FORM REW-1-1040
MAINE REVENUE SERVICES
99
2011
REAL ESTATE WITHHOLDING RETURN
FOR TRANSFER OF REAL PROPERTY
*1101401*
For sellers who are individuals or sole proprietors
TO BE COMPLETED BY THE BUYER OR OTHER TRANSFEREE REQUIRED TO WITHHOLD
For MULTIPLE SELLERS, complete a separate Form REW-1 for each seller receiving proceeds.
1. Use Form REW-1-1040 only for sellers who are individuals or sole proprietors.
Check here if
2. Name of seller subject to withholding.
installment sale
Seller’s Last Name
First Name
M.I.
Spouse’s Last Name (if fi ling jointly)
Spouse’s First Name
M.I.
3. Enter the social security number(s) of the seller and the seller’s spouse.
-
-
-
-
Seller’s Social Security Number
Spouse’s Social Security Number
4. Address of seller
Number and street
City
State
ZIP Code
5. Seller’s daytime telephone number:
6. Date of transfer
7. Total consideration
8. Percentage of total gross
proceeds received by this
$
,
,
.00
,
%
seller ...............................
9. Physical location and use of property
10. Date property acquired by seller
11. Rate of withholding
12. Amount withheld for this seller:
$
,
,
,
.00
a. 2.5% of sales price
DO NOT SEND CASH -
Make check payable to: Treasurer, State of Maine.
b. Less than 2.5% - attach withholding certifi cate
Write seller’s social security number on the check.
(Enter certifi cate number: _______________________)
13. Name of Buyer (Withholding agent or other transferee)
14. Address of Buyer/Withholding Agent
Number and street
15. Social security number/federal ID number of withholding agent
City
State
ZIP Code
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my
knowledge and belief, they are true, correct and complete.
_______________________________________
_______________
____________________________________________
______________
Signature of buyer
Date
Signature of buyer’s spouse if property held jointly
Date
_______________________________________
_______________
____________________________________________________________
Signature of real estate escrow person
Date
Real estate escrow person’s EIN or social security number
________________________________________________________
_____________________________________________________________
Real estate escrow person’s daytime phone number
Real estate escrow person’s address
NOTE: Payments received by Maine Revenue Services will not be refunded prior to fi ling of the taxpayer’s Maine income tax return.
(Any claim for refund of an overpayment of this withholding must be fi led within three years from
the time the return was fi led or three years from the time the tax was paid, whichever expires later.)
Mail this form and check to:
Maine Revenue Services, Income/Estate Tax Division - REW, P.O. Box 9101, Augusta, ME 04332-9101
Overnight delivery address:
Maine Revenue Services, Income/Estate Tax Division - REW, 26 Edison Drive, Augusta, ME 04330
Telephone: 207-626-8473
Fax: 207-624-5062
realestate.withholding@maine.gov
Rev. 12/10