2004-08-06 1099S Form Heuring
OVOID
o CORRECTED
FILER'S name, street address, city, state, ZIP code, and telephone no.
OMB No. 1545-0997
~@04
Proceeds From Real
Estate Transactions
FILER'S Federal identification number T N
~
Form 1099-5
TRAN, SFEROR'S name, L1. " ",
(;6<<:cL', l~l,j" ~l"l.Ae.
Mrr'7 - re If, ':ULr)
S~_t address't, luding ,apt. no. , ,
!30ocP ~ -Ilit;()11 /In '
, state, and ZIVc~~ ~, f"::""'"
,. . ;/)e IL/ S'? 3t>
~
!rlL,rrie /luA-
Ilth.erh'/(7 J11J) <
Copy C
For Filer
4 Check here if the transferor received or wiil receive
property or services as part of the consideration. ~ 0
5 Buyer's part of real estate tax
$
For Privacy Act
and Paperwork
Reduction Act
Notice, see the
2004 General
Instructions for
Forms 1099,
1098, 5498,
and W-2G.
Form 1099-5
Department of the Treasury - Internal Revenue Service