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Form301
- 1. Clear FEDERAL RESIDENCY DECLARATIONS IRC 則1445 Citizen Status DATE:_____________, 20______, at _______________________________________________________, California Items left blank or unchecked are not applicable. NOTE: If the declarations differ for FACTS: individual Sellers, then each Seller 1. This declaration complies with Section 1445 of the United States Internal must fill out a separate form. Revenue Code regarding the Sellers status as a citizen or resident of the United States or otherwise, and is for reliance by the broker and any buyer. 1.1 Seller: __________________________________________________________________________________ U.S. Tax Identification Number (or Social Security Number): Seller: __________________________________________________________________________________ 1.2 U.S. Tax Identification Number (or Social Security Number):_______________________________________ 2. Regarding the proposed sale of real estate described as: _____________________________________________ ___________________________________________________________________________________________ SELLER'S DECLARATION: 3. Seller hereby declares: 3.1 I am a citizen of the United States of America; 3.2 I am a resident alien of the United States of America; my resident status is established by the following: a. I have been declared a permanent legal resident of the United Exclusions: States by the U.S. Immigration and Naturalization Service. Resident Alien registration number: Residency does not include days ____________________________________________, or; during which the seller: b. I have resided at least 31 days in the United States during the remained in the U.S. due to a current calendar year, and my days of residence in the United medical condition which arose while he was visiting; States over the last three years are as follows: was in transit between two Current calendar year . . . . . . . . . . . ______ X 1 = ______ points outside the U.S.; 0 Last calendar year . . . . . . . . . . . . . ______ X 0.334 = ______ worked for an agency of a 0 Second preceding year . . . . . . . . . . ______ X 0.667 = ______ foreign government; 0 TOTAL DAYS ______ was a teacher or trainee, or Since the total days equals or exceeds 183 days, I meet the was a student; or participated substantial presence test of Internal Revenue Code as a professional athlete in a 則7701(b)(3). charitable event. 4. I am neither a United States citizen nor a resident alien as defined in item 3, above; and 4.1 Unless I obtain a qualifying statement [IRC 則1445(b)(4), or other special permission from the Internal Revenue Service, I authorize the Buyer of the above-referenced real estate to deduct and withhold 10% of the sales price for the federal government. I further authorize escrow holder to deduct these amounts from funds due me at close of escrow, and to deposit it as a tax deposit in an authorized commercial bank. 5. I consent to the reliance on this declaration of the brokers, agents, escrow-holder, and Buyer in any transaction regarding this real estate. 6. Note: This transaction is exempt from IRC 則1445 withholding if the sales price is $300,000 or less and the Buyer will use the real estate as his residence. BUYERS ACKNOWLEDGMENT: 7. I have read and received a copy of this Sellers Residency Declaration. 8. I hereby declare I will use the real estate as my residence. If the final sales price is $300,000 or less, I consent to reliance on this declaration by brokers, agents, escrow holder and Seller. I declare under penalty of perjury that the foregoing is I declare under penalty of perjury that the foregoing is true and correct. true and correct. Date:_____________, 20______ Date:_____________, 20______ Seller: _________________________________________ Buyer: ________________________________________ Date:_____________, 20______ Date:_____________, 20______ Seller: _________________________________________ Buyer: ________________________________________ FORM 301 06-05 息2005 first tuesday, P.O. BOX 20069, RIVERSIDE, CA 92516 (800) 794-0494