Form W-9 - Request For Taxpayer Identification Number And Certification - 2017 Page 5
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65
Form W-9 (Rev. 11-2017)
Page
1. Interest, dividend, and barter exchange accounts opened
For this type of account:
Give name and EIN of:
before 1984 and broker accounts considered active during 1983.
14. Account with the Department of
The public entity
You must give your correct TIN, but you do not have to sign the
Agriculture in the name of a public
certification.
entity (such as a state or local
2. Interest, dividend, broker, and barter exchange accounts
government, school district, or
opened after 1983 and broker accounts considered inactive during
prison) that receives agricultural
1983. You must sign the certification or backup withholding will apply. If
program payments
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
15. Grantor trust filing under the Form
The trust
1041 Filing Method or the Optional
certification before signing the form.
Form 1099 Filing Method 2 (see
3. Real estate transactions. You must sign the certification. You may
Regulations section 1.671-4(b)(2)(i)(B))
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
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List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person’s number
have to sign the certification unless you have been notified that you
must be furnished.
have previously given an incorrect TIN. “Other payments” include
payments made in the course of the requester’s trade or business for
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Circle the minor’s name and furnish the minor’s SSN.
rents, royalties, goods (other than bills for merchandise), medical and
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You must show your individual name and you may also enter your
health care services (including payments to corporations), payments to
business or DBA name on the “Business name/disregarded entity”
a nonemployee for services, payments made in settlement of payment
name line. You may use either your SSN or EIN (if you have one), but the
card and third party network transactions, payments to certain fishing
IRS encourages you to use your SSN.
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
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List first and circle the name of the trust, estate, or pension trust. (Do
5. Mortgage interest paid by you, acquisition or abandonment of
not furnish the TIN of the personal representative or trustee unless the
secured property, cancellation of debt, qualified tuition program
legal entity itself is not designated in the account title.) Also see Special
payments (under section 529), ABLE accounts (under section 529A),
rules for partnerships, earlier.
IRA, Coverdell ESA, Archer MSA or HSA contributions or
*Note: The grantor also must provide a Form W-9 to trustee of trust.
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification.
Note: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
What Name and Number To Give the Requester
Secure Your Tax Records From Identity Theft
For this type of account:
Give name and SSN of:
Identity theft occurs when someone uses your personal information
1. Individual
The individual
such as your name, SSN, or other identifying information, without your
2. Two or more individuals (joint
The actual owner of the account or, if
permission, to commit fraud or other crimes. An identity thief may use
account) other than an account
combined funds, the first individual on
your SSN to get a job or may file a tax return using your SSN to receive
maintained by an FFI
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the account
a refund.
3. Two or more U.S. persons
Each holder of the account
To reduce your risk:
(joint account maintained by an FFI)
• Protect your SSN,
The minor ²
4. Custodial account of a minor
• Ensure your employer is protecting your SSN, and
(Uniform Gift to Minors Act)
• Be careful when choosing a tax preparer.
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5. a. The usual revocable savings trust
The grantor-trustee
If your tax records are affected by identity theft and you receive a
(grantor is also trustee)
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notice from the IRS, respond right away to the name and phone number
b. So-called trust account that is not
The actual owner
printed on the IRS notice or letter.
a legal or valid trust under state law
If your tax records are not currently affected by identity theft but you
6. Sole proprietorship or disregarded
The owner ³
think you are at risk due to a lost or stolen purse or wallet, questionable
entity owned by an individual
credit card activity or credit report, contact the IRS Identity Theft Hotline
7. Grantor trust filing under Optional
The grantor*
at 1-800-908-4490 or submit Form 14039.
Form 1099 Filing Method 1 (see
For more information, see Pub. 5027, Identity Theft Information for
Regulations section 1.671-4(b)(2)(i)
Taxpayers.
(A))
Victims of identity theft who are experiencing economic harm or a
For this type of account:
Give name and EIN of:
systemic problem, or are seeking help in resolving tax problems that
8. Disregarded entity not owned by an
The owner
have not been resolved through normal channels, may be eligible for
individual
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
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9. A valid trust, estate, or pension trust
Legal entity
calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
The corporation
10. Corporation or LLC electing
Protect yourself from suspicious emails or phishing schemes.
corporate status on Form 8832 or
Phishing is the creation and use of email and websites designed to
Form 2553
mimic legitimate business emails and websites. The most common act
11. Association, club, religious,
The organization
is sending an email to a user falsely claiming to be an established
charitable, educational, or other tax-
legitimate enterprise in an attempt to scam the user into surrendering
exempt organization
private information that will be used for identity theft.
The partnership
12. Partnership or multi-member LLC
13. A broker or registered nominee
The broker or nominee
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