Non Foreign Affidavit
State of [State]
County of [County]
Introduction:
I/We, [Your Name], hereby swear and affirm under penalty of perjury that the following statements are true and correct:
Statement of Facts:
I/We, [Your Name], holding the Social Security Number(s)/Tax Identification Number(s) [SSN(s)/TIN(s)], am/are the legal owner(s) of the property located at [Property Address], herein referred to as the “Property.”
The mailing address for correspondence regarding this transaction is [Mailing Address, if different from the Property Address].
I/We declare that I/we am/are a U.S. citizen(s) or resident alien(s) and not a foreign person(s) as defined by the Internal Revenue Code and regulations under the Foreign Investment in Real Property Tax Act (FIRPTA).
I/We understand that this declaration is made to induce [Buyer's Name] to accept transfer of the above-mentioned property without the need to withhold a portion of the sale proceeds as required for foreign sellers under FIRPTA.
Acknowledgment:
I/We understand that if any of the above statements are found to be false, I/we may be held liable for any costs, penalties, or taxes that arise as a result of this affidavit being incorrect.
Signature:
[Your Name]
[Date]
[Co-Seller Name]
[Date]
Subscribed and sworn to before me this [day] of [month], [year]
Notary Public:
[Seal]
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