NC-1099NRS
Report of Sale of Real Property
The buyer must file this
Web
form within 15 days of the
by Nonresidents
5-02
closing date of the sale.
North Carolina Department of Revenue
Part 1. Sellers Information
(See instructions on reverse.)
Fill in applicable circle:
Individual
Partnership
Estate
Trust
Other (Specify) ______________________________________
Individuals First Name
(USE CAPITAL LETTERS )
M.I.
Individuals Last Name
(USE CAPITAL LETTERS )
Individuals Social Security Number
Spouses First Name (If property owned jointly)
M.I.
Spouses Last Name (If property owned jointly)
Spouses Social Security Number
Entitys Legal Name
(USE CAPITAL LETTERS )
Federal Employer ID Number
County
Address
City
State
Zip Code
Country (If not U.S.)
Contacts First Name
M.I.
Contacts Last Name
Contacts Phone Number
Part 2. Buyers Information
Fill in applicable circle:
Individual
Partnership
Estate
Trust
Other (Specify) _________________________
Individuals First Name (USE CAPITAL LETTERS )
M.I.
Individuals Last Name
(USE CAPITAL LETTERS )
Individuals Social Security Number
Spouses First Name
M.I.
Spouses Last Name
Spouses Social Security Number
Entitys Legal Name
(USE CAPITAL LETTERS )
Federal Employer ID Number
County
Address
City
State
Zip Code
Country (If not U.S.)
Part 3. Sale Information
Gross sales price
Is the transaction for the sale of a personal residence?
,
,
.
$
00
(Fill in applicable circle)
Yes
No
County in which property is located
Enter the book
Book number
number and
page number in
Date of closing (MM-DD-YY)
which the deed
Page number
is recorded.
Part 4. Authorized Signature
I certify that, to the best of my knowledge, this report is accurate and complete.
(
)
Preparers Name (Please Print)
Telephone Number (Include area code.)
Date
Preparers Signature
Mail To: North Carolina Department of Revenue, Central Examinations Section, P.O. Box 871, Raleigh, NC 27602-0871