Form TP-584:4/13:Combined Real Estate Transfer Tax Return ...

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 than one grantor) Social security number Mailing address Social security number City State ZIP code Federal EIN Single member EIN or SSN Name (if individual, last, first, middle initial) ( check if more than one grantee)

Page 2 of 4 TP-584 (4/13) Part III – Explanation of exemption claimed on Part I, line 1 (check any boxes that apply) The conveyance of real property is exempt from the real estate transfer tax for the following reason: a. Conveyance is to the United Nations, the United States of America, the state of New York, or any of their instrumentalities,

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