Form W-9 - Request For Taxpayer Identification Number And Certification - 2014

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Request for Taxpayer
Give Form to the
requester. Do not
Identification Number and Certification
(Rev. December 2014)
send to the IRS.
Department of the Treasury
Internal Revenue Service
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
2 Business name/disregarded entity name, if different from above
4 Exemptions (codes apply only to
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
certain entities, not individuals; see
Individual/sole proprietor or
C Corporation
S Corporation
instructions on page 3):
single-member LLC
Exempt payee code (if any)
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)
Exemption from FATCA reporting
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
the tax classification of the single-member owner.
code (if any)
Other (see instructions)
(Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
6 City, state, and ZIP code
7 List account number(s) here (optional)
Part I
Taxpayer Identification Number (TIN)
Social security number
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Employer identification number
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
Part II
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
2. 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; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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 3.
Signature of
U.S. person
General Instructions
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T
Section references are to the Internal Revenue Code unless otherwise noted.
• Form 1099-C (canceled debt)
Future developments. Information about developments affecting Form W-9 (such
• Form 1099-A (acquisition or abandonment of secured property)
as legislation enacted after we release it) is at
Use Form W-9 only if you are a U.S. person (including a resident alien), to
Purpose of Form
provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject
An individual or entity (Form W-9 requester) who is required to file an information
to backup withholding. See What is backup withholding? on page 2.
return with the IRS must obtain your correct taxpayer identification number (TIN)
which may be your social security number (SSN), individual taxpayer identification
By signing the filled-out form, you:
number (ITIN), adoption taxpayer identification number (ATIN), or employer
1. Certify that the TIN you are giving is correct (or you are waiting for a number
identification number (EIN), to report on an information return the amount paid to
to be issued),
you, or other amount reportable on an information return. Examples of information
2. Certify that you are not subject to backup withholding, or
returns include, but are not limited to, the following:
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
• Form 1099-INT (interest earned or paid)
applicable, you are also certifying that as a U.S. person, your allocable share of
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
any partnership income from a U.S. trade or business is not subject to the
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
withholding tax on foreign partners' share of effectively connected income, and
• Form 1099-B (stock or mutual fund sales and certain other transactions by
4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
page 2 for further information.
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
(Rev. 12-2014)
Cat. No. 10231X


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