Office of the County Recorder Debbie Conway

1 DV Packet Revised June 2017 Declaration of Value Form Instructions Complete the following sections: 1. Assessor parcel number(s) (APN) List all parcel numbers affected by the property transfer. If more than 4 parcel numbers, attach a list with remaining numbers. 2. Type of Property One box must be checked. If other fill in blank with description ( Timeshare, Water Rights, ) 3. Total Value/Sales Price of Property (see options below) 3a Show full purchase price of real property (for Deeds in Lieu of Foreclosure amount of unpaid debt).

2 If there is NO SALE and does not fall under exemption; use the Assessor s Taxable Value or the last sales price within the previous five years, whichever is greater (NRS ). Trustee s deeds are taxable on the bid amount plus costs (if not foreclosing on first mortgage include first mortgage as part of costs). 3b For Deeds in Lieu of Foreclosure Only the Total Value (3a) is the amount of the unpaid debt, same as the amount that will appear on 1099c. Insert at (3b) the fair market value of the property per NRS 3c Transfer Tax Value Subtract line 3b from line 3a to determine taxable value 3c.

3 If the percentage of ownership being transferred is less than 100%, apply the percentage here. If the unpaid debt is greater than the fair market value of the property, the difference is taxable. 3d Real Property Transfer Tax based on the value shown at line 3c the tax is calculated at the statutory rate of $ per each $500. 4a. If you wish to claim an exemption, please refer to exemptions listed in NRS and insert exemption number here. 4b. If an exemption is claimed, an explanation on line 4b is required. Certain exemptions require supporting documentation at the time of recording.

4 Re records and corrections require the book/instrument of the previously recorded document. 5. Partial Interest: Percentage being transferred required if the percentage is less than 100% . Signature One original signature required. Capacity Relationship of the person signing to the parties on the document. (Grantor, Grantee, Trustee, Attorney, etc.) Seller/Grantor and Buyer/Grantee Information Names and addresses of both parties must be completed (for contact purposes). Company Requesting Recording Must be completed if the party presenting the document for recording is neither the grantor nor the grantee.

5 If there is an escrow number, it must be stated. Though not an official record as defined in state statute, this document will be imaged with the deed it accompanies. There is no statute that allows a recording to take place without a Declaration of Value, or revealing the amount of tax paid on the recording stamp. Office of the County Recorder Debbie Conway Clark County Recorder STATE OF NEVADADECLARATION OF VALUE1. Assessor Parcel Number(s) Type of Property:a. Vacant Landb. Single Fam. RECORDERS OPTIONAL USE ONLYc.

6 Condo/Twnhsed. 2-4 PlexBook_____ Page:_____e. Apt. Bldgf. Comm'l/Ind'lDate of Recording: _____g. Agriculturalh. Mobile HomeNotes: Other Total Value/Sales Price of Property$ b. Deed in Lieu of Foreclosure Only (value of property) ( ) c. Transfer Tax Value:$ d. Real Property Transfer Tax Due$4. If Exemption Tax Exemption per NRS , Reason for Exemption: _____5. Partial Interest: Percentage being transferred:%The undersigned declares and acknowledges, under penalty of perjury, pursuant to NRS and NRS , that the information provided is correct to the best of their information and belief, and can be supported by documentation if called upon to substantiate the information provided herein.

7 Furthermore, the parties agree that disallowance of any claimed exemption, or other determination of additional tax due, may result in a penalty of 10% of the tax due plus interest at 1% per month. Pursuant to NRS , the Buyer and Seller shall be jointly and severally liable for any additional amount owed. Signature _____Capacity: _____Signature _____Capacity: _____SELLER (GRANTOR) INFORMATIONBUYER (GRANTEE) INFORMATION (REQUIRED) (REQUIRED)Print Name:Print Name:Address: Address:City:City.

8 State: Zip:State: Zip:COMPANY/PERSON REQUESTING RECORDING (Required if not seller or buyer)Print Name:Escrow #Address:City: State: Zip: AS A PUBLIC RECORD THIS FORM MAY BE RECORDED/MICROFILMED Real Property Transfer Tax Table (Effective 10/01/03) TRANSFER TRANSFER TRANSFER TRANSFER TAXABLE VALUE TAX TAXABLE VALUE TAX TAXABLE VALUE TAX TAXABLE VALUE TAX 0 - 100 NONE 25,001 - 25,500 50,001 - 50,500 75,001 - 75,500 101 - 500 25,501 - 26,000 50,501 - 51,000 75,501 - 76,000 501 - 1,000 26,001 - 26,500 51,001 - 51,500 76,001 - 76,500 1,001 - 1,500 26,501 - 27,000 51,501 - 52,000 76,501 - 77,000 1,501 - 2,000 27,001 - 27,500 52,001 - 52,500 77,001 - 77,500 2,001 - 2,500 27,501 - 28,000 52,501 - 53,000 77,501 - 78.

9 000 2,501 - 3,000 28,001 - 28,500 53,001 - 53,500 78,001 - 78,500 3,001 - 3,500 28,501 - 29,000 53,501 - 54,000 78,501 - 79,000 3,501 - 4,000 29,001 - 29,500 54,001 - 54,500 79,001 - 79,500 4,001 - 4,500 29,501 - 30,000 54,501 - 55,000 79,501 - 80,000 4,501 - 5,000 30,001 - 30,500 55,001 - 55,500 80,001 - 80,500 5,001 - 5,500 30,501 - 31,000 55,501 - 56,000 80,501 - 81,000 5,501 - 6,000 31,001 - 31,500 56,001 - 56,500 81,001 - 81,500 6,001 - 6,500 31,501 - 32,000 56,501 - 57,000 81,501 - 82,000 6,501 - 7,000 32,001 - 32,500 57,001 - 57,500 82,001 - 82,500 7,001 - 7,500 32,501 - 33,000 57,501 - 58,000 82,501 - 83,000 7,501 - 8,000 33,001 - 33,500 58,001 - 58,500 83,001 - 83,500 8,001 - 8,500 33,501 - 34,000 58,501 - 59,000 83,501 - 84,000 8,501 - 9,000 34,001 - 34,500 59,001 - 59,500 84,001 - 84,500 9,001 - 9,500 34,501 - 35,000 59,501 - 60,000 84,501 - 85,000 9,501 - 10,000 35,001 - 35,500 60,001 - 60,500 85,001 - 85.

10 500 10,001 - 10,500 35,501 - 36,000 60,501 - 61,000 85,501 - 86,000 10,501 - 11,000 36,001 - 36,500 61,001 - 61,500 86,001 - 86,500 11,001 - 11,500 36,501 - 37,000 61,501 - 62,000 86,501 - 87,000 11,501 - 12,000 37,001 - 37,500 62,001 - 62,500 87,001 - 87,500 12,001 - 12,500 37,501 - 38,000 62,501 - 63,000 87,501 - 88,000 12,501 - 13,000 38,001 - 38,500 63,001 - 63,500 88,001 - 88,500 13,001 - 13,500 38,501 - 39,000 63,501 - 64,000 88,501 - 89,000 13,501 - 14,000 39,001 - 39,500 64,001 - 64,500 89,001 - 89,500 14,001 - 14,500 39,501 - 40,000 64,501 - 65,000 89,501 - 90,000 14,501 - 15,000 40,001 - 40,500 65,001 - 65,500 90,001 - 90,500 15,001 - 15,500 40,501 - 41,000 65,501 - 66,000 90,501 - 91,000 15,501 - 16,000 41,001 - 41,500 66,001 - 66,500 91,001 - 91,500 16,001 - 16,500 41,501 - 42,000 66,501 - 67,000 91,501 - 92,000 16,501 - 17,000 42,001 - 42,500 67,001 - 67,500 92,001 - 92,500 17,001 - 17,500 42,501 - 43.