Charles Jones; Inc. 50 Capi Seas 0. Box 5488 i Trentan, MJ 086500888 1099-S Reporting Form (605) 35690007800) 792-8888 mended by the Tax Reform Act of 1986, requires tat information rreithe Internal Revenve Service. You are required to provide the {ryou fail to fumish the required information and your ities inmposed by law Section 6045(e) of the Internal Revenue Code, as 2 regarding certain realestate transactions be report Chesing agent with your correct taxpayer identification numbe aoe payer identification number, you may be subject 10 civil or criminal pena (Please print or tyee) [ J CORRECTED FORM [SELLER INFORMATION: “Type of Taxpayer 1D Number: Social Security Number ‘Taxpayer ID Number: u) {| Employer ID Number eee asa ogee Vs SEC EvESEEESaPeSEE CEES Seller Name Line 2: (continued) _ Lind 2 provided for spouse, rstr or business ame ‘of sate proprietorship. Use a sepa Forwarding Address (as of 1231 next year): Street: pecs ae city sate Zip: PROPERTY INFORMATION: street Address Brief Property Block Lot Description: ees eee eee eee cape eee eee (Ging ees reece Contract Sale Price Seller's Allocation: $ tor Gross Proceeds: 3 ay (Fedifferent) Buyer's Ponion of Real Estate Tax (18. ax credits easived by sll: 5 Closing Date: xchange of other property or services (as partof consideration): [ Tes (1No SELLER CERTIFICATION: ‘number shown on this statement is We information is correct and that the shed to the Intemal Revenue Under penalties of perjury, 1 certify thatthe abo\ re, | understand that this information will be furnis correct taxpayer identification number. Furthermor Service. Date: Signature: Gallen) Fiease indicate f Power of Atomey or Attorney in Fact LOSING AGENT OR ATTORNEY INFORMATION: Git Account Number Name adress : Taxpayer 1D Number cy ‘Scae Zip ‘Your Case/File Number Tivcepz.pmnd 12729192