NON-FOREIGN AFFIDAVIT UNDER

INTERNAL REVENUE CODE

SECTION 1445(b)(2)

STATE OF ________________

COUNTY OF ________________

I/WE, ______________________________, the “Seller(s)”, being first duly sworn, state under penalties of perjury:

1.         That I/WE am/are the Transferor(s) of the property located at ____________________________, in the City of ___________________, County of ________________, State of _____________________, and described as follows:

District _______________ Section _______________ Block __________, Township __________________, Range _____________________ or Parcel Number _____________________

1. That my/our United States taxpayer identification number is/are:

Seller: ________________________       Tax ID: __________________

Address: ________________________________________________

City State Zip _____________________________________________

Seller: ________________________       Tax ID: __________________

Address: ________________________________________________

City State Zip ____________________________________________

Seller: ________________________        Tax ID: _________________

Address: ________________________________________________

City State Zip _____________________________________________

Seller: ________________________         Tax ID: __________________

Address: ________________________________________________

City State Zip _____________________________________________

3.         That I/WE am/are not a “foreign person” as that term is defined in Section 1445(f) of the Internal Revenue Code.

This affidavit is given to ______________________________________, the “transferee(s) or Buyer(s)” of the property described in paragraph 1 above for the purpose of establishing and documenting the non-foreign affidavit exemption to the withholding requirement of Section 1445 of the Internal Revenue Code.

___________________________          ___________________________

Seller                                        Date                        Seller                                          Date

___________________________           ___________________________

Seller                                        Date                        Seller                                          Date

Sworn to and Subscribed before me this the ___ day of ______________, 20 ____.

__________________________

Notary Public

My Commission Expires:                                             _______________________________________

State Specific Affidavit Forms

—-For State Specific Affidavit Forms you can download in Word Format go to

http://www.uslegalforms.com/affidavits/