California Form 597-W - Withholding Exemption Certificate And Nonresident Waiver Request For Real Estate Sales Page 2

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Part II Nonresident Withholding Waiver Request (please print or type)

Seller’s Information

Name of seller (see instructions if more than one)

Seller’s social security number (SSN)

Seller’s Entity Type

Individual(s)

Mailing address

PMB no.

California corporation no.

FEIN

Corporation

S Corporation

City, state, and ZIP Code (province, country, and postal zone)

Seller’s spouse’s SSN (if applicable)

Estate

Trust

Phone number

Ownership

Seller’s email address

percentage

(

)

Property Information

Property Address (if no street address, provide parcel number and county):

Seller acquired property by (check one):

Date seller acquired property:

Purchase

Inheritance

Foreclosure/Repossession

Gift

1031 Exchange

call (888) 792-4900 U.S. toll-free

Seller’s adjusted basis:

or (916) 845-4900

Purchase price

$ ____________________________

Other____________________

Add: improvements

____________________________

Use of property at time of sale:

Length of time used for this purpose:

Less: depreciation

____________________________

Rental / Commercial

Adjusted basis

$ ____________________________

Secondary / Vacation home

Years ________ Months _________

Vacant land

Provide all required documentation listed in the instructions. Attach any other

Other (attach explanation)

documents necessary to verify the adjusted basis.

Escrow Information

Name and address of Escrow Company:

Escrow Company email address

Name of Escrow Officer:

Escrow number:

Escrow Company or Officer

FAX number:

telephone number:

(

)

(

)

Contract price (total sale price):

Estimated close of escrow date:

Buyer’s Information

Name of buyer (see instructions if more than one)

Buyer’s social security number (SSN)

Address (number and street, PO box or rural route)

PMB no. (if applicable)

California corporation no.

FEIN

City, state, and ZIP Code (province, country, and postal zone)

Buyer’s spouse’s SSN (if applicable)

State in detail your reason for requesting a withholding waiver or reduced withholding. If there is more than one nonresident seller, attach a separate

sheet listing additional nonresident seller’s information. See instructions for examples of situations for which a waiver or reduced withholding is

allowed and for the required information and documentation.

Attach additional sheets if needed. The FTB cannot make a determination on your request unless you provide all required information and

documentation. See instructions.

Under penalties of perjury, I hereby certify that the information provided above is, to the best of my knowledge, true and correct. If conditions change, I will

promptly inform the withholding agent. I understand that completing this form does not exempt me from filing a California income tax return to report this

sale.

Seller’s name (or seller’s agent if seller is

not an individual) and title (type or print) ____________________________________________________________________________________________

Seller’s Signature ____________________________________________________________________________________ Date: _____________________

Side 2 Form 597-W

597W01209

(REV 2001)