DO NOT STAPLE                                                                          Print Form                   Reset Form
                     New Hampshire  
                     Department of                        CD-57-P                       *0CD57P2311862*
                 Revenue Administration                                                                        0CD57P2311862
REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE PURCHASER (GRANTEE)
STEP 1 - PURCHASER                  Grantee / Assignee / Transferee              (use new mailing address)
                                                                                                                               Original Return
Entity Type - (Check One):       Individual     Joint        Partnership       Corporation      Trust             LLC
                                                                                                                               Amended Return
Last Name / Entity                                                           First Name                           FEIN / SSN
DEMERS                                                                       MICHAEL                              0    1 4   7 8   5 2 3      6
Last Name / Entity                                                           First Name                           FEIN / SSN
DEMERS                                                                       SARA                                 9    6 3   2   5 8 7      4 1
Street No.           Street Name                                                 Apt / Unit                    Phone Number 
851                  ORANGE TREE LN                                                                            6  0    3 5   2 4   8 7 7      8
City                                                      State          Zip Code + 4 (or Canadian Postal Code)
BELMONT                                                   NH             0 3 2 2 0

STEP 2 - SELLER               Grantor / Assignor / Transferor            
Last Name / Entity                                                           First Name
SUMMERS                                                                      EMILY
Last Name / Entity                                                           First Name

STEP 3 - REAL ESTATE
Municipality                                  County
PEMBROKE                                      MERRIMACK
Street No.           Street Name                                                 Apt / Unit
17                   LOCK ST
Multi Town Sale?              If Yes, list municipalities:
     Yes         No

STEP 4 - DEED        Transfer Date                        Recording Date                    Book No.                     Page No.
                     0        8 1 5 2       0 2 3         0  8     2     1 2 0 2 3                             1 2 2 5               3 2

                     Warranty       Quitclaim             Mortgage           Sheriffs       Tax                   Foreclosure
Deed Type 
(Check one):                                                                 Probate        In Lieu of Foreclosure
                     Commissioner's                       Fiduciary

     CD-57-P 
     Rev 3.5 03/2023                                                                                                             Page 1 of 5

                New Hampshire  
                      Department of                           CD-57-P *0CD57P2321862*
                Revenue Administration                                                                            0CD57P2321862
REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE PURCHASER (GRANTEE)
STEP 5 - TAX AMOUNT
a) Full price or consideration for the real estate                                                                                      3   5 0 0   0    0

b) Divide Line 5(a) by $100                                                                                                           3 5   0 0 .   0    0

c) Tax rate per $100 at time of transfer                                                                                                      0 .      7 5

d) Subtotal of Purchaser's tax (Minimum of $20 for all considerations $4,000 or less, per RSA 78-B:1)                                         2 6   2    5

e) Total tax paid to County on behalf of Seller and Purchaser                                                                                 1 5   0    0

Are you claiming tax 
exemption under             Yes No       DO NOT file form CD-57-P for transfers specifically exempted from taxation under RSA 78-B:2, EXCEPT transfers exempted 
RSA 78-B:2, IX?                          by RSA 78-B:2, IX. Form CD-57-P must be filed for non-contractual transfers exempted under RSA 78-B:2, IX. 

STEP 6 - TAXPAYER'S SIGNATURE & INFORMATION (Purchaser's Signature is Required) 
Under penalties of perjury, I declare that I have examined this return and to the best of my belief it is true, correct and complete.  I also agree and affirm that the full 
price or consideration paid for the real estate transferred by this deed is as reported in Step 5(a) of this form.
Purchaser 1 Signature                                                                                 MMDDYYYY

Purchaser1 Printed Name

Purchaser 2 Signature                                                                                 MMDDYYYY

Purchaser 2 Printed Name

CD-57-P 
Rev 3.5 03/2023                                                                                                                             Page 2 of 5

                New Hampshire  
                Department of                           CD-57-P                          *0CD57P2331862*
           Revenue Administration                                                                    0CD57P2331862

REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE PURCHASER (GRANTEE) 
                                                        SIGNATURE PAGE
STEP 7 - PREPARER'S SIGNATURE & INFORMATION (If prepared by someone other than the Purchaser)
Power of Attorney (POA): By checking this box and signing Step 6, you authorize the preparer listed on this return to act on your behalf for this return 
only, including entering the book and page numbers and filing this return electronically.

Under penalties of perjury, I declare that I have examined this return and to the best of my belief it is true, correct and complete. (If prepared by a person other 
than the taxpayer, this declaration is based on all information of which the preparer has knowledge.)
Preparer's Signature (if other than taxpayer)                                                        MMDDYYYY

Preparer's Printed Name (required if POA box is checked)

Entity

Last Name                                                       First Name

Street No.      Street Name                                     Apt / Unit                                   Phone Number 

City                                                    State Zip Code + 4 (or Canadian Postal Code)
                                                         
CD-57-P 
Rev 3.5 03/2023                                                                                                           Page 3 of 5

                    New Hampshire  
                    Department of                   CD-57-P                             General Questions
            Revenue Administration

WHAT IS REAL ESTATE TRANSFER TAX?  
It is a tax on the transfer, sale, or granting of real property or an interest in real property. Where the price or consideration is $4,000 or less there 
is a minimum tax of $20 to both, the purchaser and the seller. The tax rate from 7/1/99 to present is $0.75 per $100 . 

WHAT IS FAIR MARKET VALUE?  
Rev 801.04 "Fair market value" means the price property would command in an arms length transaction if sold by a seller who is willing, but not 
compelled, to sell and purchased by a purchaser who is willing, but not compelled, to purchase. 

WHAT IS PRICE OR CONSIDERATION?  
Price or consideration means the amount of money, other property and services, or property or services valued in money which is given in 
exchange for real estate, and measured at a time immediately after the transfer of the real estate. 

WHEN TO FILE  
A Declaration of Consideration (Form CD-57-P) and an Inventory of Property Transfer (Form PA-34) formally known as Real Estate  Transfer 
Questionnaire, must be filed with the NH Department of Revenue Administration (NH DRA) within 30 days of recording the deed. 

WHO MUST FILE 
For all contractual transfers , and non-contractual transfers under RSA 78-B:2, IX, the purchaser, grantee, assignee, or transferee must file and 
sign the Declaration CD-57-P. 

ARE THERE EXEMPTIONS FOR PAYMENT OF THE TAX? 
Every transfer, sale or granting of real property or an interest in real property is taxable unless exempted by statute. Please refer to the list of 
exemptions under RSA 78-B:2. Please note that the Form CD-57-P is not required for transfers exempted by RSA 78-B:2, except transfers 
exempted by RSA 78-B:2, IX. 

WHO MUST PAY? 
The tax is assessed on both     the purchaser and the seller, with a minimum charge of $20 each. The tax is paid at the Register of Deeds office in 
the county where the property is located. DO NOT send the tax payment with this Declaration. 

WHERE TO FILE 
File online at Granite Tax Connect www.revenue.nh.gov/gtc or mail to NH DRA, Taxpayer Services Division, PO Box 3308, Concord,  NH 
03302-3308. 

PENALTIES 
FAILURE TO FILE: If a return is not filed on a timely basis, a failure to file penalty equal to 5% of the outstanding balance, with a minimum of $10 
per month, is charged for each of the first five months or parts thereof after the return is due.  The total amount of this penalty shall not exceed 
25% of the balance of tax due or $50, whichever is greater. 

FAILURE TO PAY: A penalty equal to 10% of any nonpayment or underpayment of taxes shall be imposed if the taxpayer fails to pay when due.  If 
the failure to pay is due to fraud, the penalty shall be 50% of the amount of nonpayment or underpayment. 

In addition, there is a penalty equal to 100% of the additional tax due if either the buyer or seller makes a false statement on either the
transfer tax form or deed that no tax is due, or pays tax on less than the actual price or consideration for the transfer. The 100% false
statement penalty is in lieu of the 10% late payment penalty. 

NEED FORMS? 
To obtain additional forms please visit our website www.revenue.nh.gov/ or call the Forms Line at (603) 230-5001. An original (not 
photocopied) Form PA-34 must also be obtained for filing whenever a sale or transfer of real estate occurs. Contact the Department at (603) 
230-5950 if you need an original Form PA-34.

NEED HELP? 
Questions not covered here may be answered in our Frequently Asked Questions (FAQ) available on our website at www.revenue.nh.gov/ or by 
calling Taxpayer Services at (603) 230-5920, Monday through Friday, 8:00 am to 4:30 pm. All written correspondence to the Department should 
include the taxpayer name, taxpayer identification number, the name of a contact person and a daytime telephone number. Individuals who 
need auxiliary aids for effective communications in programs and services of the New Hampshire Department of Revenue Administration are 
invited to make their needs and preferences known. Individuals with hearing or speech impairments may call TDD Access: Relay NH 1-800-735- 
2964. 

    CD-57-P 
    Rev 3.5 03/2023                                                                                                          Page 4 of 5

                 New Hampshire  
                      Department of                CD-57-P                          Line-By-Line Instructions
                 Revenue Administration
First select the applicable Entity Type of the purchaser and identify if the return is original or amended. 

STEP 1  - Purchaser 
Enter the full name and address (use new mailing address, if applicable), phone number, and the taxpayer identification number(s) of the 
purchaser(s), grantee(s), assignee(s), or transferee(s). Each Purchaser or group of joint purchasers must file a CD-57-P. Please file an additional CD-57-
P for two or more joint purchasers. 

STEP 2  - Seller 
Enter the full name of the seller(s), grantor(s), assignor(s), or transferor(s).   

STEP 3  - Real Estate 
Property Location and Description: Enter the municipality, county, street number, street name, and apartment/unit number where the property is 
located.  Provide the tax map, block, and lot (parcel identification number) used by the municipality to identify the parcel.  If the sale is a multi-town 
sale, please enter all of the municipalities where parcels are located. 

STEP 4  - Deed 
Enter the transfer date, recording date, and Book and Page numbers assigned by the County Register of deeds.  Please indicate the deed type for the 
transactions (only one deed type may be selected). 

STEP 5  - Tax Amount 
  (a): Enter the full price or consideration paid for the real estate transferred.  
  (b): Divide the amount on (a) by $100. 
  (c): Enter the tax rate in effect as of the date of transfer.  Tax rate from 7/1/99  - Present is $0.75 per $100.  Please contact the  
         NH DRA for rates prior to 7/1/99. 
  (d): Enter the subtotal of the tax for the Purchaser by multiplying (b) by (c), rounding to the nearest whole dollar. 
  (e): Enter the total tax paid to the County on behalf of the Seller and Purchaser.  Multiply 5(d) by 2. 

Check the appropriate box as to whether or not the Purchaser is claiming tax exemption under RSA 78-B:2. 

STEP 6  - Signatures (Paper Form) 
Purchaser's Signature and Information:  The Form must be signed and dated by the Purchaser(s). 

STEP 7  - Preparer 
Power of Attorney (POA): By checking the POA box and signing Step 6, the taxpayer authorizes the preparer listed to act on the Purchaser's behalf 
for this return only, including entering the Book and Page numbers and filing this return.  This is a limited POA for this return only.  
Preparer's Signature and Information: If this Form was filled out by someone other than the Purchaser, please enter the full name, entity, address, 
and phone number of the preparer.

CD-57-P 
Rev 3.5 03/2023                                                                                                                          Page 5 of 5