Maryland Form Mw506ae - Application For Certi Cate Of Full Or Partial Exemption - 2009 Page 2

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2009

MARYLAND FORM

Application for Certificate of Full or Partial Exemption

MW506AE

Page 2

Transfer/Sellers Name

Your Social Security Number/FEIN

Reason for Full or Partial Exemption from Withholding

(Attach documentation and calculation)

Amount of Total Payment Subject to Tax is:

Reason for Exemption

None (totally Exempt)

Only a portion

Transfer is to a corporation controlled by transferor for purposes of IRC

$ ______________________

§351:

Transfer is pursuant to a tax-free reorganization for purposes of IRC §351:

$ ______________________

Transfer is pursuant to an installment sale under IRC §453 and the

transferor/seller will receive less than the full purchase price during the

$ ______________________

taxable year.

Transfer is by a tax-exempt entity for purposes of IRC §501(a) and transfer

involves limited or no unrelated business taxable income under IRC §512:

$ ______________________

Transfer is by transferor to a partnership, such that no gain or loss is

recognized on the transfer under IRC §721:

$ ______________________

Transfer is treated as a transfer by a partnership for purposes of IRC §731:

$ ______________________

Transfer is treated as a transfer by a real estate investment trust for purposes

of IRC §857:

$ ______________________

Transfer is a tax-free exchange for purposes of IRC §1031 and is treated as:

simultaneous without boot,

simultaneous with boot, or

delayed, with funds in escrow for acquiring replacement property:

$ ______________________

Transfer is pursuant to a condemnation and conversion into similar property

for purposes of IRC §1033.

$ ______________________

10.

Transfer is between spouses or incidents to divorce for purposes or IRC

§1041:

$ ______________________

11.

Transfer is treated as a transfer by an S corporation for purposes of IRC

IRC §1368:

$ ______________________

12.

Transfer is by transferor to a disregarded entity, classified as such under 26

CFR §301.7701-3, that is solely owned by the transferor:

$ ______________________

13.

Transfer is otherwise fully or partially exempt from the recognition of gain in

accordance with the attached explanation:

$ ______________________

Provide Brief Explanation of Your Reason for Requesting Exemption

Calculation of Tax to be Withheld

1. Enter the amount subject to tax .......................................................................................................................................

2. Enter tax rate, whichever applies.

a. If you are a business entity, enter 8.25%

...........................................................

.......................................

...........................................................

b. If you are an individual, enter 7.50%

3. Amount of tax to be withheld at closing. Line 1 multiplied by line 2. (This line MUST be completed.) ............................

Under the penalties of perjury, I declare that I have examined this application, including any schedules or statements

attached, and to the best of my knowledge and belief, it is true, correct and complete. If prepared by a person other

than taxpayer, the declaration is based on all information of which the preparer has any knowledge.

_____________________________________________

___________________________ ___________________________