Form W-9 - Request For Taxpayer Identification Number And Certification - 2013 Page 4

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Form W-9 (Rev. 8-2013)

Page

What Name and Number To Give the Requester

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.

For this type of account:

Give name and SSN of:

Secure Your Tax Records from Identity Theft

1. Individual

The individual

Identity theft occurs when someone uses your personal information such as your

2. Two or more individuals (joint

The actual owner of the account or,

name, social security number (SSN), or other identifying information, without your

account)

if combined funds, the first

permission, to commit fraud or other crimes. An identity thief may use your SSN to

individual on the account

get a job or may file a tax return using your SSN to receive a refund.

3. Custodian account of a minor

The minor

To reduce your risk:

(Uniform Gift to Minors Act)

• Protect your SSN,

4. a. The usual revocable savings

The grantor-trustee

• Ensure your employer is protecting your SSN, and

trust (grantor is also trustee)

b. So-called trust account that is

• Be careful when choosing a tax preparer.

The actual owner

not a legal or valid trust under

If your tax records are affected by identity theft and you receive a notice from

state law

the IRS, respond right away to the name and phone number printed on the IRS

5. Sole proprietorship or disregarded

The owner

notice or letter.

entity owned by an individual

If your tax records are not currently affected by identity theft but you think you

The grantor*

6. Grantor trust filing under Optional

are at risk due to a lost or stolen purse or wallet, questionable credit card activity

Form 1099 Filing Method 1 (see

or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit

Regulation section 1.671-4(b)(2)(i)(A))

Form 14039.

For this type of account:

Give name and EIN of:

For more information, see Publication 4535, Identity Theft Prevention and Victim

Assistance.

7. Disregarded entity not owned by an

The owner

individual

Victims of identity theft who are experiencing economic harm or a system

8. A valid trust, estate, or pension trust

problem, or are seeking help in resolving tax problems that have not been resolved

Legal entity

through normal channels, may be eligible for Taxpayer Advocate Service (TAS)

9. Corporation or LLC electing

The corporation

assistance. You can reach TAS by calling the TAS toll-free case intake line at

corporate status on Form 8832 or

1-877-777-4778 or TTY/TDD 1-800-829-4059.

Form 2553

Protect yourself from suspicious emails or phishing schemes. Phishing is the

10. Association, club, religious,

The organization

creation and use of email and websites designed to mimic legitimate business

charitable, educational, or other

emails and websites. The most common act is sending an email to a user falsely

tax-exempt organization

claiming to be an established legitimate enterprise in an attempt to scam the user

The partnership

11. Partnership or multi-member LLC

into surrendering private information that will be used for identity theft.

12. A broker or registered nominee

The broker or nominee

The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does

not request personal detailed information through email or ask taxpayers for the

13. Account with the Department of

The public entity

PIN numbers, passwords, or similar secret access information for their credit card,

Agriculture in the name of a public

bank, or other financial accounts.

entity (such as a state or local

government, school district, or

If you receive an unsolicited email claiming to be from the IRS, forward this

prison) that receives agricultural

message to phishing@irs.gov. You may also report misuse of the IRS name, logo,

program payments

or other IRS property to the Treasury Inspector General for Tax Administration at

1-800-366-4484. You can forward suspicious emails to the Federal Trade

14. Grantor trust filing under the Form

The trust

Commission at: spam@uce.gov or contact them at or 1-877-

1041 Filing Method or the Optional

IDTHEFT (1-877-438-4338).

Form 1099 Filing Method 2 (see

Regulation section 1.671-4(b)(2)(i)(B))

Visit IRS.gov to learn more about identity theft and how to reduce your risk.

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.

Circle the minor’s name and furnish the minor’s SSN.

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

have one), but the IRS encourages you to use your SSN.

List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the

personal representative or trustee unless the legal entity itself is not designated in the account

title.) Also see Special rules for partnerships on page 1.

*Note. Grantor also must provide a Form W-9 to trustee of trust.

Privacy Act Notice

Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with

the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation

of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS,

reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District

of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The 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 intelligence agencies to combat terrorism. You must provide your TIN

whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other

payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.