Form W-9 - Request For Taxpayer Identification Number And Certification - 2014 Page 4

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Form W-9 (Rev. 12-2014)
Page
Part II. Certification
3
You must show your individual name and you may also enter your business or DBA name on
the “Business name/disregarded entity” name line. You may use either your SSN or EIN (if you
To establish to the withholding agent that you are a U.S. person, or resident alien,
have one), but the IRS encourages you to use your SSN.
sign Form W-9. You may be requested to sign by the withholding agent even if
4
List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the
items 1, 4, or 5 below indicate otherwise.
personal representative or trustee unless the legal entity itself is not designated in the account
For a joint account, only the person whose TIN is shown in Part I should sign
title.) Also see Special rules for partnerships on page 2.
(when required). In the case of a disregarded entity, the person identified on line 1
*Note. Grantor also must provide a Form W-9 to trustee of trust.
must sign. Exempt payees, see Exempt payee code earlier.
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.
Signature requirements. Complete the certification as indicated in items 1
through 5 below.
Secure Your Tax Records from Identity Theft
1. Interest, dividend, and barter exchange accounts opened before 1984
and broker accounts considered active during 1983. You must give your
Identity theft occurs when someone uses your personal information such as your
name, SSN, or other identifying information, without your permission, to commit
correct TIN, but you do not have to sign the certification.
fraud or other crimes. An identity thief may use your SSN to get a job or may file a
2. Interest, dividend, broker, and barter exchange accounts opened after
tax return using your SSN to receive a refund.
1983 and broker accounts considered inactive during 1983. You must sign the
To reduce your risk:
certification or backup withholding will apply. If you are subject to backup
withholding and you are merely providing your correct TIN to the requester, you
• Protect your SSN,
must cross out item 2 in the certification before signing the form.
• Ensure your employer is protecting your SSN, and
3. Real estate transactions. You must sign the certification. You may cross out
• Be careful when choosing a tax preparer.
item 2 of the certification.
If your tax records are affected by identity theft and you receive a notice from
4. Other payments. You must give your correct TIN, but you do not have to sign
the IRS, respond right away to the name and phone number printed on the IRS
the certification unless you have been notified that you have previously given an
notice or letter.
incorrect TIN. “Other payments” include payments made in the course of the
requester’s trade or business for rents, royalties, goods (other than bills for
If your tax records are not currently affected by identity theft but you think you
merchandise), medical and health care services (including payments to
are at risk due to a lost or stolen purse or wallet, questionable credit card activity
corporations), payments to a nonemployee for services, payments made in
or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
settlement of payment card and third party network transactions, payments to
Form 14039.
certain fishing boat crew members and fishermen, and gross proceeds paid to
For more information, see Publication 4535, Identity Theft Prevention and Victim
attorneys (including payments to corporations).
Assistance.
5. Mortgage interest paid by you, acquisition or abandonment of secured
Victims of identity theft who are experiencing economic harm or a system
property, cancellation of debt, qualified tuition program payments (under
problem, or are seeking help in resolving tax problems that have not been resolved
section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
distributions, and pension distributions. You must give your correct TIN, but you
assistance. You can reach TAS by calling the TAS toll-free case intake line at
do not have to sign the certification.
1-877-777-4778 or TTY/TDD 1-800-829-4059.
What Name and Number To Give the Requester
Protect yourself from suspicious emails or phishing schemes. Phishing is the
creation and use of email and websites designed to mimic legitimate business
For this type of account:
Give name and SSN of:
emails and websites. The most common act is sending an email to a user falsely
claiming to be an established legitimate enterprise in an attempt to scam the user
1. Individual
The individual
into surrendering private information that will be used for identity theft.
2. Two or more individuals (joint
The actual owner of the account or,
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does
account)
if combined funds, the first
not request personal detailed information through email or ask taxpayers for the
1
individual on the account
PIN numbers, passwords, or similar secret access information for their credit card,
bank, or other financial accounts.
3. Custodian account of a minor
2
The minor
(Uniform Gift to Minors Act)
If you receive an unsolicited email claiming to be from the IRS, forward this
message to phishing@irs.gov. You may also report misuse of the IRS name, logo,
1
4. a. The usual revocable savings
The grantor-trustee
or other IRS property to the Treasury Inspector General for Tax Administration
trust (grantor is also trustee)
(TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal
b. So-called trust account that is
1
The actual owner
Trade Commission at: spam@uce.gov or contact them at or
not a legal or valid trust under
1-877-IDTHEFT (1-877-438-4338).
state law
Visit IRS.gov to learn more about identity theft and how to reduce your risk.
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5. Sole proprietorship or disregarded
The owner
entity owned by an individual
Privacy Act Notice
The grantor*
6. Grantor trust filing under Optional
Form 1099 Filing Method 1 (see
Section 6109 of the Internal Revenue Code requires you to provide your correct
Regulations section 1.671-4(b)(2)(i)
TIN to persons (including federal agencies) who are required to file information
(A))
returns with the IRS to report interest, dividends, or certain other income paid to
For this type of account:
Give name and EIN of:
you; mortgage interest you paid; the acquisition or abandonment of secured
property; the cancellation of debt; or contributions you made to an IRA, Archer
7. Disregarded entity not owned by an
The owner
MSA, or HSA. The person collecting this form uses the information on the form to
individual
file information returns with the IRS, reporting the above information. Routine uses
8. A valid trust, estate, or pension trust
Legal entity
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of this information include giving it to the Department of Justice for civil and
9. Corporation or LLC electing
The corporation
criminal litigation and to cities, states, the District of Columbia, and U.S.
corporate status on Form 8832 or
commonwealths and possessions for use in administering their laws. The
Form 2553
information also may be disclosed to other countries under a treaty, to federal and
state agencies to enforce civil and criminal laws, or to federal law enforcement and
10. Association, club, religious,
The organization
intelligence agencies to combat terrorism. You must provide your TIN whether or
charitable, educational, or other tax-
not you are required to file a tax return. Under section 3406, payers must generally
exempt organization
withhold a percentage of taxable interest, dividend, and certain other payments to
The partnership
11. Partnership or multi-member LLC
a payee who does not give a TIN to the payer. Certain penalties may also apply for
12. A broker or registered nominee
The broker or nominee
providing false or fraudulent information.
13. Account with the Department of
The public entity
Agriculture in the name of a public
entity (such as a state or local
government, school district, or
prison) that receives agricultural
program payments
14. Grantor trust filing under the Form
The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)
(B))
1
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 must be furnished.
2
Circle the minor’s name and furnish the minor’s SSN.

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