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FORM REW-1

2005

REAL ESTATE WITHHOLDING RETURN

*0501400*

FOR TRANSFER OF REAL PROPERTY

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. Check space to indicate whether seller is:

Other

Grantor

Check here if

Individual

Partnership

C Corp

S Corp

Trust

Estate

Other

installment sale

2. Name of person or entity subject to withholding (seller). Corporations and trusts must enter federal ID number on line 3.

Last name or entity name

First name

M.I.

Spouse’s last name (if filing jointly)

Spouse’s first name

M.I.

3. Social Security number of seller (if applicable)

Federal ID number of seller (if applicable)

Taxpayer:

Spouse:

Address (number and street)

City

State

ZIP Code

6. Location, description and use of property

7. Date property acquired by seller

10. Percentage of total gross

8. Date of transfer

9. Total consideration

proceeds received by this seller

12. Amount withheld for this seller

11. Rate of withholding

a. 2.5% of sales price

Make check payable to:

b. Less than 2.5% - attach withholding certificate;

TREASURER, State of Maine.

(Enter certificate number ____________________ )

13. Name of withholding agent (buyer or other transferee)

14. Social Security no./Federal ID no.

15. Address (number and street)

16. City, state and 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 is held jointly

Date

Signature of real estate escrow person

Date

Real estate escrow person’s FIN or Social Security number

Real estate escrow person’s daytime phone number

Seller’s daytime phone number

Maine Revenue Services

Tel. 207-626-8473

Overnight delivery address:

Mail this form

Income/Estate Tax Division - REW

Fax 207-287-4028

26 Edison Drive, Augusta, ME 04330

and your check to:

P.O. Box 1068, Augusta, ME 04332-1068

DO NOT SEND CASH - Write seller’s social security number on the check

NOTE: Payments received by Maine Revenue Services will not be refunded prior to filing of the taxpayer’s Maine income tax return.

(Any claim for refund of an overpayment of this withholding must be filed within three years from the time the return was filed or three years

from the time the tax was paid, whichever expires later.)

Rev. 10/04

Form Rew-1 - Real Estate Withholding Return For Transfer Of Real Property - Maine Revenue Services - 2005

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