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                                                                             1830019105                                        RECORDER’S USE ONLY
                                               (EX) MOD 06-19 (FI)                                              State Tax Paid:
                                                                                                                Book:                   Page:
                                 Bureau of IndIvIdual Taxes 
                                 REV-183                           REALTY TRANSFER TAX                          Instrument Number:
                                 Po Box 280603                     STATEMENT OF VALUE 
                                 HarrIsBurg, Pa 17128-0603         COMPLETE EACH SECTION                        Date Recorded:

       SECTION I                 TRANSFER DATA
START  Date of Acceptance of Document  MM/DD/YYYY
Ü
       Grantor(s)/Lessor(s)                             Telephone Number        Grantee(s)/Lessee(s)                                     Telephone Number

       Mailing Address                                                          Mailing Address

       City                                             State       ZIP Code    City                                                     State  ZIP Code

       SECTION II                REAL ESTATE LOCATION
       Street Address                                                           City, Township, Borough

       County                                           School District                                          Tax Parcel Number

       SECTION III               VALUATION DATA
       Was transaction part of an assignment or relocation?        YES         NO
       1. Actual Cash Consideration                     2. Other Consideration                                   3. Total Consideration 
                                                            +                                                        =
       4. County Assessed Value                         5. Common Level Ratio Factor                             6. Computed Value 
                                                            x                                                        =
      VSECTION IV                EXEMPTION DATA - Refer to instructions for exemption status.
       1a. Amount of Exemption Claimed                  1b. Percentage of Grantor’s Interest in Real Estate   1c. Percentage of Grantor’s Interest Conveyed
             $                                                                                                %                                                        %
       2. Fill in the Appropriate Oval Below for Exemption Claimed.
               Will or intestate succession. 
                                                                                                  (Name of Decedent)                                                           (Estate File Number) 
               Transfer to a trust. (Attach complete copy of trust agreement and all amendments.) 
               Transfer from a trust. (Attach complete copy of trust agreement and all amendments.) 
               Transfer between principal and agent/straw party. (Attach complete copy of agency/straw party agreement.) 
               Transfers to the commonwealth, the U.S. and instrumentalities by gift, dedication, condemnation or in lieu of condemnation. 
               (If condemnation or in lieu of condemnation, attach copy of resolution.) 
               Transfer from mortgagor to a holder of a mortgage in default. (Attach copy of mortgage and note/assignment.) 
               Corrective or confirmatory deed. (Attach complete copy of the deed to be corrected or confirmed.) 
               Statutory corporate consolidation, merger or division. (Attach copy of articles.) 
               Other (Provide a detailed explanation of exemption claimed. If more space is needed attach additional sheets.)

       SECTION V                 CORRESPONDENT INFORMATION - All inquiries may be directed to the following person:
       Name                                                                                                                               Telephone Number

       Mailing Address                                                          City                                                     State  ZIP Code

      Under penalties of law, I declare that I have examined this statement, including accompanying information, and to the best of my knowledge and belief, it is true, correct and complete.
      Signature of Correspondent  or Responsible Party                                                                                   Date  MM/DD/YYYY
                                                                   PLEASE SIGN AFTER PRINTING
      FAILURE TO COMPLETE THIS FORM PROPERLY OR ATTACH REQUESTED DOCUMENTATION MAY RESULT IN THE RECORDER’S REFUSAL TO RECORD THE DEED.

                                       1830019105                                                                     1830019105

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Pennsylvania Department of Revenue

Instructions for REV-183
rev-183 In (ex) 06-19 realty Transfer T axst tame en oft aluev

5. Common Level Ratio Factor – Enter the common
GENERAL INFORMATION
level ratio factor for the county in which the real estate
Complete each section and file in duplicate with the is located. An explanation of this factor is provided
Recorder of Deeds when (1) the full value/consideration is below.
not set forth in the deed, (2) the deed is without considera- 6. Computed Value– Enter the product of Lines 4 and 5 .
tion or by gift, or (3) a tax exemption is claimed. If more
space is needed, please attach additional sheets. A
SECTION IV
Statement of Value (SOV) is not required if the transfer is
wholly exempt from tax based on family relationship or
Complete only for transactions claiming an exemption. For
public utility easement. However, it is recommended that a
exemptions refer to Title 61 §91.193 of the Pennsylvania
SOV accompany all documents filed for recording.
Code.

LINE INSTRUCTIONS 1a. Amount of Exemption Claimed – Enter the dollar
amount of the value claimed as exempt.
SECTION I –
1b. Percentage of Grantor’s Interest in Real Estate
Enter the percentage of grantor’s ownership interest in
Date of Acceptance – Enter the date the document was
the real estate listed in Section II.
delivered to and accepted by the grantee/lessee.
Enter the full names and addresses of all grantor(s)/ 1c. Percentage of Grantor’s Interest Conveyed – Enter
lessor(s) and all grantee(s)/lessee(s). Attach additional the fraction or percentage of grantor’s interest in the
sheets if necessary. real estate on Line 1b that the grantor conveyed to the
grantee. For example, if you indicated on Line 1b that
SECTION II grantor owns a 50 percent tenant-in-common interest
in the real estate and grantor is conveying his entire 50
This section identifies the real estate to be transferred. percent interest to the grantee, then you would enter
Complete fully, including the tax parcel number where 100 percent on this line.
applicable and the county where the statement is to be
filed. 2. Fill in the Appropriate Oval for Exemption Claimed –
Ovals are provided for the most common Pennsylvania
realty exemptions. Each is explained in order of
SECTION III
appearance on the Realty Transfer Statement of Value
Indicate by filling in YES or NO, whether the document form.
represents two or more transactions accomplished by an
assignment of the agreement of sale or by the use of a Will or Intestate Succession – A transfer by will for no or
relocation arrangement. Complete for all transactions: nominal consideration, or under the intestate succession
laws, is exempt from tax. Provide the name of the decedent
1. Actual Cash Consideration – Enter the amount of
and estate file number in the space provided.
cash or cash equivalent that the grantor received for
the transfer of the real estate. Transfer to a Trust – A transfer for no or nominal
2. Other Consideration – Enter the total amount of consideration to a trust is exempt from tax when the
noncash consideration that the grantor received for the transfer of the same property would be exempt from tax if
transfer of the real estate, such as property and the transfer were made directly by the grantor to all the
securities. Include mortgages and liens existing before possible (including contingent) beneficiaries. Attach a
the transfer and not removed thereby, and the agreed complete copy of the trust agreement and identify the
consideration for the construction of improvements. grantor’s relationship to each beneficiary.
3. Total Consideration – Enter the sum of Lines 1 and 2.
Transfer from a Trust– Attach a complete copy of the
This will be the total consideration for the purchase of
original trust and all amendments to the trust.
the real estate.
4. County Assessed Value – Enter the actual assessed Transfer Between Principal and Agent/Straw Party – A
value of the entire real estate, per records of the county transfer between an agent/straw party and principal for no
assessment office. Do not reduce the assessed value or nominal consideration is exempt. Attach a complete
by the grantor’s fractional interest in the real estate. copy of the agency/straw party agreement.

www.revenue.pa.gov REV-183 1
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Transfer to the Commonwealth, the U.S. and Attach a copy of the articles of consolidation, merger or
Instrumentalities by Gift, Dedication, Condemnation or division.
in Lieu of Condemnation – If the transfer is by Other – When claiming an exemption other than those
condemnation or in lieu of condemnation, attach a copy of listed, you must specify what exemption is claimed. When
the resolution. possible, provide the applicable statutory and regulatory
Transfer from Mortgagor to Holder of a Mortgage in citation. Attach additional pages, if necessary. Attach a
copy of supporting documentation.
Default – A transfer from a mortgagor to a holder of a
mortgage in default, whether pursuant to a foreclosure or in
SECTION V
lieu thereof, is exempt. Provide a copy of the mortgage and
note, and any documentation evidencing the assignment Enter the name, address and telephone number of party
thereof. completing this form.
Corrective or Confirmatory Deed – A deed for no or
nominal consideration that corrects or confirms a previously COMMON LEVEL RATIO FACTOR
recorded deed but does not extend or limit the title or This is a property valuation factor provided by the PA
interest under the prior deed is exempt from tax. Attach a Department of Revenue by which the county assessed
complete copy of the prior deed being corrected or value is multiplied to determine the taxable value of real
confirmed. estate for all non-arm’s-length transactions, leases and
acquired companies. The factor is based on the common
Statutory Corporate Consolidation, Merger or Division level ratio established by the State Tax Equalization Board.
– A document that evidences the transfer of real estate The common level ratio is a ratio of assessed values to
pursuant to the statutory consolidation or merger of two or current fair market values as reflected by actual sales of
more corporations (15 Pa. C.S. §1921-1932 or 15 Pa. C.S. real estate in each county. A statewide list of the factors is
§5921-5930) – or the statutory division of a nonprofit available at the Recorder of Deeds’ office in each county
corporation (15 Pa. C.S. §5951-5957) – is exempt from tax. and on the department’s website at www.revenue.pa.gov

THIS STATEMENT MUST BE SIGNED BY A RESPONSIBLE PERSON CONNECTED WITH THE TRANSACTION.

2 REV-183 www.revenue.pa.gov
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