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TP-584.2 (10/96)
Recording Office Time Stamp
Real Estate Transfer Tax Return
For Public Utility Companies’
and Governmental Agencies’
Easements and Licenses
This form may only be used by public utility companies regulated by the Public Service
Commission and governmental agencies for the recording of easements and licenses
where the consideration for the grant of such easement or license is $500.00 or less.
Name of grantee (public utility company or governmental agency) Federal employer identification number
(if applicable)
Address of grantee Name and telephone number of person to contact
Name(s) of Grantor Address of Property Consideration Given
Of Easement or License For Easement or License
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
If more than fifteen conveyances are to be recorded, attach a schedule of such other conveyances.
Signature of Grantee
I certify that the grantee is a public utility regulated by the Public Service Commission or is a governmental agency and the grantee of the easements and/or
licenses above; that it is true to the best knowledge of the grantee that the granting of each such easement and/or license is exempt from Real Estate
Transfer Tax imposed by Article 31 of the Tax Law by reason that each such conveyance is for a consideration of five hundred dollars or less and/or the
conveyance is being made to a governmental agency.
Name of grantee Signature of partner, officer of corporation, governmental official, etc.
Title
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