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E-TAX FORMS QUESTIONNAIRE
Email: ESamuels@FirstAm.com
Fax No: 212.331-1648
COOP APARTMENT E TAX FORM STARTER SHEET
To engage Modern Abstract at a fee of $100.00 to perform the data entry for ACRIS E-Tax Forms for
your residential cooperative apartment transactions please enter/verify all of the information
requested in the form below and promptly return this page to Modern Abstract. Use additional sheets if
necessary to provide complete information. Modern Abstract will enter the information provided in E-
Tax Forms and forward the E-Tax Forms to you for your review and approval. Also indicate who should
be contacted if further information is required. Please fax back this form to Erica Samuels @ 212-331-
1648 or email @ ESamuels@firstam.com.
Information MUST be completed in order for us to complete your ACRIS real estate tax forms. You may
fill in this form or send us completely filled in tax forms.
GRANTOR (SELLER)
a. Name _______________________________________________________________
b. Street Address _______________________________________________________________
c. City, State, Zip _______________________________________________________________
d. SSN/EIN _______________________________________________________________
See Rider for Additional Grantor(s)
GRANTEE (PURCHASER)
a. Name _______________________________________________________________
b. Street Address _______________________________________________________________
c. City, State, Zip _______________________________________________________________
d. SSN/EIN _______________________________________________________________
See Rider for Additional Grantee(s)
PROPERTY
a. Street Address ____________________________________________ Unit No. _____
b. County ________________________________________
c. Block: ________________ Lot: ____________________
Will the seller be residing at the property? Yes No I Don’t know
633 Third Avenue -17th Floor
New York, NY 10017-6706
Tel 212.334.1181 * Fax 212.334.9296
WWW.MODERNABSTRACT.COM
Page 1
E-TAX FORMS QUESTIONNAIRE
Email: ESamuels@FirstAm.com
Fax No: 212.331-1648
CONDITION OF TRANSFER: CHECK ALL OF THE CONDITIONS THAT APPLY
a. …Arms length transfer m …Transfer to a governmental body
b. …Transfer in exercise of option to purchase n. …Correction deed
c. …Transfer from cooperative sponsor to cooperative o. …Transfer by or to a tax exempt organization (complete schedule
corporation G, page 8)
d. …Transfer by referee or receiver (complete Schedule A, p. …Transfer of property partly within and partly without NYC
page 5)
e. …Transfer pursuant to marital settlement agreement or q. …Transfer of successful bid pursuant to foreclosure
divorce decree
f. …Deed in lieu of foreclosure (complete Schedule C, page r. Transfer by borrower solely as security for a debt or a transfer by
6) lender solely to return such security
g. Transfer pursuant to liquidation of an entity (complete s. …Transfer wholly or partly exempt as a mere change of identity
schedule D, page 6) or form of ownership. (Complete Schedule M, pages 9)
h. …Transfer from principal to agent, dummy, strawman or t. …Transfer to a REIT or to a corporation or partnership controlled
conduit or vice-versa (complete Schedule E, page 7) by a REIT. (Complete Schedule R, pages 10 and 11)
i. …Transfer pursuant to trust agreement or will (attach a u. …Other transfer in connection with financing (describe):
copy of trust agreement or will) ___________________________________________________
j. …Gift transfer not subject to indebtedness ___________________________________________________
k. …Gift transfer subject to indebtedness v. …Other (describe):_________________
l …Transfer to a business entity in exchange for an interest ___________________________________________________
in the business entity (complete Schedule F, page 7)
PERCENTAGE OF INTEREST TRANSFERRED _____________________________________________
DATE OF TRANSFER_________________________________________________
COOP CORPORATION__________________________________________________________________
ADDRESS (Complete if different from property address) _________________________________________
NOTE: IF THE PURCHASE PRICE IS OVER $400,000 A COPY OF THE CONTRACT OF SALE MUST ACCOMPANY
THIS FORM
DETAILS OF CONSIDERATION:
AMOUNT
A. Cash _______________________
B. Purchase money mortgage _______________________
C. Accrued interest _______________________
D. Liens on property _______________________
E. Liens on property _______________________
F. Value of shares transferred _______________________
G. RPTT or other taxes paid by grantee _______________________
H. Other (explain) _______________________
I. TOTAL _______________________
633 Third Avenue -17th Floor
New York, NY 10017-6706
Tel 212.334.1181 * Fax 212.334.9296
WWW.MODERNABSTRACT.COM
Page 2
E-TAX FORMS QUESTIONNAIRE
Email: ESamuels@FirstAm.com
Fax No: 212.331-1648
WHO WILL BE PAYING THE TRANSFER TAXES? SELLER PURCHASER
ARE YOU CLAIMING AN EXEMPTION? If YES, explain NO
_________________________________________________
_________________________________________________
ARE YOU CLAIMING A CONTINUING LIEN DEDUCTION? YES NO
If “Yes”, enter lien deduction amount _______________
APPLICANT INFORMATION (COMPLETE IF DIFFERENT THAN GRANTOR’S (SELLER) ATTORNEY):
a. Firm Name _______________________________________________________
b. Attention _______________________________________________________
c. Street Address _______________________________________________________
d. City, State, Zip _______________________________________________________
e. Telephone Number _______________________________________________________
GRANTOR’S (SELLER) ATTORNEY
a. Firm Name _______________________________________________________
b. Attention _______________________________________________________
c. Street Address _______________________________________________________
d. City, State, Zip _______________________________________________________
e. Telephone Number _______________________________________________________
GRANTEE’S (BUYER) ATTORNEY
a. Firm Name _______________________________________________________
b. Attention _______________________________________________________
c. Street Address _______________________________________________________
d. City, State, Zip _______________________________________________________
e. Telephone Number _______________________________________________________
633 Third Avenue -17th Floor
New York, NY 10017-6706
Tel 212.334.1181 * Fax 212.334.9296
WWW.MODERNABSTRACT.COM
Page 3
E-TAX FORMS QUESTIONNAIRE
Email: ESamuels@FirstAm.com
Fax No: 212.331-1648
How would you like the completed forms returned to you?
___ E-mail Enter e-mail address __________________________________________
PDF TIFF
___ Fax Enter name & fax number ____________________________________
633 Third Avenue -17th Floor
New York, NY 10017-6706
Tel 212.334.1181 * Fax 212.334.9296
WWW.MODERNABSTRACT.COM
Page 4
E-TAX FORMS QUESTIONNAIRE
Email: ESamuels@FirstAm.com
Fax No: 212.331-1648
ADDITIONAL GRANTOR(S)/GRANTEE(S)
NAME _____________________________________
PERMANENT STREET ADDRESS (AFTER TRANSFER)
_____________________________________________________________________
CITY AND STATE ________________________ ZIP CODE ________________
EMPLOYER ID NUMBER OR SOCIAL SECURITY NUMBER
_________________________ ___________________________
ADDITIONAL GRANTOR(S)/GRANTEE(S)
NAME _____________________________________
PERMANENT STREET ADDRESS (AFTER TRANSFER)
______________________________________________________________
CITY AND STATE ________________________ ZIP CODE ________________
EMPLOYER ID NUMBER OR SOCIAL SECURITY NUMBER
_________________________ ___________________________
ADDITIONAL GRANTOR(S)/GRANTEE(S)
NAME _____________________________________
PERMANENT STREET ADDRESS (AFTER TRANSFER)
CITY AND STATE ________________________ ZIP CODE ________________
EMPLOYER ID NUMBER OR SOCIAL SECURITY NUMBER
633 Third Avenue -17th Floor
New York, NY 10017-6706
Tel 212.334.1181 * Fax 212.334.9296
WWW.MODERNABSTRACT.COM
Page 5
E-TAX FORMS QUESTIONNAIRE
Email: ESamuels@FirstAm.com
Fax No: 212.331-1648
_________________________ ___________________________
633 Third Avenue -17th Floor
New York, NY 10017-6706
Tel 212.334.1181 * Fax 212.334.9296
WWW.MODERNABSTRACT.COM
Page 6
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