Withholding agent’s name, street address, city, state, and ZIP code

1 Date of transfer

Statement of Withholding on
Dispositions by Foreign Persons

2 Federal income tax withheld of U.S. Real Property Interests

OMB No. 1545-0902
Expires 5-31-93

Withholding agent's Federal identification no. Identification number of foreign person subject | 3 Amount realized ‘4 Gain recognized by foreign
to withholding (if any) corporation Copy C

For

Name of person subject to withholding 5 Description of property transferred Withholding
Agent

Street address 6 Person subject to withholdingis: An individual [_] For Fapenwark
Acorporation [_] Other (specify) > Notice Nee the

City, province or state, postal code, and country Mailing address of person subject to withholding (if different) instructions for
Form 8288.

Form 8288-A (Rev. 6-90)

Keep for your records.

Department of the Treasury - Internal Revenue Service


Instructions to Person Subject
to Withholding

Generally, if you are a foreign person that disposes of real
property located in the U.S., 10% of the amount realized
must be withheld by the buyer or other transferee.
Generally, certain foreign interest holders that are
beneficiaries or shareholders are also subject to the
withholding, but at a rate of 34%. Even though tax may
have been withheld, you are required to file a Form
1040NR, 1041, 1065, or 1120F to report the sale or
other disposition as effectively connected with the
conduct of a trade or business in the U.S. To receive credit
for any Federal income tax withheld shown in Box 2,
attach Form 8288-A to your Federal income tax return, or
send it with any request for refund. However, foreign
partnerships should report the withholding on and attach
Form 8288-A to Form 8804, Annual Return for
Partnership Withholding Tax (Section 1446). See
Publication 519, U.S. Tax Guide for Aliens, for more
information about filing requirements.

If the amount shown in Box 2 is greater than your
maximum tax liability, you may apply for an early refund
before filing your tax return. To do so, you must also apply
for a withholding certificate (if you do not already have
one). Send your application for early refund to the Director,
Philadelphia Service Center, P.O. Box 21086, Philadelphia,
PA 19114. No particular form is required for the
application, but it must include the following information in
separate paragraphs numbered as shown below:

(1) Your name, address, and identification number,

(2) The amount required to be withheld as stated in the
withholding certificate issued by IRS,

(3) The amount withheld, shown in Box 2 (attach a copy
of this Form 8288-A), and

(4) The amount to be refunded.

See Regulations sections 1.1445-3 and 1.1445-6, Revenue
Procedure 88-23, and Form 8288-B, Application for
Withholding Certificate for Dispositions by Foreign Persons
of U.S. Real Property Interests, for information about how
to request a withholding certificate.


Instructions to Withholding
Agent

Prepare Form 8288-A for each person subject to
withholding. Attach Copies A and B to Form 8288,

U.S. Withholding Tax Return for Dispositions by Foreign
Persons of U.S. Real Property Interests. Copy B will be
stamped by IRS and sent to the person subject to
withholding for that person’s future use. Copy C is for your
records. You need not give a copy of this form to the
foreign person subject to withholding.

Address.—You must enter the home address (for an
individual) or the office address (for other than an
individual) for the person subject to withholding.
However, in addition, you may enter a separate mailing
address in the space provided. If provided, IRS will use
the separate mailing address to forward Copy B to the
person subject to withholding.

Box 1.—Enter the date of transfer. Enter the date of
distribution if you withheld under section 1445(e)(2) or (3)
or you made the large trust election to withhold at the date
of distribution.

Box 2.—Enter the Federal income tax withheld by you for
the foreign person whose name appears on this form.

Box 3.—Enter the amount realized by the foreign person
whose name appears on this form.

Box 4.—Complete only if you are a foreign corporation
required to withhold under section 1445(e)(2).

Box 6.—Check the applicable box to indicate whether the
person subject to withholding is an individual ora
corporation. If other, please specify whether the person is a
partnership, trust, or estate.

For definitions and other rules, see the instructions for
Form 8288.


Withholding agent's name, street address, city, state, and ZIP code 1 Date of transfer

Dispos

Expires 5-31-93

Statement of Withholding on
ns by Foreign Persons
2 Federal income tax withheld of U.S. Real Property Interests
OMB No. 1545-0902

Withholding agent's Federal identification no. | Identification number of foreign person subject | 3 Amount realized 4 Gain recognized by foreign
to withholding (if any)

corporation

Name of person subject to withholding

Street address

City, province or state, postal code, and country

5 Description of property transferred

6 Person subject to withholdingis: An individual [_ |
Acorporation [_] _ Other (specify) >
Mailing address of person subject to withholding (if different)

CopyA

For Internal
Revenue
Service Center

For Paperwork
Reduction Act
Notice, see the
instructions for
Form 8288.

Form 8288-A (Rev. 6-90)

Attach Copies A and B to Form 8288. Department of the Treasury - Internal Revenue Service




Withholding agent's name, street address, city, state, and ZIP code 1 Date of transfer

Statement of Withholding on
Dispositions by Foreign Persons
of U.S. Real Property Interests

OMB No. 1545-0902
Expires 5-31-93,

2 Federal income tax withheld

Withholding agent's Federal identification no. Identification numberof foreign person subject | 3 Amount realized 4 Gain recognized by foreign
to withholding if any) corporation Copy B
Send to Internal

Revenue

Name of person subject to withholding 5 Description of property transferred C Service
‘enter—For
Use by Person

ibject to
Street address 6 Person subject to withholdingis: An individual [_] wihhoding

Acorporation [_] _ Other (specify) > , a
" — This information is
City, province or state, postal code, and country Mailing address of person subject towithholding i itferent) | being furnished to

the Internal
Revenue Service.

Form 8288-A (Rev. 6-90) Department of the Treasury - Internal Revenue Service