Taxpayer Identification Number (Tin) Verification Page 2
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3SW9 (4/2009)
Instructions for Completing Taxpayer Identification Number Verification
(Substitute W-9)
Legal Name As entered with IRS
certain other payments to a payee who does not furnish a
TIN to a payer. Certain penalties may also apply.
Individuals: Enter Last Name, First Name, MI
Sole Proprietorships: Enter Last Name, First Name, MI
What Name and Number to Give the Requester
LLC Single Owner: Enter owner's Last Name, First
Name, MI
For this type of account:
Give name and SSN of:
All Others: Enter Legal Name of Business
1. Individual
The individual
Trade Name
2. Two or more individuals (joint
The actual owner of the account
account)
or, if combined funds, the first
Individuals: Leave Blank
individual no the account
1
Sole Proprietorships: Enter Business Name
LLC Single Owner: Enter LLC Business Name
3. Custodian account of a minor
The minor
2
All Others: Complete only if doing business as a D/B/A
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
The grantor-trustee
1
Primary Address
trust (grantor is also trustee)
Address where 1099 should be mailed.
b. So-called trust account that
1
The actual owner
is not a legal or valid trust
Remit Address
under state law
Address where payment should be mailed. Complete
5. Sole proprietorship or Single-
3
The owner
only if different from primary address.
Owner LLC
Entity Designation
For this type of account:
Give name and EIN of:
3
6. Sole Proprietorship or Single-
The owner
Check ONE box which describes the type of business
Owner LLC
entity.
7. A valid trust, estate, or pension
Legal entity
4
trust
Taxpayer Identification Number
8. Corporate or LLC electing
The corporation
LIST ONLY ONE: Social Security Number OR Employer
corporate status on Form
Identification Number. See “What Name and Number to
8832
Give the Requester” at right.
9. Association, club, religious,
The organization
If you do not have a TIN, apply for one immediately.
charitable, educational, or
Individuals use federal form SS-05 which can be obtained
other tax-exempt organization
from the Social Security Administration. Businesses and
all other entities use federal form SS-04 which can be
10. Partnership or multi-member
The partnership
LLC
obtained from the Internal Revenue Service.
11. A broker or registered
The broker or nominee
Certification
nominee
You must cross out item 2 above if you have been
12. Account with the Department
The public entity
notified by the IRS that you are currently subject to
of Agriculture in the name of a
backup withholding because you have failed to report all
public entity (such as a state
interest and dividends on your tax return. For real estate
or local government, school
transactions, item 2 does not apply. For mortgage
district or prison) that receives
interest paid, acquisition or abandonment of secured
agricultural program payments
property, cancellation of debt, contributions to an
individual retirement arrangement (IRA), and generally,
1
List first and circle the name of the person whose number you
payments other than interest and dividends, you are not
furnish. If only one person on a joint account has an SSN, that
required to sign the certification, but you must provide
person’s number must be furnished.
2
Circle the minor’s name and furnish the minor’s SSN.
your correct TIN.
3
You must show your individual name, but you may also enter your
business or “DBA” name. You may use either your SSN or EIN (if you
Privacy Act Notice
have one).
4
List first and circle the name of the legal trust, estate, or pension
Section 6109 of the Internal Revenue Code requires you
trust. (Do not furnish the TIN of the personal representative or trustee
to furnish your correct TIN to persons who must file
unless the legal entity itself is not designated in the account title.)
information returns with the IRS to report interest,
dividends, and certain other income paid to you,
NOTE: If no name is circled when more than one name is listed, the
mortgage interest you paid, the acquisition or
number will be considered to be that of the first name listed.
abandonment of secured property, or contributions you
made to an IRA. The IRS uses the numbers for
identification purposes and to help verify the accuracy of
your tax return. You must provide your TIN whether or
not you are required to file a tax return. Payers must
generally withhold 28% of taxable interest, dividend, and
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