Form R-5e - Virginia Nonresident Real Property Owner Exemption Certificate printable pdf download

Form R-5e - Virginia Nonresident Real Property Owner Exemption Certificate

Virginia Department of Taxation

Form R-5E

1501234 10/11

Nonresident Real Property Owner Exemption Certificate

Part VII. Exempt Transfers of Real Property

Part I. Owner/Seller

SSN, Fed. Employer Identification #, or Virginia Business Account #

Gain on sale of principal residence up to

$250,000 ($500,000 on joint return) exclud-

Name

ed from income pursuant to IRC § 121.

(If Trust) Name and Title of Fiduciary

Like-kind exchange under IRC § 1031.

Address (of Fiduciary if Trust) Number & Street or Rural Route & Box #

Involuntary conversions eligible for tax

City or Town, State and ZIP Code

deferral under IRC §§ 1033 & 1034.

(

)

Daytime Phone Number

Tax free gift or inheritance under IRC §

Part II. Type of Entity (check one)

102.

Individual

C-Corp.

Tax free contribution for partnership interest

under IRC § 721.

Trust/Estate

Partnership

Transfer of property pursuant to tax-free

LLC

S-Corp

corporate reorganization.

Part III. Property Information

Tax free contribution to corporation in ex-

Legal Description

change for stock under IRC § 351.

Address (Number and Street or Rural Route and Box Number)

Other transactions not subject to federal or

Virginia income taxes. Explain: _________

City or County

___________________________________

Part IV. Transaction Type (Check one)

___________________________________

Sales

Rental

Part V. Broker or Real Estate Reporting Person

For Assistance:

SSN, Fed. Employer Identification #, or Virginia Business Account #

Write to:

Department of Taxation

Office of Customer Services

Name

P. O. Box 1115

Richmond, VA 23218-1115

Address (Number and Street)

Call:

804-367-8031

City or Town, State and ZIP Code

Internet:

To get forms: 804-440-2541

Part VI. Exemption for rental/lease gross annual

payments of less than $600..................

I, the undersigned, hereby certify that the condition cited applies to the property described herein and that this

transaction, property and/or income is exempt from the Nonresident Real Property Owner Registration Re-

quirements.

Signature___________________________________________ Date _____________________

Mail this certificate to: Department of Taxation, P. O. Box 2390, Richmond, VA 23218-2390

Form R-5e - Virginia Nonresident Real Property Owner Exemption Certificate

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