MARYLAND       Certification of Exemption from Withholding Upon                                             2023
 FORM           Disposition of Maryland Real Estate Affidavit of 
WH-AR           Residence or Principal Residence

Based on the certification below, Transferor claims exemption        in ownership of real property is presented for recordation. The 
from the tax withholding requirements of §10-912 of the Tax-         requirements of §10-912 do not apply when a transferor provides 
General  Article,  Annotated  Code  of  Maryland.  Section  10-912   a  certification  of  Maryland  residence  or  certification  that  the 
provides  that  certain  tax  payments  must  be  withheld  and      transferred property is the transferor’s principal residence.
paid  when  a  deed  or  other  instrument  that  effects  a  change 

1.  Transferor Information
 Name of Transferor  ___________________________________________________________________________________

2.  Description of Property (Street address.  If no address is available, include county, district, subdistrict and lot numbers).   
  ___________________________________________________________________________________________________ 

3.  Reasons for Exemption

 Resident Status            As of the date this form is signed, I, Transferor, am a resident of the State of Maryland.
                            Transferor is a resident entity as defined in Code of Maryland Regulations 
                            (COMAR)03.04.12.02B(11), I am an agent of Transferor, and I have authority to sign this 
                            document on Transferor’s behalf.
 Principal Residence        Although I am no longer a resident of the State of Maryland, the Property is my principal 
                            residence as defined in IRC 121 (principal residence for 2 (two) of the last 5 (five) years) and is 
                            currently recorded as such with the State Department of Assessments and Taxation.

 Under penalty of perjury, I certify that I have examined this declaration and that, to the best of my 
 knowledge, it is true, correct, and complete.

3a. Individual Transferors

 Witness                                                             Name                              **Date

                                                                     Signature

3b. Entity Transferors

 Witness/Attest                                                      Name of Entity

                                                                     By

                                                                     Name                              **Date

                                                                     Title

** Form must be dated to be valid.
Note: Form is only valid if it was executed on the date the Property was transferred and is properly recorded with the Clerk of the 
     Court.
To the Clerk of the Court: Only an un-altered Form WH-AR should be considered a valid certification for purposes of Section 10-912.
     01/22