E-Tax Form Request

---

The City of New York is now requiring that transfer documents be completed on-line using ACRIS 2.1 E-Tax Forms. ACRIS 2.1 is required for all conveyances of property within the counties of Kings, Bronx, New York, and Queens. As a service to our clients, First Nationwide of New York will create the E-Tax Forms prior to closing upon your request.

If you wish to have First Nationwide of New York prepare these forms, please review the following information carefully and confirm that all the entered information is correct. Please enter the social security numbers of all parties, addresses as they appear on the deed and any other applicable field that is left blank. If possible, allow at least 3 days prior to closing to ensure timely delivery of the completed forms.

PLEASE NOTE: A fee of $150.00 will be charged to the seller at closing for creating these forms.

Title Number	*
Closing Date (mm/dd/yyyy)	*
Contact Email	*

Property Information

County	*
Block	*
Lot	*
Street Address (Line 1)	*
Street Address (Line 2)
City	*
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code	*
Property Type	*
Total Consideration	*
Contract of Sale Date	*

Seller's Information

Primary

Name	*
Street Address (Line 1)	*
Street Address (Line 2)
City	*
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code	*
Phone Number	*
Social Security Number	*

Additional (1)

Name
Street Address (Line 1)
Street Address (Line 2)
City
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone Number
Social Security Number

Additional (2)

Name
Street Address (Line 1)
Street Address (Line 2)
City
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone Number
Social Security Number

Additional (3)

Name
Street Address (Line 1)
Street Address (Line 2)
City
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone Number
Social Security Number

Buyer's Information

Primary Buyer

Name	*
Street Address (Line 1)	*
Street Address (Line 2)
City	*
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code	*
Phone Number	*
Social Security Number	*

Additional (1)

Name
Street Address (Line 1)
Street Address (Line 2)
City
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone Number
Social Security Number

Additional (2)

Name
Street Address (Line 1)
Street Address (Line 2)
City
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone Number
Social Security Number

Additional (3)

Name
Street Address (Line 1)
Street Address (Line 2)
City
State	New York Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code
Phone Number
Social Security Number
Address	Humans: please leave this field blank.

*It is required that this information be provided.

Additional Comments or Notes

If any concerns please feel free to email or call us at any time
Closings@FirstNW.net
(516) 439-5026