Form 1099-S - Proceeds From Real Estate Transactions - 2012 Page 5
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6VOID
CORRECTED
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 C
FILER'S federal identification number
TRANSFEROR'S identification number
3
Address or legal description (including city, state, and ZIP code)
For Filer
TRANSFEROR'S name
For Privacy Act
and Paperwork
Reduction Act
Street address (including apt. no.)
Notice, see the
2012 General
Instructions for
4 Check here if the transferor received or will receive
City, state, and ZIP code
Certain
property or services as part of the consideration
▶
Information
Account or escrow number (see instructions)
5 Buyer's part of real estate tax
Returns.
$
1099-S
Form
Department of the Treasury - Internal Revenue Service
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