Form 1099-S - Proceeds From Real Estate Transactions - 2012 Page 3
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1
2
3
4
5
6CORRECTED (if checked)
FILER'S name, street address, city, state, ZIP code, and telephone no.
1 Date of closing
OMB No. 1545-0997
Proceeds From Real
2012
Estate Transactions
2 Gross proceeds
1099-S
$
Form
Copy B
FILER'S federal identification number
TRANSFEROR'S identification number
3
Address or legal description
For Transferor
This is important tax
TRANSFEROR'S name
information and is being
furnished to the Internal
Revenue Service. If you
are required to file a
Street address (including apt. no.)
return, a negligence
penalty or other
sanction may be
4 Transferor received or will receive property or services
City, state, and ZIP code
imposed on you if this
as part of the consideration (if checked)
.
.
▶
item is required to be
reported and the IRS
Account or escrow number (see instructions)
5 Buyer's part of real estate tax
determines that it has
$
not been reported.
1099-S
(keep for your records)
Form
Department of the Treasury - Internal Revenue Service
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