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Part 1: Contact Information:
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Contact Name
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First Name
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*
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Middle Name or Initial
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Last Name
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*
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Contact Address
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Street Address or P.O. Box
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*
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City
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*
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State
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*
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Zip Code
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*
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Contact Methods
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Main Number
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*
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Alternate Number
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Facsimile Number
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E-mail Address
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*
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Preferred Method of Contact
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Part 2: Taxpayer Information:
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*
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Name(s) of Person(s) or Legal Entity who will be reporting
the 1031 exchange on their/its income tax return.
(Should be the same name as the "Owner of Record" on the
title commitment for Relinquished Property)
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Part 3: Relinquished Property Information:
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Property Information
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Location of
Relinquished Property
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Street Address, City, State, Zip Code or Short Legal
Description including County and State
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Contract Information
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Date of Sale &
Purchase Contract
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*
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Date of Closing/
Close of Escrow
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*
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(Must be at least five business days from the date of
submission)
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Buyer’s Name(s)
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*
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Exact Contract Sales Price
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*
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Name of Listing Real Estate Agent/Broker
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Listing Agent/Broker Telephone Number
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Closing / Escrow Information
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Name of Closing Agent /
Escrow Agent /
Closing Attorney
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*
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Name of Title Company / Escrow Service / Law Firm
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*
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Closing Agent/
Escrow Agent/
Closing Attorney Telephone Number
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*
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Title Commitment Number / Escrow Number
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Additional Relinquished Properties
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Additional Relinquished Properties
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(If "Yes", then please provide information on additional
Relinquished Properties when you are contacted by
National 1031 Exchange Service.)
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If you have contracted for the purchase of a property as a part of this 1031 exchange Replacement
Property, please fill out the following information. If not, then please proceed to Part 5.
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Part 4: Replacement Property Information:
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Property Information
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Location of
Replacement Property
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Street Address, City, State, Zip Code or Short Legal
Description including County and State
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Contract Information
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Date of Sale &
Purchase Contract
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Date of Closing/
Close of Escrow
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Seller’s Name(s)
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Name of Buyer’s
Real Estate Agent/Broker
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Buyer’s Agent/Broker Telephone Number
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Closing / Escrow Information
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Name of Closing Agent /
Escrow Agent /
Closing Attorney
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Name of Title Company / Escrow Service /
Law Firm
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Closing Agent/Escrow Agent/Closing Attorney
Telephone Number
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Title Commitment Number
/ Escrow Number
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Additional Replacement Properties
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Additional Replacement Properties
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(If "Yes", then please provide information on additional
Replacement Properties when you are contacted by
National 1031 Exchange Service.)
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Part 5: Request to be Contacted to Set Up 1031 Exchange
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Please Read and Check Box Below:
I request that National 1031 Exchange Service, LLC ("National 1031") contact me regarding the set up and processing of a like kind exchange under Section 1031 of the Internal Revenue Code for the "Exchangor" identified above. I understand that I will not be obligated to National 1031 for the payment of any fee or other cost until I am contacted and give my express authorization for National 1031 to act as the "Qualified Intermediary" to set up and process a like kind exchange under Section 1031 of the Internal Revenue Code for the "Exchangor" identified above. I understand and agree that I am entitled to a $100.00 discount off of the "Set Up Fee" described in the Schedule of Fees and Costs for this exchange only upon my completion and submission of this form to National 1031, my subsequent agreement to initiate a 1031 exchange with National 1031, and the closing of the Relinquished Property described above. I understand and agree that National 1031 exchange has no responsibility or obligation to take any action in this matter unless and until I have been contacted by National 1031 to confirm the information provided above and I have given my express approval to begin processing a 1031 exchange of the Relinquished Property described above. I further agree that it is my responsibility to contact National 1031 by telephone at to initiate this exchange if I have not been contacted by National 1031 within one (1) business day after my submission of this form by checking the box marked "Yes" below.
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Yes, I have read and agree to the paragraph above.
Please submit this form and contact me regarding this 1031 exchange.
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