Form TP-584:4/13:Combined Real Estate Transfer …

New York State Department of Taxation and FinanceCombined Real EstateTransfer Tax Return,Credit Line Mortgage Certificate, andCertification of Exemption from thePayment of estimated Personal income TaxTP-584 (4/13)Recording office time stampSee Form TP-584-I, Instructions for Form TP-584, before completing this form. Print or A Information relating to conveyanceCondition of conveyance (check all that apply) of fee of a controlling interest (statepercentage acquired %) of a controlling interest (statepercentage transferred %) to cooperative pursuant to or in lieu offoreclosure or enforcement of securityinterest (attach Form , Schedule E)Grantor/TransferorIndividualCorporatio nPartnershipEstate/TrustSingle member LLCO therGrantee/TransfereeIndividualCorporat ionPartnershipEstate/TrustSingle member LLCO ther Name (if individual, last, first, middle initial) ( check if more th)

Page 4 of 4 TP-584 (4/13) Schedule D - Certification of exemption from the payment of estimated personal income tax (Tax Law, Article 22, section 663) Complete the following only if a fee simple interest or a cooperative unit is being transferred by an individual or estate or trust.

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  Income, Payments, Estimated, Tp 584, Income tax

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