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North Carolina G.S. 105-361. (a)

Duty to Furnish Certificate. On the request of any of the persons prescribed in subdivision (a) (2), below, the tax collector shall furnish a written certificate stating the amount of taxes and special assessments for the current year and for prior years is his hands for collections (together with any penalties, interests, and costs accrued thereon) including the amount due under G.S. 105-277.4 (c) if the property should lose its eligibility for the benefit of classification under G.S. 105-277.2 et seq. that are a lien on a parcel of real property in the taxing unit.

Duty of Person making Request. With respect to taxes, the collector shall not be required to furnish a certificate unless the person making the request specifies in whose name the real property was listed for taxation for each year for which the information is sought. With respect to assessments, the tax collector shall not be required to furnish a certificate unless the person making the request furnishes such identification of real estate as may be reasonably required by the tax collector.

Buyer(s): ___ Deed Book & Pages: ___

Parcel ID # ___ (One Parcel per form please.) Original Deed must have Parcel Number included.

Name Of Current Owner(s): ___

Is the Parcel to be conveyed ☐ in whole or ☐ in part?

Is there a manufactured home on the property? Make And Model

Property Owners(s) for the past 10 years:

Year Name Parcel Number (Office use only)

_____

Date Signature:

ation must be filled out before the Tax Department can certify th

(Fax 336-401-8132)

(Fax 336-401-8132)

Surry County Deed And Tax Certification (Office use Only)

Property Description: ___

Parcel ID#: ___ Township:

Real Valuation: $

Personal Valuation: $

Exemptions: $ ___

Value Of Manufactured Home: __Deferred: ___

Statement Of Taxes Due

Year Name

Total Due

2023

Total Due

____

___ ___

_____

____

___ ___

___

___

I am

Other Personal Property Taxes Due: ___

Total Dues As Of ___ $ ___

Additional Cost And/Or Interest Will Be Added: ___

G.S. 105-277.4

Deferred taxes in the amount of $_____ plus interest will become due upon disqualification of Use Value Assessment. I certify that in accordance with G.S. 105-361, the above is a true statement of the tax status for individual(s) listed above, in my hands for collection.

Date Signature:

2023

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