1.
 
a. Name: _______________________________________
 
b. Taxpayer is an individual, a trust (revocable or irrevocable), a partnership, a corporation ("C" or "S"),
 
   or LLC: ____________________________________________________________________________________
 
 
2.
 
a. Anticipated closing date of property being relinquished?
 
_____________________________________________
 
 
3.
 
a. Property(ies) being relinquished:
 
  Property #1 Property #2 Property #3
Fair Market Value      
Amount of existing mortgages      
Equity      
Adjusted basis      
If applicable, amount of suspended passive losses      
If applicable, prior low income or rehab tax credits      

 
b. Anticipated replacement property, if known:
 
  Property #1 Property #2 Property #3
Fair Market Value      
Anticipated acquisition financing      
Equity      

 
 
4.  With respect to the property being relinquished:
 
  1. Date of the acquisition of the property ?______________________________
  2. Any accelerated depreciation taken with respect to the improvements on the property? Yes/ No
  3. Any depreciation taken on the personal property located on the premises? Yes/ No

 
 
5.  Purpose for the property being relinquished?
 
_____________________________________________________________________________________
 
_____________________________________________________________________________________
 
 
6.  Intention for the use of the replacement property?
 
_____________________________________________________________________________________
 
_____________________________________________________________________________________
 
 
7.  Any recent refinancing on the property being relinquished or intention to refinance this property before the exchange?
 
Yes / No.
 
If yes, when, for what amount and for what purpose?
 
_____________________________________________________________________________________
 
_____________________________________________________________________________________
 
 
8.  After the exchange, any intention to refinance the property being acquired?
 
Yes / No.
 
If yes, when, for what amount and what purpose?
 
_____________________________________________________________________________________
 
_____________________________________________________________________________________
 
 
9.  Any anticipation of disposition (e.g., sale, gift) of the acquired property in the future?
 
Yes / No.
 
If yes, explain:
 
_____________________________________________________________________________________
 
_____________________________________________________________________________________
 
 
10.  Will any personal property (e.g. furniture or equipment) be received as a result of this transaction?
 
Yes /No.
 
If so, what value has been placed on it?
 
_____________________________________________________________________________________
 
 
11.  Is any personal property (e.g. furniture or equipment) being relinquished in this transaction?
 
Yes / No.
 
If so, what value has been placed on it? _________________
 
 
12.  Any promissory notes, cash or non-like-kind property to be part of the transaction or any other boot?
 
Yes / No.
 
If so, explain:
 
_____________________________________________________________________________________
 
_____________________________________________________________________________________
 
 
13.  Are any major expenditures (capital improvements or structures to be built) anticipated to be made to any of the properties?
 
Yes / No.
 
If yes, which property?
 
_____________________________________________________________________________________
 
What is the estimated cost? $_________________________________________
 
 
14.  Is there a need to have the replacement property acquired before the disposition of the property being relinquished (i.e. "Reverse Starker")?
 
_______________________________________________________________