| 0010 |
Identifying Number |
|
| 0020 |
Buyer |
|
| 0030 |
Seller |
|
| 0040 |
Name of Other Party to Transaction |
I 1 |
| 0050 |
Other Party's Identification Number |
I 1 |
| 0060 |
Address |
I 1 |
| 0070 |
City |
I 1 |
| 0080 |
State |
I 1 |
| 0090 |
Zip Code |
I 1 |
| 0100 |
Sale Date |
I 2 |
| 0110 |
Total Sales Price |
I 3 |
| 0120 |
Assets Transferred Market Value Class I |
II 4 |
| 0130 |
Assets Transferred Sales Price Class I |
II 4 |
| 0140 |
Assets Transferred Market Value Class II |
II 4 |
| 0150 |
Assets Transferred Sales Price Class II |
II 4 |
| 0160 |
Assets Transferred Market Value Class III |
II 4 |
| 0170 |
Assets Transferred Sales Price Class III |
II 4 |
| 0180 |
Assets Transferred Market Value Class IV |
II 4 |
| 0190 |
Assets Transferred Sales Price Class IV |
II 4 |
| 0200 |
Assets Transferred Market Value Class V |
II 4 |
| 0210 |
Assets Transferred Sales Price Class V |
II 4 |
| 0220 |
Assets Transferred Market Value Class VI & VII |
II 4 |
| 0230 |
Assets Transferred Sales Price Class VI & VII |
II 4 |
| 0240 |
Total Assets Transferred Market Value |
II 4 |
| 0250 |
Total Assets Transferred Sales Price |
II 4 |
| 0260 |
Purchaser/Seller Provide for an Allocation - Yes |
II 5 |
| 0270 |
Purchaser/Seller Provide for an Allocation - No |
II 5 |
| 0280 |
Are Aggregate Fair Market Values Listed - Yes |
II 5 |
| 0290 |
Are Aggregate Fair Market Values Listed - No |
II 5 |
| 0300 |
In Connection with a Purchase - Yes |
II 6 |
| 0310 |
In Connection with a Purchase - No |
II 6 |
| 0315 |
Attach a Schedule of Agreement |
II 6 |
| 0330 |
Supplemental Stmt Tax Year and Return Form Number |
III 7 |
| 0340 |
Supplemental Stmt Allocation Sales Price Class I |
III 8 |
| 0350 |
Supplemental Stmt Increase/Decrease Class I |
III 8 |
| 0360 |
Supplemental Stmt Redetermined Allocation Class I |
III 8 |
| 0370 |
Supplemental Stmt Allocation Sales Price Class II |
III 8 |
| 0380 |
Supplemental Stmt Increase/Decrease Class II |
III 8 |
| 0390 |
Supplemental Stmt Redetermined Allocation Class II |
III 8 |
| 0400 |
Supplemental Stmt Allocation Sales Price Class III |
III 8 |
| 0410 |
Supplemental Stmt Increase/Decrease Class III |
III 8 |
| 0420 |
Supplemental Stmt Redetermined Class III |
III 8 |
| 0430 |
Supplemental Stmt Allocation Sales Price Class IV |
III 8 |
| 0440 |
Supplemental Stmt Increase/Decrease Class IV |
III 8 |
| 0450 |
Supplemental Stmt Redetermined Allocation Class IV |
III 8 |
| 0460 |
Supplemental Stmt Allocation Sales Price Class V |
III 8 |
| 0470 |
Supplemental Stmt Increase/Decrease Class V |
III 8 |
| 0480 |
Supplemental Stmt Redetermined Allocation Class V |
III 8 |
| 0490 |
Supplemental Stmt Sales Price Class VI & VII |
III 8 |
| 0500 |
Supplemental Stmt Incr/Decrease Class VI & VII |
III 8 |
| 0510 |
Supplemental Stmt Redetermined Class VI & VII |
III 8 |
| 0520 |
Total Assets Allocation of Sales Price |
III 8 |
| 0530 |
Total Assets Redetermined Allocation |
III 8 |
| 0540 |
Reason(s) for Increase |
III 9 |
| 0550 |
Reason(s) for Increase |
III 9 |
| 0560 |
Reason(s) for Increase |
III 9 |
