Part 1: Contact Information:
Contact Name
* First
Name Middle
Name or Initial
* Last
Name Contact Address * Street
Address or P.O. Box * City * State
Select State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
* Zip
Code Contact Methods
* Main
Number Alternate Number
Facsimile Number
* E-mail
Address
Preferred Method of Contact
Part 2: Taxpayer Information:
* Exchangor Name
Part 3: Relinquished Property Information:
Property Information
* Location of
Relinquished Property
Contract Information
* Date
of Sale &
* Date of Closing/
(Must be at least five business days from the date of submission)
* Buyer's
Name(s) * Exact
Contract Sales Price Name of Listing Real Estate Agent/Broker
Listing Agent/Broker Telephone Number
Closing / Escrow Information
* Name
of Closing Agent / * Name
of Title Company / Escrow Service / Law Firm * Closing
Agent/ Title Commitment Number / Escrow Number
Additional Relinquished Properties
Additional Relinquished Properties
(If "Yes", then please provide information on additional Relinquished Properties when you are contacted by National 1031 Exchange Service.)
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.
Part 4: Replacement Property Information:
Property Information
Location
of Replacement Property
Street Address, City, State, Zip Code or Short Legal Description including County and State
Contract Information
Date of Sale & Purchase Contract
Date
of Closing/ Close of Escrow
Seller's Name(s)
Name
of Buyer's Real Estate Agent/Broker
Buyer's
Agent/Broker Telephone Number
Closing / Escrow Information
Name
of Closing Agent / Escrow Agent / Closing Attorney
Name
of Title Company / Escrow Service / Law Firm
Closing
Agent/Escrow Agent/Closing Attorney Telephone Number
Title Commitment Number / Escrow Number
Additional Replacement Properties
Additional
Replacement Properties
(If "Yes", then please provide information on additional Replacement Properties when you are contacted by National 1031 Exchange Service.)
Part 5: Request to be Contacted to Set Up 1031 Exchange
Please Read and Check Box Below: 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 866-890-1031 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.
Yes, I have read and agree to the paragraph above. Please submit this form and contact me regarding this 1031 exchange.
