Form W-9 - Request For Taxpayer Identification Number And Certification - 2013 Page 3

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Form W-9 (Rev. 8-2013)
Page
Exempt payee code. Generally, individuals (including sole proprietors) are not
G—A real estate investment trust
exempt from backup withholding. Corporations are exempt from backup
H—A regulated investment company as defined in section 851 or an entity
withholding for certain payments, such as interest and dividends. Corporations are
registered at all times during the tax year under the Investment Company Act of
not exempt from backup withholding for payments made in settlement of payment
1940
card or third party network transactions.
I—A common trust fund as defined in section 584(a)
Note. If you are exempt from backup withholding, you should still complete this
J—A bank as defined in section 581
form to avoid possible erroneous backup withholding.
K—A broker
The following codes identify payees that are exempt from backup withholding:
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
1—An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the requirements
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
of section 401(f)(2)
Part I. Taxpayer Identification Number (TIN)
2—The United States or any of its agencies or instrumentalities
Enter your TIN in the appropriate box. If you are a resident alien and you do not
3—A state, the District of Columbia, a possession of the United States, or any of
have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer
their political subdivisions or instrumentalities
identification number (ITIN). Enter it in the social security number box. If you do not
4—A foreign government or any of its political subdivisions, agencies, or
have an ITIN, see How to get a TIN below.
instrumentalities
If you are a sole proprietor and you have an EIN, you may enter either your SSN
5—A corporation
or EIN. However, the IRS prefers that you use your SSN.
6—A dealer in securities or commodities required to register in the United
If you are a single-member LLC that is disregarded as an entity separate from its
States, the District of Columbia, or a possession of the United States
owner (see Limited Liability Company (LLC) on page 2), enter the owner’s SSN (or
7—A futures commission merchant registered with the Commodity Futures
EIN, if the owner has one). Do not enter the disregarded entity’s EIN. If the LLC is
Trading Commission
classified as a corporation or partnership, enter the entity’s EIN.
8—A real estate investment trust
Note. See the chart on page 4 for further clarification of name and TIN
combinations.
9—An entity registered at all times during the tax year under the Investment
Company Act of 1940
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for an SSN, get Form SS-5, Application for a Social Security Card, from your local
10—A common trust fund operated by a bank under section 584(a)
Social Security Administration office or get this form online at You
11—A financial institution
may also get this form by calling 1-800-772-1213. Use Form W-7, Application for
12—A middleman known in the investment community as a nominee or
IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4,
custodian
Application for Employer Identification Number, to apply for an EIN. You can apply
for an EIN online by accessing the IRS website at and
13—A trust exempt from tax under section 664 or described in section 4947
clicking on Employer Identification Number (EIN) under Starting a Business. You
The following chart shows types of payments that may be exempt from backup
can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-
withholding. The chart applies to the exempt payees listed above, 1 through 13.
TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN
IF the payment is for . . .
THEN the payment is exempt for . . .
and write “Applied For” in the space for the TIN, sign and date the form, and give it
to the requester. For interest and dividend payments, and certain payments made
with respect to readily tradable instruments, generally you will have 60 days to get
Interest and dividend payments
All exempt payees except
a TIN and give it to the requester before you are subject to backup withholding on
for 7
payments. The 60-day rule does not apply to other types of payments. You will be
subject to backup withholding on all such payments until you provide your TIN to
Broker transactions
Exempt payees 1 through 4 and 6
the requester.
through 11 and all C corporations. S
corporations must not enter an exempt
Note. Entering “Applied For” means that you have already applied for a TIN or that
payee code because they are exempt
you intend to apply for one soon.
only for sales of noncovered securities
Caution: A disregarded U.S. entity that has a foreign owner must use the
acquired prior to 2012.
appropriate Form W-8.
Barter exchange transactions and
Exempt payees 1 through 4
Part II. Certification
patronage dividends
To establish to the withholding agent that you are a U.S. person, or resident alien,
Payments over $600 required to be
Generally, exempt payees
sign Form W-9. You may be requested to sign by the withholding agent even if
1
2
reported and direct sales over $5,000
1 through 5
items 1, 4, or 5 below indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign
Payments made in settlement of
Exempt payees 1 through 4
(when required). In the case of a disregarded entity, the person identified on the
payment card or third party network
“Name” line must sign. Exempt payees, see Exempt payee code earlier.
transactions
Signature requirements. Complete the certification as indicated in items 1
1
through 5 below.
See Form 1099-MISC, Miscellaneous Income, and its instructions.
1. Interest, dividend, and barter exchange accounts opened before 1984
2
However, the following payments made to a corporation and reportable on Form
and broker accounts considered active during 1983. You must give your
1099-MISC are not exempt from backup withholding: medical and health care
correct TIN, but you do not have to sign the certification.
payments, attorneys' fees, gross proceeds paid to an attorney, and payments for
2. Interest, dividend, broker, and barter exchange accounts opened after
services paid by a federal executive agency.
1983 and broker accounts considered inactive during 1983. You must sign the
Exemption from FATCA reporting code. The following codes identify payees
certification or backup withholding will apply. If you are subject to backup
that are exempt from reporting under FATCA. These codes apply to persons
withholding and you are merely providing your correct TIN to the requester, you
submitting this form for accounts maintained outside of the United States by
must cross out item 2 in the certification before signing the form.
certain foreign financial institutions. Therefore, if you are only submitting this form
for an account you hold in the United States, you may leave this field blank.
3. Real estate transactions. You must sign the certification. You may cross out
Consult with the person requesting this form if you are uncertain if the financial
item 2 of the certification.
institution is subject to these requirements.
4. Other payments. You must give your correct TIN, but you do not have to sign
A—An organization exempt from tax under section 501(a) or any individual
the certification unless you have been notified that you have previously given an
retirement plan as defined in section 7701(a)(37)
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
B—The United States or any of its agencies or instrumentalities
merchandise), medical and health care services (including payments to
C—A state, the District of Columbia, a possession of the United States, or any
corporations), payments to a nonemployee for services, payments made in
of their political subdivisions or instrumentalities
settlement of payment card and third party network transactions, payments to
certain fishing boat crew members and fishermen, and gross proceeds paid to
D—A corporation the stock of which is regularly traded on one or more
attorneys (including payments to corporations).
established securities markets, as described in Reg. section 1.1472-1(c)(1)(i)
5. Mortgage interest paid by you, acquisition or abandonment of secured
E—A corporation that is a member of the same expanded affiliated group as a
property, cancellation of debt, qualified tuition program payments (under
corporation described in Reg. section 1.1472-1(c)(1)(i)
section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
F—A dealer in securities, commodities, or derivative financial instruments
distributions, and pension distributions. You must give your correct TIN, but you
(including notional principal contracts, futures, forwards, and options) that is
do not have to sign the certification.
registered as such under the laws of the United States or any state

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