Certification Of Nonforeign Status Form
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1Certification of Nonforeign Status
(Individual)
Section 1445 of the Internal Revenue Code provides that a transferee (buyer) of a U.S. real property interest
must withhold tax if the transferor (seller) is a foreign person. To inform the transferee (buyer) that
withholding of tax is not required upon our disposition of a U.S. real property interest, we,
____________________________________________________________________, hereby the following:
1. We are not nonresident aliens for purposes of U.S. income taxation.
2. Our U.S. taxpayer identifying numbers are:
______________________________________
______________________________
Name
Social Security Number
______________________________________
______________________________
Name
Social Security Number
3. Our home address is:
______________________________________________________________________________
______________________________________________________________________________
We understand that this certificate may be disclosed to the Internal Revenue Service by the transferee and
that any false statement we have made here could be punished by fine, imprisonment, or both.
Under penalties of perjury we declare that we have examined this certification and to the best of our
knowledge and belief it is true, correct, and complete.
Dated: ______________________________________
Signature: ____________________________________
Signature: ____________________________________
State of
) Ss..:
County of
)
On this _____ day of _____________, in the year ______, before me, the undersigned,
personally appeared ______________________________________________________, personally
known to me or proved to me on the basis of satisfactory evidence to be the individual(s)
whose name(s) is (are) subscribed to the within instrument and acknowledged to me
that he/she/they executed the same in his/her/their capacity(ies), and that by
his/her/their signature(s) on the instrument, the individual(s), or the person on behalf
of which the individual(s) acted, executed the instrument.
____________________________
Notary Public
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