SELLER'S CERTIFICATE INFORMATION FOR IRS FORM 1099-S FILING as Required by Section 6045(e) of the Internal Revenue Code You are required by law to provide Goodwin Procter with your correct taxpayer identification number and certain other information. If you do not provide Goodwin Procter with (i) your correct taxpayer identification number and (ii) the information provided below, both to the best of your knowledge, you may be subject to civil or criminal penalties imposed by law. TRANSACTION INFORMATION: Closing Date: _______________ Contract Sales Price: $_______________ Additional Property/Services Received by Seller as Consideration: If more than one Seller, proceeds allocated to this Seller: $_______________ Description of Property (Street Address or brief form of legal description): Prior to this transaction, was the subject property the Seller's principal residence? / / YES / / NO
FOR RESIDENTIAL TRANSACTIONS ONLY: Amount of pre-paid real estate property taxes charged to Buyer at Settlement: $_____ Was the Seller's financing (if any) federally-subsidized indebtedness? /__/ YES /__/ NO
SELLER NAME, ADDRESS AND FEDERAL TAX IDENTIFICATION NUMBER: Name: ______________________________________________ Street: ____________________________________________ City: ___________________ State: ___ Zip Code: ____________ Taxpayer ID Number(s): ______________________ 1
099998.000522 DEC LIBD/70823.2 10/18/01 02:25 pm
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Taxpayer ID Type (check one): / / Business / / Individual
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SELLER CERTIFICATION: Under penalties of perjury, I certify that the number shown on this form is my correct Federal Taxpayer Identification Number and that the other information is correct to the best of my knowledge.
By: _____________________
DATE:
REPORTING PERSON NAME, ADDRESS, AND FEDERAL TAX IDENTIFICATION NUMBER: Name: Street: City: Zip Code: Taxpayer ID Number(s): Taxpayer ID Type (check one): / / Business / / Individual State:
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099998.000522 DEC LIBD/70823.2 10/18/01 02:25 pm
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