Re: Exchange #:

Relinquished Property Address:

This §1031 Property Identification Statement (hereinafter referred to as “Statement”) is a supplement to the Exchange Agreement bearing the above referenced Exchange number. This Statement is intended to comply with Internal Revenue Code §1031 (a) (3) (A) identifying the following potential Replacement Properties:(Please provide either a complete street address, City and State, or the legal description, County and State as well as the percentage you intend to acquire if you are not acquiring the entire property. If the property is being improved, attach a description of said improvements.)

Exchangor Name:

HEREBY IDENTIFIES THE FOLLOWING PROPERTIES, USING THE: (PLEASE SPECIFY WHICH RULE APPLIES):

Three Property Rule      200% Rule      95% Exception (If applicable list TIC % below!)

Identifying more than three properties requires the use of either the 200% Rule or 95% exception and a determination of the fair market value of all properties identified. Please review the 1031 Time Deadlines and/or consult with your attorney or CPA if you have questions.

PLEASE ENTER TAX ID or
SOCIAL SECURITY NUMBER(s):

Identified and submitted:

Exchangor(s):

Identified and submitted:

Exchangor(s):

Sign: _________________________________________ Date:__________
Print: _________________________________________

Sign: _________________________________________ Date:__________
Print: _________________________________________


Receipt acknowledged:

By Qualified Intermediary:

By: __________________________________________ Date:__________
Its: __________________________________________


____________________________________________________________________________________

Qualified Intermediary Instruction:
PLEASE FAX OR EMAIL (list one) THIS SIGNED RECEIVED FORM BACK TO THE EXCHANGOR AT:
 

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