Parcel Number:*

Document Number:*

Purchaser:*

Property Address:*

Check any box that applies to this sale:

Sale between relatives or corporate affiliates

Advertised via internet or auction sale

Advertised out-of-state

Deed in lieu of foreclosure or repossession

Sale by judicial order

Sale between government agency/public utility

Sale of only partial interest

Sale involved a trade or exchange of property

Includes water rights

Property leased/rented by Buyer at time of sale

Includes an existing business

Visited the property before purchase

Check use of property and items included at time of sale:

Vacant land only

Minor improvement(s)

Manufactured home

Site built home

Multiple Residences

Farm/Ranch

Apartments

Commercial/Industrial

Agricultural lands

Inventory

Garage

Carport

Shop

Shed

Fireplace/Wood stove

Well

Septic

Power on to property

Surface water rights

# of water righted acres

Underground water rights

Total acre feet

Finished basement

Unfinished basement

Complete for all residential property:

Number of bedrooms

Number of bathrooms

Basement number of bedrooms

Basement number of bathrooms

Type of heating

Type of cooling

Complete for manufactured homes:

Year

Make

Model

Size

Serial Number

Perimeter foundation

Yes

No

Was any personal property included in the sale price?

Furniture

Equipment

Machinery

Crops

Business franchise

Inventory

Other

Are you aware of any of the following changes to the property since July 1st?

New construction

Additions

Remodel

Demolition

Was the price paid for the property a fair indication of market value?

Yes

No

How was the property listed for sale?

Sale by Owner

Realtor

Name of Realtor

Other

How long was the property listed for sale?

0-3 months

3-6 months

6-9 months

9-12 months

Over 1 year

What was the asking price?

What was the sales price?

Date price was agreed upon?

What was the condition at the time of sale?

Poor

Fair

Average

Good

Was the residence livable?

Yes

No

Was an appraisal made on the property?

Yes

No

If yes, amount of appraisal?

Were any delinquent taxes assumed by the Buyer?

Yes

No

If yes, amount of delinquent taxes?

Does the Buyer hold title to any adjoining property?

Yes

No

Buyer financing?

Financial institution

Interest rate

Seller financing

Interest rate

Assumption of existing loan

Interest rate

None/Cash

Comments

Name of person filling out form*

Date*

Phone number*

Email address*