STATE OF SOUTH CAROLINA ) COUNTY OF LEXINGTON ) AFFIDAVIT FOR TAXABLE OR EXEMPT TRANSFERS Page 1of 2 PERSONALLY appeared before me the undersigned, who being duly sworn, deposes and says: 1. I have read the information on this affidavit and I understand such information. 2. The property being transferred is located at, ________________________________ bearing County Tax Map Number , __________________________________________ was transferred by _______________________________________________________ to _____________________________________________________________________ on ____________________________________________________________________ . 3. Check one of the following: The deed is (a) subject to the deed recording fee as a transfer for consideration paid or to be paid in money or money's worth. (b) subject to the deed recording fee as a transfer between a corporation, a partnership, or other entity and a stockholder, partner, or owner of the entity, or is a transfer to a trust or as a distribution to a trust beneficiary. (c) exempt from the deed recording fee because (See Information section of affidavit): ___________________________________________ (If exempt, please skip items 4 - 7, and go to item 8 of this affidavit.) If exempt under exemption #14 as described in the Information section of this affidavit, did the agent and principal relationship exist at the time of the original sale and was the purpose of this relationship to purchase the realty? Check Yes or No _____ 4. Check one of the following if either item 3(a) or item 3(b) above has been checked (See Information section of this affidavit.): (a) The fee is computed on the consideration paid or to be paid in money or money's worth in the amount of: _________________________. (b) The fee is computed on the fair market value of the realty which is: _____________________________ (c) The fee is computed on the fair market value of the realty as established for property tax purposes which is: _________________________________________________________________________________________ 5. Check Yes or No to the following: Yes____________ No_______ A lien or encumbrance existed on the land, tenement, or realty before the transfer and remained on the land, tenement, or realty after the transfer. (This includes, pursuant to Code Section 12-59-140(E)(6), any lien or encumbrance on realty in possession of a forfeited land commission which may subsequently be waived or reduced after the transfer under a signed contract or agreement between the lien holder and the buyer existing before the transfer.) If "Yes," the amount of the outstanding balance of this lien or encumbrance is: ________________________. 6. The deed recording fee is computed as follows: (a) Place the amount listed in item 4 above here: ________________________ (b) Place the amount listed in item 5 above here: ________________________ (If no amount is listed, place zero here.) (c) Subtract Line 6(b) from Line 6(a) and place result here: ________________________ 7. The deed recording fee due is based on the amount listed on Line 6(c) above and the deed recording fee due is: ____________________________ American LegalNet, Inc. www.FormsWorkFlow.com Pg 2 of 2 8. As required by Code Section 12-24-70, I state that I am a responsible person who was connected with the transaction as: _________________________________ 9. I understand that a person required to furnish this affidavit who willfully furnishes a false or fraudulent affidavit is guilty of a misdemeanor and, upon conviction, must be fined not more than one thousand dollars or imprisoned not more than one year, or both. Responsible Person Connected with the Transaction ___________________________________________________ Print or Type Name Here _________________________________________________________________________ SWORN to and subscribed before me this _______day of ______________20 Notary Public for ___________________________________ My Commission Expires: ____________________________ Notary (L.S.): _____________________________________ Notary (printed name):_______________________________ INFORMATION Except as provided in this paragraph, the term "value" means "the consideration paid or to be paid in money or money's worth for the realty.' Consideration paid or to be paid in money's worth includes, but is not limited to, other realty, personal property, stocks, bonds, partnership interest and other intangible property, the forgiveness or cancellation of a debt, the assumption of a debt, and the surrendering of any right. The fair market value of the consideration must be used in calculating the consideration paid in money's worth. Taxpayers may elect to use the fair market value of the realty being transferred in determining fair market value of the consideration. In the case of realty transferred between a corporation, a partnership, or other entity and a stockholder, partner, or owner of the entity, and in the case of realty transferred to a trust or as a distribution to a trust beneficiary, "value" means the realty's fair market value. A deduction from value is allowed for the amount of any lien or encumbrance existing on the land, tenement, or realty before the transfer and remaining on the land, tenement, or realty after the transfer. (This includes, pursuant to Code Section 12-59-140(E)(6), any lien or encumbrance on realty in possession of a forfeited land commission which may subsequently be waived or reduced after the transfer under a signed contract or agreement between the lien holder and the buyer existing before the transfer.) Taxpayers may elect to use the fair market value for property tax purposes in determining fair market value under the provisions of the law. Exempted from the fee are deeds: (1) transferring realty in which the value of the realty, as defined in Code Section 12-24-30, is equal to or less than one hundred dollars; (2) transferring realty to the federal government or to a state, its agencies and departments, and its political subdivisions, including school districts; (3) that are otherwise exempted under the laws and Constitution of this State or of the United States; (4) transferring realty in which no gain or loss is recognized by reason of Section 1041 of the Internal Revenue Code as defined in Section 12-640(A); (5) transferring realty in order to partition realty as long as no consideration is paid for the transfer other than the interests in the realty that are being e