Form 1099-S - Proceeds From Real Estate Transactions

Form 1099-S - Proceeds From Real Estate Transactions - 2016 Page 3

CORRECTED (if checked)

FILER'S name, street address, city or town, state or province, country, ZIP

1 Date of closing

OMB No. 1545-0997

or foreign postal code, and telephone number

Proceeds From Real

2016

Estate Transactions

2 Gross proceeds

1099-S

Form

Copy B

FILER'S federal identification number

TRANSFEROR'S identification number

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 or town, state or province, country, and ZIP or foreign postal 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

Form 1099-S - Proceeds From Real Estate Transactions - 2016 Page 3