DOCUMENTARY TRANSFER TAX DISCLOSURE

Statement of tax due and request that said amount not be made part of permanent record in the office of the county recorder.

TO: ________________________ County Recorder

The amount of remittance below is in full payment of the Documentary Transfer Tax for the document attached and described below. When tax payment is verified and after the permanent record is made, attach this request to the document pursuant to Section 11932 R & T Code.

GRANTOR:

GRANTEE:

AMOUNT OF REMITTANCE: $______________

( ) Computed on full value of property conveyed, or

( ) Computed on full value less liens and encumbrances remaining thereon at time of sale.

Grantor:

By: ________________________________