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Maryland Affidavit of Residence Or Principal Residence

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Maryland Affidavit of Residence Or Principal Residence
Maryland Affidavit of Residence Or Principal Residence
Based on the certification below, Transferor claims exemption from the tax withholding
requirements of §10-912 of the Tax-General Article, Annotated Code of Maryland. Section
10-912 provides that certain tax payments must be withheld and paid when a deed or other
instrument that effects a change in ownership of real property is presented for recordation. The
requirements of §10-912 do not apply when a transferor provides a certification of Maryland
residence or certification that the transferred property is the transferor’s principal residence.
1. Transferor Information
Name of Transferor
2. Reasons for Exemption
Resident I, Transferor, am a resident of the State of Maryland.
Status Transferor is a resident entity as defined in Code of Maryland Regulations (COMAR)
03.04.12.02B(11), I am an agent of Transferor, and I have authority to sign this document
on Transferor’s behalf.
Principal Although I am no longer a resident of the State of Maryland, the Property is my principal
Residence residence as defined in IRC 121 and is recorded as such with the State Department of
Assessments and Taxation.
Under penalty of perjury, I certify that I have examined this declaration and that, to the best of my
knowledge, it is true, correct, and complete.
3a. Individual Transferors
3b. Entity Transferors
Witness Name
Signature
Witness/Attest Name of Entity
By
Name
Title
2012
MARYLAND
FORM
Certification of Exemption from Withholding Upon
Disposition of Maryland Real Estate
Affidavit of Residence or Principal Residence
11-49
Maryland Affidavit of Residence Or Principal Residence