FIRPTA AFFIDAVIT
Date:
PROPERTY ADDRESS:
ESCROW NUMBER:
LEGAL DESCRIPTION:
Section 1445 of the Internal Revenue Code provides that a transferee (Buyer) of a U.S. real property interest must withhold tax if transferor (Seller) is a foreign person. To relieve the transferee of any withholding tax obligation with respect to the sale of the Property, the transferor hereby certifies to the transferee the following:
1. That transferor (Seller):
Is not a foreign person, foreign corporation, foreign partnership, foreign trust, or foreign estate (as those terms are defined in the Internal Revenue Code and Income Tax Regulations);
2. That transferor's (Seller) tax payer identification number or social security number is:
_____________________________________________________** See below for Multiple Sellers
3. That transferor's address is:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Transferor understands that this certification may be disclosed to the Internal Revenue Service by various parties to the closing, including, but not limited to the transferor's attorney, transferor, brokerage agents, and the title company, their successors or assigns, and that any false statement contained herein could be punishable by fine, imprisonment or both.
The understanding declares that the undersigned has examined this certificate and to the best of the undersigned's knowledge and belief is true, correct and complete and further declares that the undersigned has authority to sign this documents on behalf of transferor (Seller).
________________________________________________ _____________________________________
STATE OF _____________ )
) ss.
COUNTY OF _____________ )
The foregoing instrument was acknowledged before me this _____________ day of _____________, _____________ by ________________________________________________________________________________________.
WITNESS MY HAND AND OFFICIAL SEAL.
_____________________________________________
Notary Public: _____________
My commission expires: _____________
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