STG Certification - Entity Transferor 1992

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STG Certification - Entity Transferor 1992

Form Document
V 4


Re: Transfer by ______________________ to _____________________ ; Legal
____________________________________ .

Section 1445 of the Internal Revenue Code provides that a transferee of a U.S. real property interest must withhold tax if the transferor is a foreign person. To inform the transferee that withholding of tax is not required upon the disposition of a U.S. real property interest by _____ (name of transferor) _____ , the undersigned hereby certifies the following on behalf of _____ (name of transferor) ____ :

1.  ____ (name of transferor) _____ is not a foreign corporation, foreign partnership, foreign trust or foreign estate (as those terms are defined in the Internal Revenue Code and Income Tax Regulations);

2.  ____ (name of transferor) _____ 's U.S. employer identifying number is ___________________ ; and

3.  ____ (name of transferor) _____ 's office address is ____________________
____________________________________________________________ .

_____ (name of transferor) _____ understands that this certification may be disclosed to the Internal Revenue Service by transferee and that any false statement contained herein could be punished by fine, imprisonment, or both.

Under penalties of perjury, I declare that I have examined this certification and to the best of my knowledge and belief it is true, correct, and complete and I further declare that I have authority to sign this document on behalf of _____ (name of transferor) _____ .




NOTE:  The transferee must retain this certification until the end of the fifth taxable year following the taxable year in which the transfer takes place. The Internal Revenue Service may require this certificate to be filed with it. This certificate is furnished for the information of the transferee; the transferee should seek legal advice as to the effect of same.


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