Form Doa-6448 (Substitute W-9) - Taxpayer Identification Number (Tin) Verification - State Of Wisconsin Department Of Administration (Page 3 of 3) in pdf

Form Doa-6448 (Substitute W-9) - Taxpayer Identification Number (Tin) Verification - State Of Wisconsin Department Of Administration Page 3

Taxpayer Identification Request

In order for the State of Wisconsin to comply with the Internal Revenue Service regulations, this letter is

to request that you complete the enclosed Substitute Form W-9. Failure to provide this information may

result in delayed payments or backup withholding. This request is being made at the direction of the

Wisconsin State Controller in order that the State may update its vendor file with the most current

information.

Please return or FAX the Substitute Form W-9 even if you are exempt from backup withholding within (10)

days of receipt. Please make sure that the form is complete and correct. Failure to respond in a timely

manner may subject you to a 29% withholding on each payment or require the State to withhold

payment of outstanding invoices until this information is received.

We are required to inform you that failure to provide the correct Taxpayer Identification Number (TIN) /

Name combination may subject you to a $50 penalty assessed by the Internal Revenue Service under

section 6723 of the Internal Revenue Code.

Only the individual’s name to which the Social Security Number was assigned should be entered on the

first line.

The name of a partnership, corporation, club, or other entity, must be entered on the first line exactly as it

was registered with the IRS when the Employer Identification Number was assigned.

DO NOT submit your name with a Tax Identification Number that was not assigned to your name. For

example, a doctor MUST NOT submit his or her name with the Tax Identification Number of a clinic he or

she is associated with.

Thank you for your cooperation in providing us with this information. Please return the completed form to:

Phone:

Enclosure

Form Doa-6448 (Substitute W-9) - Taxpayer Identification Number (Tin) Verification - State Of Wisconsin Department Of Administration Page 3