Form Bfm-0001 - Substitute W-9 Taxpayer Identification Number (Tin) Verification - 2013 Page 4

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Taxpayer Identification Request
In order for the State of South Dakota to comply with Internal Revenue Service regulations, this letter requests that you
complete the enclosed Substitute Form W-9. Failure to provide this information may result in delayed payments and/or
backup withholding. This request is being made at the direction of the South Dakota Bureau of Finance and Management
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 reportable 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 6722
of the Internal Revenue
Only the individual’s name to which the Social Security Number (SSN) 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 (EIN) was assigned.
DO NOT submit your name with a Tax Identification Number (TIN) 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 with which he or she is
Thank you for your cooperation in providing us with this information. Please return the completed form to:
DENR Fiscal Office
523 East Capitol Ave
Pierre, SD 57501-3182
Or send faxes to: 605.773.4068
Or scan and email to: with "Attn: Fiscal Section" in the subject line


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