Form R-5 Virginia Department Of Taxation Nonresident Real Property Owner Registration
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1
2Form R-5
Virginia Department of Taxation
Nonresident Real Property Owner Registration
Do not complete if exemptions on Form R-5E apply
If the property is disposed of by the non-resident payee,
Part I.
Nonresident Payee
indicate the use of the property by the non-resident payee
SSN, FEIN, or Virginia Business Account Number
immediately prior to disposal:
Primary Residence;
Name
Secondary Residence (Vacation Property, etc.) ;
(If Trust) Name and Title of Fiduciary
Leased or Rented property to third-party;
Address (of Fiduciary if Trust) Number & Street or Rural Route & Box #
Other - Describe __________________________
City or Town, State and ZIP Code
Part IV.
Check either Rentals and/or Sales
and complete the appropriate
PARTNERSHIPS, S-CORPORATIONS, ESTATES and
information
TRUSTS must provide the above information on all
Rental
nonresident partners, shareholders, and beneficiaries on
Average Gross Monthly Rental Income . . $
Form R-5P. Substitute schedules may be used provided the
First date property placed in service by
same format is followed.
. . . . . . . (mm/dd/yyyy)
nonresident payee
Part II.
Type of Entity (check one and enter
Sales
total shares)
. . . . . . . . . . . .
Gross Proceeds From Sale
$
Individual
C-Corp.
. . . . . . . . . (mm/dd/yyyy)
Date of closing
Trust/Estate
Partnership
Installment
LLC
S-Corp
. . . (mm/dd/yyyy)
Date payments begin
Check here if filing a unified individual
. . . . (mm/dd/yyyy)
Date payments end
income tax return for nonresident shareholders
or partners
Total number of partners, shareholders or
Part V.
Broker or Real Estate Reporting
. . . . . . . . . . . . . . . . . . . . . .
beneficiaries
Person
SSN, FEIN, or Virginia Business Account Number
Part III.
Property Information
Name
If more than one piece of property is being rented or sold,
attach a separate schedule listing the legal description of
Address ( Number & Street)
each property.
Legal Description
City or Town, State and ZIP Code
Address (Number and Street or Rural Route and Box Number)
Where To Get Help. If you have any questions, call (804)
367-8037 or write to Virginia Department of Taxation, P.O.
City or County and ZIP Code
Box 1115, Richmond, Virginia 23218-1115.
Where To Get Forms. Forms can be downloaded from the
Indicate type of property:
website at or ordered by phone from
Residential
Commercial
Agricultural
the Department of Taxation, 804-367-8031.
Other - Describe __________________________
I, the undersigned, do declare under penalties provided by law the information provided in Parts I, II, III, IV and
V is true, correct and complete to the best of my knowledge and belief.
Signature
____________________________________________________ Date_______________________
Mail this certificate to: Department of Taxation, P. O. Box 1880, Richmond, VA 23218-1880
1501231 Rev. 02/15
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