Form W-8ben - Certificate Of Foreign Status Of Beneficial Owner For United States Tax Withholding And Reporting (Individuals) - 2014

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Building & Apartment
For 2017-18 Damage Deposit Escrow Account
W-8BEN
Certificate of Foreign Status of Beneficial Owner for United
Form
States Tax Withholding and Reporting (Individuals)
(Rev. February 2014)
OMB No. 1545-1621
For use by individuals. Entities must use Form W-8BEN-E.
Information about Form W-8BEN and its separate instructions is at
Department of the Treasury
Give this form to the withholding agent or payer. Do not send to the IRS.
Internal Revenue Service
Do NOT use this form if:
Instead, use Form:
• You are NOT an individual .
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. W-8BEN-E
• You are a U.S. citizen or other U.S. person, including a resident alien individual .
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. W-9
• You are a beneficial owner claiming that income is effectively connected with the conduct of trade or business within the U.S.
(other than
personal services) .
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. W-8ECI
• You are a beneficial owner who is receiving compensation for personal services performed in the United States
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8233 or W-4
• A person acting as an intermediary
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. W-8IMY
Part I
Identification of Beneficial Owner (see instructions)
1
Name of individual who is the beneficial owner
2 Country of citizenship
3
Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state or province. Include postal code where appropriate.
Country
4
Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate.
Country
5
U.S. taxpayer identification number (SSN or ITIN), if required (see instructions)
6 Foreign tax identifying number (see instructions)
7
Reference number(s) (see instructions)
8 Date of birth (MM-DD-YYYY) (see instructions)
Part II
Claim of Tax Treaty Benefits (for chapter 3 purposes only) (see instructions)
within the meaning of the income tax treaty
9
I certify that the beneficial owner is a resident of
between the United States and that country.
Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article
10
of the treaty identified on line 9 above to claim a
% rate of withholding on (specify type of income):
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Explain the reasons the beneficial owner meets the terms of the treaty article:
Part III
Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I further certify under
penalties of perjury that:
I am the individual that is the beneficial owner (or am authorized to sign for the individual that is the beneficial owner) of all the income to which this form relates or am using
this form to document myself as an individual that is an owner or account holder of a foreign financial institution,
The person named on line 1 of this form is not a U.S. person,
The income to which this form relates is:
(a) not effectively connected with the conduct of a trade or business in the United States,
(b) effectively connected but is not subject to tax under an applicable income tax treaty, or
(c) the partner’s share of a partnership's effectively connected income,
The person named on line 1 of this form is a resident of the treaty country listed on line 9 of the form (if any) within the meaning of the income tax treaty between the United
States and that country, and
For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or any
withholding agent that can disburse or make payments of the income of which I am the beneficial owner. I agree that I will submit a new form within 30 days if any
certification made on this form becomes incorrect.
Sign Here
Signature of beneficial owner (or individual authorized to sign for beneficial owner)
Date (MM-DD-YYYY)
Print name of signer
Capacity in which acting (if form is not signed by beneficial owner)
W-8BEN
For Paperwork Reduction Act Notice, see separate instructions.
Cat. No. 25047Z
Form
(Rev. 2-2014)

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