Form W-9 - Request For Taxpayer Identification Number And Certification - Internal Revenue Service

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Terrain Racing
Angry Monkey Productions
Award Acknowledgment
Date of Race:
____________________________________
City of Race:
____________________________________
Name of Recipient:
____________________________________
Ranking for Award:
1st / 2nd / 3rd
circle appropriate description:
Gender for Award:
Female / Male
circle appropriate description:
Distance for Award:
5k / 10k
circle appropriate description:
Cash Value Received:
$________
I hereby acknowledge receipt of the award described above. I further acknowledge that the full
value of the award is taxable and will be reported to IRS and any necessary state, county, city or
other officials as required by law.
Signature of Recipient: ____________________________________
Date:
____________________________________

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