1099-S INPUT

Company No. Office No. Type Order/Escrow/File Number Actual Closing Date
«VALUE(EOPRC «VALUE(EOID «VALUE(TEXT1,This)» Add «VALUE(TEXT2,This)» Change «VALUE(TEXT3,This)» Delete «VALUE(FILENO,This)» «VALUE(FDSETL,This)»
,This)»
[1] CD,This)»
[2] [3] («VALUE(ESOFINIT,This)
[4] [5]
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SUBJECT PROPERTY INFORMATION

Street Address or Brief Form of Legal Description (for vacant land, use APN)
[6] «IF(PI1ADA>1,PI1ADA,This)» «IF(PI1ADA<1,PI1TXID,This)»
City (for vacant land use county) State Zip
«IF(PI1ADA>1,PI1CTY,This)» «VALUE(PI1STA «VALUE(PI1ZIP,This)»
«IF(PI1ADA<1,PI1CNT,This)» ,This)»
Transaction Data
Contract Sales Price. No. of 1099-S 2 or More 1099-S Buyers Part of Real Contingent Exchange. Was
(Line 401 of HUD-1 Form) forms required Forms. Estate Tax. Show any Transaction. Is this a (or will there be)
Note: If this is an for the sale of If 2 or more 1099-S real estate tax, on a contingent transaction other property or
exchange, provide total this property. forms are required for residence, charged to wherein gross proceeds services received?
dollar value of cash, notes this transaction, record the buyer at settlement. cannot be determined
and debt relief received by the dollar amount for with certainty at time of
this exchanger. this seller based on the closing?
seller’s declaration.

[7] [8] $«VALUE(TEXT5,T $«VALUE(TEXT6,Thi « Yes « Yes

$«VALUE(SALEPRICE, «VALUE(TEX his)» s)» V V
SELLER INFORMATION – PLEASE PRINT CLEARLY
This)» T4,This)» A A
Seller’s Name L L
[9] «VALUE(SENAME,This)» U U
Seller’s Forwarding Street Address E E
«VALUE(SEFADA,This)» ( (
City State
T
Zip (or country if not USA)
T
E E
«VALUE(SEFCSZ,This)»
X X
SELLER’S SOCIAL SECURITY NUMBER T
SELLER’S TAX IDENTIFICATION NUMBER T
[10] «VALUE(SETXID,This)» OR «VALUE(SETRNO,This)»7 8
You are required by law to provide your closing agent with your correct Under penalties of perjury, I certify that the number shown ,above is my
,
T
Taxpayer Identification Number. If you do not provide your closing correct Taxpayer Identification Number. T
agent with your correct Taxpayer Identification Number, you may be h h
subject to civil or criminal penalties imposed by law under the Tax [11] i i
Reform Act of 1986 under Internal Revenue Code Section 6045(E), 6676, √
6722, 6723, and 7203. Seller’s Signature s s Date
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» »
INSTRUCTIONS
A) Make sure all data fields and areas indicated by numbers are accurately completed.
B) If there is more than one seller in this transaction, each seller must have a separate 1099-S form. In most cases a husband and
wife are considered one seller and only one name and corresponding Social Security Number or Tax Identification Number can
appear on this form.
C) Also, if more than one seller, indicate the total number of 1099-S forms required for the transaction and report the correct dollar value for this
seller in area number [8].
D) Make sure all seller’s information (name, forwarding address, Social Security or Taxpayer Identification Number, and seller’s signature) is
obtained. Missing or incorrect information may be subject to IRS penalty.
E) Double check all information for completeness and accuracy before submitting for processing.
Reproduced by «VALUE(UWNAME,This)» 1/2001