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Rhode Island Seller's Residency Affidavit Form

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Rhode Island Seller's Residency Affidavit Form
Rhode Island Seller
STATE OF RHODE ISLAND - DIVISION OF TAXATION
Seller’s Residency Affidavit
Withholding of Rhode Island Tax
R.I. General Laws 44-30-71.3
THIS IS AN AFFIDAVIT OF FACTS. WHETHER OR NOT THIS AFFIDAVIT IS SUFFICIENT TO RELIEVE THE
BUYER OF THE RESPONSIBILITY TO WITHHOLD IS GOVERNED BY THE ABOVE LAW AND ATTENDANT
REGULATIONS. READ THIS AFFIDAVIT CAREFULLY BEFORE SIGNING.
IN THE CASE OF MULTIPLE SELLERS, EACH SELLER MUST COMPLETE AN AFFIDAVIT. IF ALL SELLERS DO
NOT COMPLETE AN AFFIDAVIT, THE BUYER MUST WITHHOLD.
The undersigned on oath, being first duly sworn, hereby certifies:
1. This affidavit is being given in connection with a sale of real estate pursuant to Section 44-30-71.3
RIGL 1956 and attendant regulations.
2. I have attached to this affidavit a full description of the realty and any tangible personality being
sold as part of this sale and the undersigned is the seller of the property described in the attached
description. The realty is generally located in ____________________, Rhode Island.
(city/town)
3. The closing date of this sale is
___________________________________________________________________
4. List names of all the owners appearing on the deed:
_______________________________________________________________________________
_______________________________________________________________________________
5. The affiant’s name is
__________________________________________________________________________
6. If the seller is a corporation, estate or trust, the person authorized and taking responsibility to sign
on the seller’s behalf is _________________________________ Title ______________________
7. The affiant’s address is ________________________________________________
(number, street or rural route)
________________________________________________
(city, state and zip code)
8. The affiant’s telephone number is ( ) _________________________ (business)
( ) _________________________ (home)
9. The affiant’s social security or taxpayer federal identification number is
__________________________________
10. ( ) Resident Corporations. At the date of the closing, the affiant is a corporation incorporated in
Rhode Island or authorized to do business in Rhode Island by the Secretary of State, the Board of
Bank Incorporation or the Insurance Division of the Department of Business Regulation.
Corporations subject to tax under Chapter 44-11 must comply with Section 44-11-29 RIGL.
Rhode Island Seller's Residency Affidavit Form
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