DO NOT STAPLE

                   New Hampshire  
                          Department of                         CD-57-P                  *0CD57P2411862*
                  Revenue Administration                                                                       0CD57P2411862
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

Last Name / Entity                                                            First Name                        FEIN / SSN

Street No.                Street Name                                                  Apt / Unit               Phone Number 

City                                                           State     Zip Code + 4 (or Canadian Postal Code)
                                                                
STEP 2 - SELLER               Grantor / Assignor / Transferor            
Last Name / Entity                                                            First Name

Last Name / Entity                                                            First Name

STEP 3 - REAL ESTATE
Municipality                                   County
 
Street No.                Street Name                                                  Apt / Unit

Multi Town Sale?                   If Yes, list municipalities:
     Yes          No

STEP 4 - DEED             Transfer Date                        Recording Date                        Book No.         Page No.

                          Warranty             Quitclaim        Mortgage      Sheriffs               Foreclosure
Deed Type                                                                                Tax
(Check one):
                          Commissioner's       Fiduciary        Probate       In Lieu of Foreclosure 5SBOTGFS PO %FBUI

     CD-57-P                                                                                                                  Page 1 of  
     7FSTJPO       0 /202 

                New Hampshire  
                      Department of                          CD-57-P *0CD57P2421862*
                Revenue Administration                                                                            0CD57P2421862

REAL ESTATE TRANSFER TAX DECLARATION OF CONSIDERATION REAL ESTATE PURCHASER (GRANTEE)
STEP 5 - TAX AMOUNT

a) Full price or consideration for the real estate

b) Divide Line 5(a) by $100

c) Tax rate per $100 at time of transfer                                                                                                    0.75

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

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

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                                                                                                                                     Page 2 of  
7FSTJPO            

             New Hampshire  
                        Department of                   CD-57-P                          *0CD57P2431862*
             Revenue Administration                                                                  0CD57P2431862

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                                                                                                              Page 3 of  
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