HomeMy WebLinkAboutBlumberg, Lewis and Juanita D. Certificate of Non-Foreign Status -2002 05 08CERTIFICATE OF NON-FOREIGN STATUS
Section 1445 of the Internal Revenue Code provides that a TRANSFEREE of a U. S. real
property interest must withhold tax if the TRANSFEROR is a foreign person. To inform the
TRANSFEREE that withholding of tax is not required upon the disposition of a U. S. real property
interest by LEWIS BLUMBERG and JUANITA D. BLUMBERG (hereinafter collectively referred
to as "TRANSFEROR"), the undersigned hereby certifies the following as TRANSFEROR:
1. TRANSFEROR is not a foreign person, foreign corporation, foreign partnership,
foreign trust, or foreign estate (as those terms are defined in the Internal Revenue Code and Income
Tax Regulations); and
2. TRANSFEROR' S U. S. Social Security numbers are:
Lewis Blumberg and
Juanita D. Blumberg
TRANSFEROR'S address is:
Post Office Box 195430
Winter Springs, Florida 32719
TRANSFEROR understands that this certification maybe disclosed to the Internal Revenue
Service by TRANSFEREE and that any false statement contained herein could be punished by fine,
imprisonment, or both.
Under penalties of perjury, I declare that I have examined this certification and to the best of
my knowledge and belief it is true, correct, and complete, and I further declare that I have authority
to sign this document as TRANSFEROR.
DATEi~ this ~ of May, 2002.
LEWIS BLUMBERG
ANITA D. BLUMBERG