Fillable Printable Op-236
Fillable Printable Op-236
Op-236
Last name, fi rst name, middle initial Taxpayer identifi cation number
Address after conveyance City or town State ZIP code
Last name, fi rst name, middle initial Taxpayer identifi cation number
Address after conveyance City or town State ZIP code
Last name, fi rst name, middle initial Taxpayer identifi cation number
Address after conveyance City or town State ZIP code
Last name, fi rst name, middle initial Taxpayer identifi cation number
Address after conveyance City or town State ZIP code
Last name, fi rst name, middle initial Taxpayer identifi cation number
Address after conveyance City or town State ZIP code
Last name, fi rst name, middle initial Taxpayer identifi cation number
Address after conveyance City or town State ZIP code
Last name, fi rst name, middle initial Taxpayer identifi cation number
Address after conveyance City or town State ZIP code
SSN
FEIN
SSN
FEIN
SSN
FEIN
SSN
FEIN
SSN
FEIN
SSN
FEIN
Use OP-236 Schedule A to provide the required information if there are additional grantors/sellers. If the grantor is a partnership,
S corporation, limited liability company (LLC), estate, or trust, enter the name, address, and taxpayer identifi cation number of the partners,
shareholders, members, or benefi ciaries. If a partner , shareholder, member or benefi ciary of the grantor is an LLC or a qualifi ed subchapter
S corporation (QSS), enter the name of such entity, its address and tax identifi cation number. Do not combine grantors/sellers and
grantee/buyers on the same schedule.
Town W as the transaction completed on one deed? Date conveyed
Yes
No
Location of property conveyed Date recorded
Name of grantor as shown on the deed
__ __ __ __ __ __ __ __
m m d d y y y y
/ /
__ __ __ __ __ __ __ __
m m d d y y y y
/ /
SSN
FEIN
Department of Revenue Services
State of Connecticut
OP236A 1016W 01 9999
OP-236 Schedule A - Grantors
Supplemental Information for Connecticut
Real Estate Conveyance Tax Return
(Rev. 10/16)
