STATE OF RHODE ISLAND - DIVISION OF TAXATION  
                                  Seller’s Residency Affidavit  
                                  Withholding of Rhode Island Tax  
                                  R.I. General Laws 44-30-71.3  
      
     THIS IS AN AFFIDAVIT OF FACTS.  WHETHER OR NOT THIS AFFIDAVIT IS SUFFICIENT TO RELIEVE THE 
     BUYER OF THE RESPONSIBILITY TO WITHHOLD IS GOVERNED BY THE ABOVE LAW AND ATTENDANT  
            REGULATIONS.  READ THIS AFFIDAVIT CAREFULLY BEFORE SIGNING.  
     
    IN THE CASE OF MULTIPLE SELLERS, EACH SELLER MUST COMPLETE AN AFFIDAVIT.  IF ALL SELLERS DO 
    NOT COMPLETE AN AFFIDAVIT, THE BUYER MUST WITHHOLD.  

    The undersigned on oath, being first duly sworn, hereby certifies:  
       
      1.   This affidavit is being given in connection with a sale of real estate pursuant to Section 44-30-71.3  
          RIGL 1956 and attendant regulations.  

      2.   I have attached to this affidavit a full description of the realty and any tangible personality being  
          sold as part of this sale and the undersigned is the seller of the property described in the attached  
          description.  The realty is generally located in ____________________, Rhode Island.  
                                                  (city/town)  
      3.  The closing date of this sale is  
          ___________________________________________________________________  

      4.   List names of all the owners appearing on the deed:  
          _______________________________________________________________________________  
          _______________________________________________________________________________  
       
      5.   The affiant’s name is  
          __________________________________________________________________________  
       
      6.   If the seller is a corporation, estate or trust, the person authorized and taking responsibility to sign  
          on the seller’s behalf is _________________________________  Title  ______________________  
       
      7.  The affiant’s address is  ________________________________________________ 
                                  (number, street or rural route) 
                                  ________________________________________________ 
                                  (city, state and zip code) 

      8.  The affiant’s telephone number is  (  ) _________________________  (business) 
                                            (   ) _________________________  (home) 

The9.                                                                                                                affiant’s social security or taxpayer federal identification number is  
          __________________________________  

      10.                                                                                                            (   ) ResidentAtCorporations.  the date of the closing, the affiant is a corporation incorporated in  
          Rhode Island or authorized to do business in Rhode Island by the Secretary of State, the Board of  
          Bank Incorporation or the Insurance Division of the Department of Business Regulation.  
          Corporations subject to tax under Chapter 44-11 must comply with Section 44-11-29 RIGL.  

                                                                                        Rev. 09/2020

       11.                                                                                                           (   ) Resident Individuals, Estates orAtTrusts.  the date of the closing, the affiant is a resident  
         individual, estate or trust as those applicable terms are defined in the Rhode Island tax laws 
         pertaining to the seller.  

       12.                                                                                                           (   ) ResidentAtPartnership.  the date of the closing, the undersigned is a general partner in the  
         seller and, having personal knowledge that all partners in the seller are Rhode Island residents, that the 
         seller is therefore a resident partnership for the purposes of compliance with RI 44-30-71.3 and related 
         regulations.  
                                       Limited Liability Companies (LLC)  
        
       13.                                                                                                           (   ) LLC declared to be taxed as a Partnership pursuant to Chapter 7-16AtRIGL.       the date of the  
         closing, the undersigned is a general partner in the seller and, the seller-partner is a Rhode Island 
         resident. That the seller is therefore a resident partnership for the purposes of compliance with RI 
         44-30-71.3 and related regulations and must comply with Section 44-11-29.  

       14.                                                                                                           (   ) LLC declared to be taxed as a Corporation. At the date of closing, the undersigned is either  
         (a) a limited liability company formed pursuant to Chapter 7-16 of RIGL; or (b) a limited liability  
         company registered with this state as a foreign limited liability company pursuant to RIGL 7-16- 
         49 and is considered a resident limited liability company and must comply with Section 44-11-29.  

15.                                                                                                                  (   ) SMLLC declared to be taxed as a Corporation. At the date of closing, the undersigned is either  
         (a) a limited liability company formed pursuant to Chapter 7-16 of RIGL; or (b) a limited liability  
         company registered with this state as a foreign limited liability company pursuant to RIGL 7-16- 
         49 and is considered a resident limited liability company and must comply with Section 44-11-29.  

      The undersigned understands that this affidavit and its contents may be disclosed or provided to the  
      Rhode Island Division of Taxation and that any false statement contained herein could be punished by 
      fine, imprisonment, or both.  
       
      Under penalties of perjury, I declare that I have examined this Affidavit and, to the best of my knowledge and 
      belief, it is true, correct and complete.  
       
      _______________________________________________ 
      (Signature)  
      _______________________________________________ 
      (Name - Please Print)  
                                                      SUBSCRIBED AND SWORN to  
                                                      Before me this ________  day  
                                                      of ________________, 20____  

                                                      ______________________________ 
                                                      Notary Public  
                                                      Commission Expires:   _____________  

                                                 ----Instructions to Buyer---- 
       
      Effective January 1, 1992, when a nonresident sells Rhode Island realty and associated tangible personal  
      property, the buyer must deduct and withhold a percentage of the total amount paid.  The buyer may rely  
      on the seller’s determination of residency only if the seller furnishes the buyer with a residency affidavit.  
      This residency affidavit must be completed by the seller and made part of all closings when any Rhode  
      Island realty and associated tangible property are sold.  In the absence of this affidavit, the buyer must  
      withhold.  Every buyer subject to withholding is liable for the amounts withheld or required to be  
      withheld and the amounts are a lien on the property until paid.  The buyer should retain the original  
      affidavit with the other records and must produce it for the Division of Taxation, if requested.  A copy of  
      the affidavit should be given to the seller.  The buyer should not send the affidavit to the Tax Division.