Form R-5 - Nonresident Real Property Owner Registration

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Form R-5
Virginia Department of Taxation
Nonresident Real Property Owner Registration
1501231 05/13
(Do not complete if exemptions on Form R-5E apply)
Part I. Nonresident Payee
If the property is disposed of by the non-resident payee,
indicate the use of the property by the non-resident payee
SSN, Fed. Employer Identification #, or Virginia Business Account #
immediately prior to disposal:
Name
Primary Residence;
Secondary Residence (Vacation
(If Trust) Name and Title of Fiduciary
Property, etc.) ;
Leased or Rented property to third-
party;
Other - Describe
Address (of Fiduciary if Trust) Number & Street or Rural Route & Box #
Part IV. Check either Sales and/or Rentals and
City or Town, State and ZIP Code
complete the appropriate information
PARTNERSHIPS, S-CORPORATIONS, ESTATES
Rental
and TRUSTS must provide the above information on
Average Gross Monthly Rental Income....$____________
all nonresident partners, shareholders, and beneficiaries
First date property placed in service by
on Form R-5P. Substitute schedules may be used
nonresident payee..........................................___/___/____
provided the same format is followed.
(mon/day/year)
Sales
Part II. Type of Entity (check one and enter total
shares)
Gross Proceeds From Sale ........................$___________
Individual
C-Corp.
Date of Closing.......................................... ___/___/____
Trust/Estate
Partnership
(mon/day/year)
LLC
S-Corp
Installment Sale: Date Payments Begin...... ___/___/____
(mon/day/year)
Check here if filing a unified individual income
Date Payments End...................................... ___/___/____
tax return for nonresident shareholders or
(mon/day/year)
partners.
Total number of partners, shareholders or
Part V. Broker or Real Estate Reporting Person
beneficiaries . . . . . . . . . . . . . . . . . . Total
SSN, Fed. Employer Identification #, or Virginia Business Account #
Part III. Property Information
Name
If more than one piece of property is being rented or sold,
attach a separate schedule listing the legal description of
Address ( Number & Street)
each property.
Legal Description
City or Town, State and ZIP Code
Address (Number and Street or Rural Route and Box Number)
For Assistance:
City or County
ZIP Code
Write to:
Department of Taxation
Office of Customer Services
P. O. Box 1115
Richmond, VA 23218-1115
Indicate type of property such as:
Residential;
Call:
804-367-8031
Commercial;
Agricultural;
Other - Describe
Internet:
To get forms:
804-440-2541
I, the undersigned, do declare under penalties provided by law the information provided in Parts I, II, III, IV and
V is true, correct and complete to the best of my knowledge and belief.
Signature___________________________________________ Date _____________________
Mail this certificate to: Department of Taxation, P. O. Box 1880, Richmond, VA 23218-1880

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