Form Wv/nrae - Application For Certificate Of Full Or Partial Exemption printable pdf download

WV/NRAE

APPLICATION FOR CERTIFICATE OF

REV 4-08

FULL OR PARTIAL EXEMPTION

MAIL TO: WV STATE TAX DEPARTMENT, IAD/WITHHOLDING, PO BOX 784, CHARLESTON WV 25323-0784

FOR CALENDAR YEAR 2008 OR OTHER TAX YEAR BEGINNING

AND ENDING

YYYY

This form is to be used only to request a Certificate of Full or Partial Exemption from the withholding requirements on the proceeds of the sale or

exchange of real property and associated tangible personal property in West Virginia by nonresident individuals and nonresident entities. This form

must be RECEIVED by the WV State Tax Department, Internal Auditing Division no later than 21 days before the closing date.

For MULTIPLE TRANSFEROR/SELLERS complete a separate Form WV/NRAE for each one receiving proceeds.

TRANSFEROR/SELLERS INFORMATION

YOUR SOCIAL SECURITY NUMBER

NAME (If joint, give first names and initials of both)

LAST NAME (Give spouse’s last name, if different)

NAME (Corporation, Partnership, Trust, Estate, etc.)

SPOUSE’S SOCIAL SECURITY NUMBER

CORPORATE OFFICER, PARTNER, TRUSTEE, EXECUTOR OR ADMINISTRATOR

FEDERAL EMPLOYER ID NUMBER

ADDRESS (Number and street)

CITY, STATE AND ZIP CODE (province, postal code and country)

Ownership Percentage

Transferor/Seller’s Entity Type

Limited Liability

Individual

Corporation

S Corporation

Partnership

Company

Limited Liability Partnership

Business trust

Estate

Trust

Other

PROPERTY INFORMATION

DATE OF CLOSING

DESCRIPTION OF PROPERTY (Include address, or county, district, partial or sub-partial if no

address is available)

YYYY

CONTRACT SALES PRICE

PROPERTY ACCOUNT ID NUMBER

Transferor/Seller acquired property by:

Transferor/Seller’s Adjusted Basis:

Purchase

1031 Exchange

Foreclosure/Repossession

Purchase price.........................

Gift

Inheritance

Other

Add: capital improvements

and settlement costs......

Use of property at time of sale:

Vacant

Secondary/

Rental/

Other ____________

Land

Vacation

Commercial

Less: depreciation (if any).......

Length of time used for this purpose: Years_________ Months__________

Adjusted basis..........................

TRANSFEREE/BUYER’S INFORMATION

NAME (If joint, give first names and initials of both)

LAST NAME (Give spouse’s last name, if different)

CORPORATE OFFICER, PARTNER, TRUSTEE, EXECUTOR OR ADMINISTRATOR

ADDRESS (Number and street)

CITY, STATE AND ZIP CODE (province, postal code and country)

Transferee/Buyer’s Entity Type

Business

Individual

Partnership

Trust

Corporation

Limited Liability

*B57040801A*

Estate

Company

Limited Liability

S Corporation

Other _____________

Partnership

Form Wv/nrae - Application For Certificate Of Full Or Partial Exemption

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