WV/RC
   REV 1-08            CERTIFICATION OF EXEMPTION FROM WITHHOLDING
                       UPON DISPOSITION OF WEST VIRGINIA REAL ESTATE
                       AFFIDAVIT OF RESIDENCE OR PRINCIPAL RESIDENCE
Based on the certification below, Transferor claims exemption from the tax withholding requirements of §11-21-71b of the West Virginia Code.
Section 11-21-71b provides that certain tax payments must be withheld and paid when a deed or other instrument that effects a change in
ownership of real property and associated tangible personal property is presented for recordation.  The requirements do not apply when a
transferor provides a certification of West Virginia residence or certification that the transferred property is the transferor’s principal
residence.

   TRANSFERORTRANSFERORINFORMATIONINFORMATION(NAME)

   REASONS FOR EXEMPTION
                       1. Transferor is a resident of the State of West Virginia.
                       2. Transferor is a resident entity as defined in  §11-21-71b of the West Virginia Code.
                       3. Although I am no longer a resident of the State of West Virginia, the property is my principal residence as
                          defined in Internal Revenue Code §121.
                       4. Although I am no longer a resident of the State of West Virginia, the property was my principal residence and
                           was purchased by my employer due to relocation for resale.
                       5. Although I am no longer a resident of the State of West Virginia, the property was my principal residence and was
                           purchased through a relocation management company (RMC) for resale.
Under penalty of perjury, I certify that I have examined this declaration and that, to the best of my knowledge, it is true, correct, and
complete.
   INDIVIDUAL TRANSFERORS

  Witness                                                                                Name

                                                                                         Signature
   ENTITY TRANSFERORS

Witness                                                                                  Name of entity

                                                                                         By

                                                                                        Name

                                                                                          Title

NOTE:  THE TRANSFEROR/SELLER MUST RETAIN A SIGNED ORIGINAL AFFIDAVIT IN THEIR FILES.  THIS AFFIDAVIT MAY BE
EXAMINED BY THE WEST VIRGINIA STATE TAX COMMISSIONER.