HomeMy WebLinkAbout11_w9_form
Fom> W-9
(Rev. Marcil 1994)
Oepil<lment orthll ['''ilS'''')'
lfllemal R<l"en.... S........ice
Request for Taxpayer
Identification Number and Certification
~Jame (II joint nameS,lis! tw;t ~nd circle 'he name of the pelSOn or ~nlil\l' ,mose number \,ou enter in Panl below. See Instruct/C)n:;; 00 p<lge 2 it your "..me has changed.)
Give form to the
requeste.... Do NOT
send to the IRS.
~
~
Rusiness name (Sole propr~tors see mstructions on page 2...
o Corporation
o Partl"lefship 0 Other'"
Requester's name and addr~s (ootiOl"',al)
F
"C
"-
.
.
.
~
City. slate. and ZIP coo"!
Please check appropriate box: 0 IndividuaVSoIe propr.et04'
Address (number. stroot. and apt or suite no,)
Tax a er Identmcation Number IN
List account numbert:s) nere (oPtional)
Enter your TIN in the appropriate box. For
individuals, lhis is your social security number
(SSN). For sole proprietors. see the instructions
on page 2. For other entities. it is your employer
identification number (EIN). If you do not have a
number, see How To Get a TIN below.
Note: 1/ the account is in mOM than one name
see the chart on page ~ for guidelines on w/,o~e
number to enter.
Certification
Under penalties of perjury, I certify that
1. The number shown on this form is my correct tall:payer identification number (or I am waiting for a number 10 be issued to me), and
2. I am not Subject to backup withholding because: (a) I am exempl from backup withholding, or (b) I have not been notified by the Internal
Revenue Service that r am subject to backup withholding as a result of a failure to report all interest or dividends, or (e) the IRS has notifieo
me that ( am no long$r subject to backup. withholding,
C.artiflcation Instructions.-You must cross out item 2 abOVe if you have been notified by the IRS that you are currently subject to backup
withholding because of underreporting interest or dividends on your tax return. For real estate transactions, item 2 doeS not apply. For mortgage
interest paid. the acquisitioo or abandonment of secured prOperty, cancellation of debt, contributions to an individual retirement arrangement
(IRA), and generaUy payments other than interest and dividends; you are not required to sign the Certification. but you must provide your correct
TIN. (Also see Part III instructions on page 2.)
~
~ Signature ~ Date ~
Section references are to the Internal
Revenue Code.
Purpose of fonn.-A person who is
required to file an infonnation return with
the IRS must get your correct TIN to report
income paid to you, real estate
transactions. mortgage interest you paid,
the acquisition or abandonment of secured
property. canceUation of debt. or
contributions you made to en IRA. Use
Form W-g to give your correct TIN to the
requester (the person requesting your TIN)
and. when applicable, (1) to certify the TIN
you are giving is correct (or you are waiting
for a number to be issued). (2) to certify
you are not subject to backup withholding,
or (3) to claim. exemption from backup
withholding if you are an exempt payee.
Giving your correct TIN and making the
appropriate certifications will prevent
certain payments from being subject to
backup withholding
Note: If a requester gives you a form other
than a W-9 to request your TIN, you must
use the requester's form if it is substantialfy
similar to IIl;s Form W-9.
What Is Backup Withholding1-Persons
making certain payments 10 you must
withhold and pay to the IRS 31% of such
I Social5eQlrlty number
I : t I + I I
OR
IPIOJ~ identitlcation number
I + I I I I I I
payments under certain conditions. This is
called Mbackup withholding." Payments
10at could be subject to backup
withholding include interest, dividends.
broker and barter exchange transactions,
rents, royafties. nooemployee pay, and
certain payments from fishing boat
operator!;. Real estate transactions are not
subject to backup withholding.
If you give the requester your correct
TIN. make the proper certifications. and
report all your taxable interest and
dividends on your tax return. your
payments will not be subject to backup
withholding. Payments you receive will be
subject to backup withholding if;
1. You do not furnish your TIN to the
requester. or
2. The IRS tells the requester that you
fumished an incorrect TIN, or
3. The IRS tells you that you are subject
to backup withholding because you did not
report all your interest and dividends on
your tax retum (for reportable in1erest and
dividends only). or
4. You do not certify to the requester
that you are not subject to backup
withholding under 3 above (for reportable
For Payees Exempt from Backup
Withholding (See Part II
instructions on page 2)
~
interest and dividend accounts opened
after 1983 only). Of
5. You do not certify your TIN, See'the
. Part III instructions far exceptions
Certain payees. and payments are
exempt from backup )Vithholding and
information reporting. See the Part II
instructions and the separate InstnJetions
for the Requester of Form W-9.
How To Get a TlN.-lf you do not have a
TIN. apply for one immediately. To apply,
get Fonn SS-5, Application for a Social
Security Number Card (for individualst.
from your ~oca'- office of the SOCial security
Administration. or Form SS-4, Application
for Employer Identification Number (for
businesses and all other entities), from
your locaf IAS office.
If you do not have a TIN. write "Applied
For" in the space fOf the TIN in Part I, sign
and date the form, and give It to the
requester. Gene~ally, you will then have 60
days to get a TIN and give it to the
requester. If the requester does not recei'v'e
your TIN within 60 days, backup
withholding, if applicable, will begin and
continue until you fumish.your TIN.
C;JI No. 107:\1)(
Fonn W-9 (Re....3.941