Additional Information: Extensive detail is not necessary, but a summary is desirable to indicate the nature and extent of the noncompliance.
a. Building disposition: Check the box for the appropriate type of disposition (sale, foreclosure, destruction, or other). For “other” dispositions, attach an explanatory statement.
b. New owner’s name and address: Ensure that the owner’s name, address and ZIP code are correct.
c. Date of disposition: The date the ownership actually transferred should be used. If the exact date is unknown, enter the best approximation.
d. New owner’s EIN: Ensure that the identification number for the owner is correct and check the SSN for individual taxpayers (xxx-xx-xxxx) or EIN for business entities (xx-xxxxxxx) such as corporations and partnerships.
Contact Person: Identify the person the IRS should call if there are any questions and include that person’s telephone number.
Signature of authorizing official: The authorizing official is a state agency official who is authorized by the state agency to sign such documents. The person need not be an executive, but may be a lower level employee within the state agency organization.
Revised October 2009