your name - connecticut

REQUEST FOR QUOTATION FORM INSTRUCTIONSSTO-93 REV. 8/89 STATE OF CONNECTICUT Please quote us your prices on the commodities listed

(STOCK NO. 6938-69-01) below. All prices must be F.O.B. Destination and you Since the State of Connecticut is exempt from the

must show Unit Price, Amount and Total or bid may be payment of Federal Excise Taxes and the Connecticut

rejected. Sales Tax, do not include such taxes.

NO. 1 PRINT THE FOLLOWING INFORMATION:The undersigned bidder affirms and declares:

VENDOR NAME:_____________________________ That this quotation is executed and signed by said

bidder with full knowledge and acceptance of the

YOUR NAME: provisions of Form SP-7A of current issue and in

effect on the date of bid issue. Form SP-7A,

YOUR PHONE #:_____________________________ entitled Standards Bid and Contract Terms and

Conditions, together with the Commodity

YOUR FAX #:________________________________ Specifications, Proposal Schedule, and Special

Bid and Contract Terms and Conditions are made

a part of this request for quotation.

YOUR E-MAIL ADDRESS:___________________________________________

This is not an order. Fill in and return to STATE OF CONNECTICUT at the address shown below.

ISSUED BY (AGENCY) AGENCY NUMBER RETURN BID ATTENTION OF BID NO. AND OR REQUISITION NO.

Department of Revenue DRSM1 Ellen Betti DRS_0627_0050 AGENCY ADDRESS CITY STATE ZIP CODE DATE ISSUED

25 Sigourney Street Hartford Connecticut 06106-5032 JUNE 27, 2008SHIP PREPAID TO THE ATTENTION OF MIKE SIROIS AT THE ABOVE AGENCY / ADDRESS: DATE AND TIME BID REQUIRED

Call Bruce Herriott @ 860-297-5724; to schedule a date / time for delivery. JULY 09, 2007 @ 5:00 p.m.

E-MAIL PHONE FAX DATE MATERIAL REQUIRED

[email protected] 860-297-5765 860-297-5703 A.S.A.P.ITEM To be completed by bidder

NO. DESCRIPTION UNIT QUANTITY Unit Price / Amount

1 PRINTING - OP-236 REAL ESTATE CONVEYANCE TAX RETURN M 150 $ $REV. 07/07 - (4 PART - NCR SNAP SET), 1 COLOR INK: BLACK INK,MARGINAL WORD(S) ON PAGE 2 (OPM COPY), PAGE 3 (ASSSESSOR COPY) AND PAGE 4 (TOWN CLERK COPY) ARE PRINTED IN RED.SIZE: OVERALL: 8-1/2" X 11-3/4" / DETACHED: 8-1/2" X 11"

PAGE 1 - PRINTING FRONT: COLOR: WHITEPAGE 2 - PRINTING FRONT: COLOR: YELLOWPAGE 3 - PRINTING FRONT: COLOR: BLUEPAGE 4 - PRINTING FRONT: COLOR: PINK

SUCCESSFUL VENDOR WILL RECEIVE A CAMERA READY COPYFOR THE PRINTING OF THE FORM AND WILL BE REQUIRED TO PROVIDE THE DEPT. WITH TWO BLUELINE PROOFS BEFORE PRINTING.IMPORTANT: FORMS ARE TO BE PACKAGED ACCORDINGLY: 150,000 TO BE PACKAGE IN GROUPS OF 50 (3,000 PACKAGES TOTAL) ***PACKAGES ARE TO BE SHRINK WRAPPED***

2 SHIPPING MUST BE INCLUDED IN YOUR BID; F.O.B. DESTINATION. $ Included $ includedYOU MAY FAX OR E-MAIL YOUR QUOTE ALONG WITH A COPY OF YOUR SBE/MBE CERTIFICATE - SEE ABOVE.

To be QUOTATION NO./DATE SUBMITTED DELIVERY TIME FRAME:

completed TOTAL

by bidder SIGNED TITLE TELEPHONE NO. AND EXTENSION CASH DISCOUNT PAYMENT TERMS

% DAYS NET 45 DAYS

VENDOR FEIN/SSN ARE YOU INCORPORATED PURCHASE ORDER ADDRESS (If different from bidder's address above)

YES NO

Department of Revenue ServicesState of ConnecticutPO Box 5035Hartford CT 06102-5035

(Rev. 07/07)

1. Town

~

OP-236RealEstateConveyanceTaxReturn Page

4. Grantor/Seller #1 (Last Name, First Name, Middle 1nitial)~

6. Address (Number and Street) (Mailing Address After Conveyance)~

8. Grantor/Seller #2 (Last Name, First Name, Middle Initial)~


If more than two grantors/sellers, check here. AttachOP-236 Schedule A to provide required information.

0 SSN

D.FEINZIP CodeState

11. City or Town~

9. Taxpayer Identification Number 0 SSN

~ 0 FEINState ZIP Code

12. Is grantor a partnership, S corporation, 13. Is this conveyanceLLC,estate, or trust? See instructions. between spouses?

~ 0 Yes 0 No ~ 0 Yes 0 No

15. Grantee/Buyer (Last Name, First Name, Middle Initial)~

17. Address (Number and Street)~

14. If this conveyance is for no consideration or less than adequate consideration,will federal and state gift tax returns }:Ie filed?

~ 0 Federal Only 0 State Only 0 Both 0 Not Applicable

16. Taxpayer Identification Number~

19. Date Conveyed~ ,22. The grantor claims no tax is due becausE

~ 22a. 0 Conveyance was for no co

~ 22b. 0 Conveyance is exernpt un C

~ 22c. If 22b exemption code is 01 9, I

Com tation of Tax Enter consideration for conveyance on the appropriate line.

~ 23. Consideration for unimproved land: See Line Ins cti s. $ x 0.005~ 24. Total consideration for residential dwelling: See L tructions. $~ 24a. Portion of Line 24 that is $800,000 or less: See Line nstructions. $

~ 24b. Portion of Line 24 that exceeds $800,~0: See Line Instructions.~ 25. Residential prope other a eside'imal d IIing~ 26. Nonresidential pr t n unimpr a~ 27. Property convey d ag uctions.~ 28. Total State of Cali rough 27.

Declaration: I declare under penalty 0 law that I have examined this return and, to the besunderstand the penalty for willfully delivering a false return to DRS is a fine of not more than

State

0 SSN

0 FEIN

ZIP Code

Quitclaim 0 Easement 0 Other

=$

=$=$=$=$=$

$

e and belief, it is true, complete, and correct Ionment for not more than five years, or both.

x 0.005x 0.01x 0.005x 0.01x 0.005

Name (Type or Print) Title

Name of Grantor's Representative (Type or Print)

DateSignature

~Provide Connecticut Juris No. (If Applicable) Telephone No.

General Instructions

All entries must be printed legibly in blue or black ink or typed on City or Town Clerk: Mail this tax return and check to thethe multi-page Form OP-236 furnished by the Department of Commissioner of Revenue Services at the address listed aboveRevenue Services (DRS). not later than ten days after receipt. You must complete the volume

and page reference in the box marked For Town Clerk Use Only.Do not staple the check to the return.

Forms and Publications: To order real estate conveyance taxreturns or copies of the real estate conveyance tax regulationsand special notices, call DRS at 1-800-382-9463 (Connecticut callsoutside the Greater Hartford calling area only) or 860-297-5962(from anywhere). TDDITTusers only call 860-297-4911. If you needinformation or assistance, call the Public Services Taxes Unit at860-541-3225, Monday through Friday, 8:30 a.m. to 4:30 p.m.Visit the DRSwebsite at www.ct.govIDRS to preview and downloadForms AU-263 and OP-236 Schedule A as well as other DRSpublications.

Line Instructions: Line instructions for completing Form OP-236are available separately on the DRS website at www.ct.govIDRSor at your city or town clerk's office.

Grantor, Grantor's Attorney, or Grantor's Authorized Agent:You must submit a completed tax return to the city or town clerkwith a check for the amount on Line 28 payable to: Commissionerof Revenue Services.

Declaration: The grantor, grantor's attorney, or grantor'sauthorized agent must sign the return.

Amended Return: If this is an amended tax return, mail it directlyto: Department of Revenue Services, PO Box 5035, Hartford CT06106-8207. Do not send the return to the city or town clerk.Remit the state tax due with an amended return, including interest,to DRS. Make the check payable to Commissioner of RevenueServices. Include the original volume and page of the recordeddeed on the amended return.

State of ConnecticutProperty Sales- Assessment Data

M-45 (Rev. 07/07)

1. Town~

State of Connecticut

Office of Policy and Manageme450 Capitol Ave.~'v1S#54FOR

Hartford CT 06106-13C~

Page

4. Grantor/Seller #1~


8. Grantor/Seller #2 (Last Name, First Name, Middle Initial)~


State ZIP Code



~9. Date Conveyed I

22. The grantor claims no tax is due because: (If pp

~ 22a. 0 Conveyance was for no consi n

~ 22b. 0 Conveyance is exempt under onn~ 22c. If 22b exemption code is 01 or 0 ent

Computation 0 Tax,~ 23. Consideration for unimproved land .

~ 24. Total consideration for residential dwelling: See Line 1"W"°ns.~ 24a. Portion of Line 24 that is $800,000 or less: See Line Instructions.~ 24b. Portion of Line 24 at ex eds $800,000: See Line Instructions.

~ 25. Residential propert e than reside"ial 'welling~ 26. Nonresidential propert er t~ unilpr~d I~ 27. Property conveyed by a elin~ 28. Total State of Connecti t Tc

Declaration: I declare under punderstand the penalty for willfj

18. City or Town~

State ZIP Code

0 Easement 0 Other

consKferation for conveyance on the appropriate line.$ x 0.005$$$$$$

=$

=$=$= $=$=$

$

.ef, it is true, complete. and correct. Inot more than five years, or both.

DateTitle SignatureName (Type or Print)

~Provide Connecticut Juris No. (If Applicable) Telephone No.Name of Grantor's Representative (Type or Print)

"C >-c: -CI> co c:..c: >- 0- (,)->-= c:.Q 0 CI>CI>0.. E1/1 CI>:J 0 CI.. CI> co0 (,) c:

U. .- CIS~ :E0

Town Code

# of four

0 family unitbuildings

Serial Number

Residential Commercial Industrial Use Assessment

~c:0CI>1/1:JIII

-..0IIIIIICI>IIIIII«..0u.

ResidentialTransactionsOnly

# of singlefamily unitbuildinQs

# of two # of three

0 family unit 0 family unitbuildings buildings

Total Assessed Value

Field Card No.Block

0 Usable 0 Non-UseableRemarks or Explanation

~.Non-Useable Code Number

Verify:

0 Total Sales Price 0 Assessor's Section Incomplete 0 Property Class 0 Mobile Home 0 Assessed Value 0 Non-Useable Code Number

Final Check By I Date IVerification Code INon-Useable Code Number IVerified Sales Price~ ~ ~

Verification Data From:

Remarks

0 Deed 0 Town Clerk 0 Assessor 0 Grantee 0 Other (Explain)0 Grantor

Ratio

Useable 0 Yes 0 No

C:COpo- Re.d Ink....


Property Sales - Assessment Data

M-45 (Rev. 07/07)

1. Town~

. State of Connecticut

Office of Policy and Manageme450 Capitol Ave.-.'\t1S#54FOR

Hartford CT 06106-13e~

Page

4. Grantor/Seller #1~.

6. Address (Number and Street) (Mailing Address After Conveyance)~ .

7..City or Town.~

State ZIP Code

8. Grantor/Seller #2 (Last Name. First Name, Middle Initial)~


State ZIP Code

15. Grantee/Buyer (Last Name. First Name, Middle Initial)~


19. Date Conveyed~ .22. The grantor claims no tax is due because: (If

~ 22a. 0 Conveyance was for no consid~

~ 22b. 0 Conveyance is exempt under'

~ 22c. If 22b exemption code is 01 or 0

Computation of Tax~ 23. Consideration for unimproved land

~ 24. Total consideration for residential dwelling: See~ructions.~ 24a. Portion of Line 24 that is $800,000 or less: See Line .Instructions.~ 24b. Portion of Line 24 that e

Re $80

1

00: See. Line Instructions.

~ 25. Residential property oth resi ntial dwelling~ 26. Nonresidential property an u proved Ian

~ 27. Property conveyed by a Ii t rtgj~ 28. Total State of Connecti a ue: d

18. City or Town~

State ZIP Code

0 Easement 0 Other

om reverse.

=$

=$=$=$=$=$

$

and belief, it is true, complete, and correcl. Iment for not more than five years, or both.

x 0.005x 0.01x 0.005x 0.01x 0.005

Title Signature DateName (Type or Print)

~Provide Connecticut Juris No. (If Applicable) Telephone No.Name of Grantor's Representative (Type or Print)

"0 >-c: -CD co c:

..c: >- 0- U->-:= c:

.Q 0 CDCD D.. EIII '+- CD:JOg)... CD co0 u c:U. .- CI'I

t::iE0

Town Code

Use Assessment

Serial Number

Residential Commercial Industrial~c:0CDIII::IIII

-...0IIIIIICDIIIIII«...0u.

Residential

Transactions Only

# of singlefamily unitbuildinas

# of two # of three



# of four


Lot Field Card No.Block

0 Usable 0 Non-UseableRemarks or Explanation

Non-Useable Code Number

Verify:0 Total Sales Price 0 Assessor's Section Incomplete 0 Property Class 0 Mobile Home 0 Assessed Value 0 Non-Useable Code Number


Verification Data From:

Remarks

0 Deed 0 Town Clerk 0 Assessor 0 Grantor 0 Grantee 0 Other (Explain)

Ratio

Useable 0 Yes 0 No----

RL& Tnk.......

State of ConnecticutProperty Sales - Assessment Data

M-45 (Rev. 07/07)

III .. ..


Office of Policy and .Manageme450 Capitol Ave. -MS#54FOR

Hartford CT 061.D6-13(?~

Page

0 Check here if this is an amended return.

If more than two grantors/sellers. check here. AttachOP-236 Schedule A to provide required information.

1. Town~

4. Grantor/Seller#1~

6. Address (Number and Street) (Mailing Address After Conveyance)~ .

8. Grantor/Seller #2 (Last Name, First Name, Middle Initial)~ .

7. City or Town.~

State ZIP Code


State ZIP Code



19. Date Conveyed~

22. The grantor claims no tax is due because: (If a

~ 22a. 0 Conveyance was for no conside-

~ 22b. 0 Conveyance is exempt under Cor~ 22c. If 22b exemption code is 01 or 09, e

Computation of~ 23. Consideration for unimproved land~ 24. Total consideration for residential dwelling: See Line I'~ 24a. Portion of Line 24 that is $ ,000 or less: See Line Ins~ons.~ 24b. Portion of Line 24 that $800,000: See Line Instructions.

~ 25. Residential property oth 'sidential dwe~ 26. Nonresidential propert thaa. ua..wved~ 27. Property conveyed by a linqu~ 28. Total State of Connecti Tax

Declaration: I declare under penalty of w that I havi!" exa)understand the penalty for willfully delivering a false return to

State ZIP Code

20. Date Recorded~ Quitclaim D Easement 0 Other

r. exemption co'r,

consideration for conveyance ""on the appropriate line.$ x 0.005$$

verse.

=$

=$=$=$=$

=$_----$

e and belief,. it is true, complete, an'd correct.Inment for not more than five years, or both.

x 0.005x 0.01

x 0.005x 0.01x 0,005

DateTitle SignatureName (Type or Print)

~Provide Connecticut Juris No. (If Applicable) Telephone No.Name of Grantor's -Representative (Type or Pdnt)

"'C >-c: -Q.) CIS c:J:: >- 0

() ....>-:: c:.Q 0 Q.)Q.) 0.. EVI - Q.);j 0 C).. Q.) CIS0 () c:U. .- (\I

== ~0

Town Code

# of four


Serial Number

-Residential Commercial Industrial Use Assessment

~c:0Q.)VI;jVI1-0VIVIQ.)VIVI«..0u.

ResidentialTransactions Only

# of singlefamily unitbuildinos

# of two # of three



Field Card No.Block

D Usable D Non-UseableRemarks or Explanation

~

Non-Useable Code Number

Verify:0 Total Sales Price 0 Assessor's Section Incomplete 0 Property Class 0 Mobile Home 0 Assessed Value 0 Non-Useable Code Number


Verification Data From: 0 Deed 0 Assessor 0 Grantor 0 Grantee 0 Other (Explain)0 Town Clerk

Remarks Ratio

Useable 0 Yes 0 No

''''-'''-' '

~Ld Ink-.J.

CT SET-AsIDE NOTICE

This Invitation to Bid (ITB) IS LIMITED TO CONNECTICUT VENDORS that arecurrently CERTIFIED through the Department of Administrative Services (DAS) as acertified Small Business Enterprise (SBE) or Minority Business Enterprise (MBE).

When a Bid. is identified as being limited to SBE or MBE vendors, Bidders are required toprovide a copy of the company's current Set-Aside certification. Bids received bynon-certified companies cannot be considered..

----------------------------------------------------------------------------------------------------

Only Vendors that are Certified by the Department of Administrative Services as meetingthe minimum requirements as Small Business, as deemed by Chapter 578, section 32-geof the General Statutes of the State of Connecticut as revised, may participate in the"Set-Aside" program.

Questions about the Set"'-Aside program and requests for forms required for certificationshould be directed to the:

Department of Administr.ative ServicesBusiness CONNections/Set-AsIde Unit, Rm. G-8A165 Capitol AvenueHartford, CT. 06106(860) 713-5236 Meg Yetishefsky- Program Director

DAS Set-Aside Program Websitehttp://www.das.state.ct.us/Purchase/SetAside/index.html

your name - connecticut

Documents