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❑ CORRECTED (if checked)
<br />FILER'S name, street address, CRY or town, state or province, country. ZIP or
<br />foreign postal code, and telephone number
<br />Collins Brown Barkett, Chartered
<br />756 Beachland Boulevard
<br />Vero Beach FL 32963
<br />(772)231-4343
<br />A TRUE COPY
<br />CERTIFICATION ON LAST PAGE
<br />RYAN L. BUTLER, CLERK
<br />1 Date of closing OMB No 1545-0997
<br />02/_/2024
<br />2 Gross proceeds 2024 Proceeds From Real
<br />Estate Transactions
<br />$ 10.00 Form 1099-S
<br />FILER'S federal identification number
<br />TRANSFEROR'S identification number
<br />3. Address or legal description
<br />Copy B
<br />59-1795861
<br />S-+ OOaOlf
<br />4730 40th Avenue
<br />Vero Beach FL 32967
<br />For Transferor
<br />This is important tax
<br />TRANSFEROR'S Name
<br />information and is being
<br />Indian River County, a political subdivision of the
<br />furnished to the Internal
<br />State of Florida
<br />Revenue Service It you
<br />are required to file a
<br />4. Transferor received or will receive property or services as
<br />return, a negligence
<br />Street Address (including apt. number)
<br />part of the consideration (if checked) ,,,,,,,,,,,,,,.❑
<br />penalty or other
<br />1801 27" Street
<br />sanction may be
<br />5. it checked, transferor Is a foreign person (nonresident
<br />imposed on you if this
<br />City, Slate, and ZIP code
<br />alien, foreign partnership, foreign estate, or foreign
<br />item is required to be
<br />trust).,,,,.,.. ❑
<br />reported and the IRS
<br />Vero Beach. Florida 32967
<br />"""""""'""""""""""
<br />determines that it has
<br />not been reported.
<br />Account or escrow number (see instructions)
<br />6. Buyer's part of real estate tax
<br />07-183.230
<br />$ .00
<br />Form 1099-S (keep for your records) www.irs gov/form1099s Department of the Treasury — Internal Revenue Service
<br />Instructions for Transferor
<br />For sales or exchanges of certain real estate, the person responsible for
<br />closing a real estate transaction must report the real estate proceeds to
<br />the IRS and must furnish this statement to you. To determine if you
<br />have to report the sale or exchange of your main home on your tax
<br />return, see the instructions for Schedule D (Form 1040). If the real
<br />estate was not your main home, report the transaction on Form 4797,
<br />Form 6252, and/or the Schedule D for the appropriate income tax form.
<br />If box 4 is checked and you received or will receive like -kind property,
<br />you must file Form 8824.
<br />Federal mortgage subsidy. You may have to recapture (pay back) all
<br />or part of a federal mortgage subsidy I all the following apply.
<br />-You received a loan provided from the proceeds of a qualified
<br />mortgage bond or you received a mortgage credit certificate.
<br />-Your original mortgage loan was provided after 1990.
<br />-You sold or disposed of your home at a gain during the first 9 years
<br />after you received the federal mortgage subsidy.
<br />-Your income for the year you sold or disposed of your home was over
<br />a specified amount.
<br />This will increase your tax. See Form 8828 and Pub. 523.
<br />Transferor's taxpayer Identification number. For your protection, this
<br />form may show only the last four digits of your social security number
<br />(SSN), individual taxpayer identification number (ITIN), adoption
<br />taxpayer identification number (ATIN), or employer identification number
<br />(EIN). However, the issuer has reported your complete identification
<br />number to the IRS.
<br />Account number. May show an account or other unique number the
<br />filer assigned to distinguish your account.
<br />Box 1. Shows the date of closing.
<br />Box 2. Shows the gross proceeds from a real estate transaction,
<br />generally the sales price. Gross proceeds include cash and notes
<br />payable to you, notes assumed by the transferee (buyer), and any notes
<br />paid off at settlement. Box 2 does not include the value of other property
<br />or services you received or will receive. See Box 4.
<br />Box 3. Shows the address or legal description of the property
<br />transferred.
<br />Box 4. If marked, shows that you received or will receive services or
<br />property (other than cash or notes) as part of the consideration for the
<br />property transferred. The value of any services or property (other than
<br />cash or notes) is not included in box 2.
<br />Box 5. If checked, shows that you are a foreign person (nonresident
<br />alien, foreign partnership, foreign estate, or foreign trust).
<br />Box 6. Shows certain real estate tax on a residence charged to the
<br />buyer at settlement. If you have already paid the real estate tax for the
<br />period that includes the sale date, subtract the amount in box 6 from the
<br />amount already paid to determine your deductible real estate tax. But if
<br />you have already deducted the real estate tax in a prior year, generally
<br />report this amount as income on the "Other income" line of the
<br />appropriate income tax form. For more information, see Pub. 523, Pub.
<br />525. and Pub. 530.
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