B. If a gift, in whole or part, state the estimated market value of the gift portion: $ Yes , No C. Was a trade of property involved in this transaction? If “Yes” estimate the value and describe the traded property: Estimated Value: $ Describe Property: If you believe this transaction does not represent market value, please attach any additional information that you want the County Assessor to consider. I certify under the penalty of law that this statement has been examined by me and to the best of my knowledge and belief is a true, correct and complete statement. A. DATE SIGNATURE OF GRANTEE OR HIS REPRESENTATIVE PRINT NAME AND POSITION THIS CERTIFICATE TO BE FILED WITH DEED AT TIME OF RECORDING FORM COV1 REV: 12/09 American LegalNet, Inc. www.FormsWorkFlow.com