Form Rw-171 - Vermont Withholding Tax Return For Transfer Of Real Property Page 2
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4*081711200*
REW - SCHEDULE A
FILE ORIGINAL ONLY. DO NOT COPY. ATTACH TO RW-171, PAGE 1
* 0 8 1 7 1 1 2 0 0 *
PLEASE TYPE OR PRINT CLEARLY. USE BLUE OR BLACK INK ONLY.
TO BE COMPLETED BY THE BUYER OR OTHER TRANSFEREE REQUIRED TO WITHHOLD
1.
Check box to indicate whether SELLER is:
Individual(s)*
C-Corporation**
Composite Business Entity**
* Partnerships, S-Corporations, Trusts & LLC’s check “Individual(s)” and complete a Schedule A for each individual receiving proceeds from the sale.
** C-Corporation and Composite Business Entity please see Line 1 instructions.
2.
3.
Taxpayer’s Social Security Number
Spouse’s Social Security Number
Federal ID number of seller (if applicable)
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-
-
-
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4.
Taxpayer’s Last Name
First Name
Initial
Spouse’s Last Name
First Name
Initial
C-Corporation Name or Composite Business Entity Name (if checked above)
5.
Mailing Address (Number and Street or Road Name)
6.
City or Town
State
Zip Code
-
Check if this is an INTERNATIONAL address
7.
Location and description of property
8.
9.
10.
Date property acquired by seller
Date of transfer
Total consideration
,
.
,
11.
12.
Percentage of total gross proceeds received by this seller
Amount withheld for this seller
.
%
,
,
.
Pass-through information. If the individual above is a shareholder, partner or member of an S-corporation, Partnership or Limited Liability
Company and sold the real property, please identify the business. Do not complete Lines 13 & 14 if composite entity is checked on Line 1.
13.
Name of Business
14.
Federal ID number
-
DO NOT COPY. For additional Schedule “A”s, call (802) 828-2515.
Form RW-171
PAGE 2
(Rev. 11/08)
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