Form 1099-S Proceeds From Real Estate Transactions

Please complete the form below by entering the information EXACTLY as it appears on your Form 1099-S
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* FILER’S name, address, city, state, ZIP code and telephone no.		1 Date of closing	2001
		2 Gross Proceeds	Form 1099-S
* FILER’S Federal ID number	* TRANSFEROR’S ID number	3 Address or legal description
* TRANSFEROR’S name, street address, city, state, and ZIP code
		4 Transferor received or will receive property or service as part of the consideration (if checked) . . . .
Account number (optional)		5 Buyer’s part of real estate tax
Form 1099-S

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