Taxpayer Identification Number (Tin) Verification Page 3
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3Taxpayer Identification Request
In order for the State of Montana 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 Montana
Department of Administration, State Accounting Division, 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 28% withholding on each payment, or require the State to withhold
payment of outstanding invoices until this information is received per Internal Revenue Code
3406(a).
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 NOTsubmit 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
Department of Public Health and Human Services, Business and Financial Services Division:
DPHHS, BFSD
PO Box 4210
Helena, MT 59604
Phone: 406-444-5932
Fax: 406-444-9763
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