Form 1099-S - Proceeds From Real Estate Transactions - 2017 Page 3

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CORRECTED (if checked)
FILER'S name, street address, city or town, state or province, country, ZIP
1 Date of closing
OMB No. 1545-0997
or foreign postal code, and telephone number
Proceeds From Real
2017
Estate Transactions
2 Gross proceeds
1099-S
$
Form
Copy B
FILER'S federal identification number
TRANSFEROR'S identification number
3
Address or legal description
For Transferor
This is important tax
TRANSFEROR'S name
information and is being
furnished to the Internal
Revenue Service. If you
4 Transferor received or will receive property or services
are required to file a
as part of the consideration (if checked)
.
.
.
Street address (including apt. no.)
return, a negligence
penalty or other
5 If checked, transferor is a foreign person (nonresident
sanction may be
alien, foreign partnership, foreign estate, or foreign
City or town, state or province, country, and ZIP or foreign postal code
imposed on you if this
trust)
.
.
.
.
.
.
.
.
.
.
.
.
item is required to be
reported and the IRS
Account or escrow number (see instructions)
6 Buyer's part of real estate tax
determines that it has
$
not been reported.
1099-S
(keep for your records)
Form
Department of the Treasury - Internal Revenue Service

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