Laserfiche WebLink
SUBSTITUTE FORM 1099 S <br /> This is important tax information and is being furnished to the Internal Revenue Service. If you are <br /> required to file a return,a negligence penalty or other sanction will be imposed on you if this item is <br /> required to be reported and the Internal Revenue Service determines that is has not been reported. <br /> Note: This form is for use only by Transnation Title Insurance Company. <br /> Do not mail to Internal Revenue Service. <br /> 1. Natne of Branch,Agent,Approved Attorney <br /> Lawyers Title Insurance Company <br /> 1099 18'h St.#2850 <br /> Denver,CO 80202 <br /> 303-291-3300 <br /> 2.Case/File No. 3.Agent/Dept.No. 4.Tax ID No. <br /> DLC 10467014 15803 540278740 <br /> 5. Seller name(Recipient)(Last Name First) <br /> OWENS BROS. CONCRETE CO.,A COLORADO CORPORATION <br /> 6. Seller forwarding address <br /> 7. �Ciity 8.State 9.Zip <br /> /1I�-re� � '9 d n OZ <br /> V <br /> 10. Tax ID No. <br /> x Ri-k-OS`t 0380 <br /> 11. Property Description(Address) 8133 COUNTY ROAD 28,PLATTEVILLE, <br /> COLORADO 80651 <br /> 12. Gross proceeds X $ t o 3.,!,8S• '� <br /> 13. Check line if consideration other than cash was or will be received. <br /> 14.Closing date 15.Buyers part of real estate tax <br /> September .2004 N/A <br /> Seller is required by law to provide the correct taxpayer identification number. If correct taxpayer <br /> identification number is not provided,then he/she may be subject to civil or criminal penalties imposed <br /> bylaw. <br /> Under penalties of perjury,I certify that the taxpayer identification number shown in this statement is <br /> my correct taxpayer identification number. <br /> OWENS BROS CONCRETE CO,A COLORADO CORPORATION <br /> BY <br /> Page 53 of 126 <br />