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

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Request for Taxpayer
Give form to the
(Rev. November 1999)
requester. Do NOT
Identification Number and Certification
send to the IRS.
Department of the Treasury
Internal Revenue Service
Name (If a joint account or you changed your name, see Specific Instructions on page 2.)
Business name, if different from above. (See Specific Instructions on page 2.)
Check appropriate box:
Individual/Sole proprietor
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
Part I
Taxpayer Identification Number (TIN)
List account number(s) here (optional)
Enter your TIN in the appropriate box. For
individuals, this is your social security number
Social security number
(SSN). However, if you are a resident alien OR a
sole proprietor, see the instructions on page 2.
Part II
For other entities, it is your employer
For Payees Exempt From Backup
identification number (EIN). If you do not have a
Withholding (See the instructions
number, see How to get a TIN on page 2.
on page 2.)
Employer identification number
Note: If the account is in more than one name,
see the chart on page 2 for guidelines on whose
number to enter.
Part III
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. (See the instructions on page 2.)
Purpose of form. A person who is
What is backup withholding? Persons
5. You do not certify to the requester
required to file an information return with
making certain payments to you must
that you are not subject to backup
the IRS must get your correct taxpayer
withhold and pay to the IRS 31% of such
withholding under 3 above (for reportable
identification number (TIN) to report, for
payments under certain conditions. This is
interest and dividend accounts opened
example, income paid to you, real estate
called “backup withholding.” Payments
after 1983 only).
transactions, mortgage interest you paid,
that may be subject to backup withholding
Certain payees and payments are
acquisition or abandonment of secured
include interest, dividends, broker and
exempt from backup withholding. See the
property, cancellation of debt, or
barter exchange transactions, rents,
Part II instructions and the separate
contributions you made to an IRA.
royalties, nonemployee pay, and certain
Instructions for the Requester of Form
payments from fishing boat operators. Real
Use Form W-9, if you are a U.S. person
estate transactions are not subject to
(including a resident alien), to give your
backup withholding.
correct TIN to the person requesting it (the
If you give the requester your correct
requester) and, when applicable, to:
Failure to furnish TIN. If you fail to furnish
TIN, make the proper certifications, and
1. Certify the TIN you are giving is
your correct TIN to a requester, you are
report all your taxable interest and
correct (or you are waiting for a number to
subject to a penalty of $50 for each such
dividends on your tax return, payments
be issued),
failure unless your failure is due to
you receive will not be subject to backup
reasonable cause and not to willful neglect.
2. Certify you are not subject to backup
withholding. Payments you receive will be
withholding, or
Civil penalty for false information with
subject to backup withholding if:
respect to withholding. If you make a
3. Claim exemption from backup
1. You do not furnish your TIN to the
false statement with no reasonable basis
withholding if you are an exempt payee.
requester, or
that results in no backup withholding, you
If you are a foreign person, IRS prefers
2. You do not certify your TIN when
are subject to a $500 penalty.
you use a Form W-8 (certificate of foreign
required (see the Part III instructions on
Criminal penalty for falsifying
status). After December 31, 2000, foreign
page 2 for details), or
information. Willfully falsifying
persons must use an appropriate Form
3. The IRS tells the requester that you
certifications or affirmations may subject
furnished an incorrect TIN, or
you to criminal penalties including fines
Note: If a requester gives you a form other
and/or imprisonment.
4. The IRS tells you that you are subject
than Form W-9 to request your TIN, you
to backup withholding because you did not
Misuse of TINs. If the requester discloses
must use the requester’s form if it is
report all your interest and dividends on
or uses TINs in violation of Federal law, the
substantially similar to this Form W-9.
your tax return (for reportable interest and
requester may be subject to civil and
dividends only), or
criminal penalties.
Cat. No. 10231X
(Rev. 11-99)


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