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Get PA DoR REV-183 EX 2004

Sideration, or by gift, or (3) a tax exemption is claimed. A Statement of Value is not required if the transfer is wholly exempt from tax based on: (1) family relationship or (2) public utility easement. If more space is needed, attach additional sheet(s). A. CORRESPONDENT All inquiries may be directed to the following person: START Name Telephone Number: Street Address City B. TRANSFER DATA State Zip Code State Zip Code Date of Acceptance of Document Grantor(s)/Lessor(s) Gra.

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