Form 13930 - Application For Central Withholding Agreement Page 6

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Continuation Sheet - For Entertainment Groups with Multiple Nonresident Aliens
Athlete/Entertainer
AE-ID
G-ID
(nonresident alien)
(IRS Use Only)
(IRS Use Only)
a. Legal Name
c. U.S. Taxpayer ID (SSN)
(last, first, middle initial)
b. Address
d. Date of birth
e. Country of residence
f. Country of citizenship
g. Applying as
Athlete
Entertainer
h. Group name
i. Percentage share of net income
(if applicable)
j. Stage name
k. Marital status
Married
Single
Athlete/Entertainer
AE-ID
G-ID
(nonresident alien)
(IRS Use Only)
(IRS Use Only)
a. Legal Name
c. U.S. Taxpayer ID (SSN)
(last, first, middle initial)
b. Address
d. Date of birth
e. Country of residence
f. Country of citizenship
g. Applying as
Athlete
Entertainer
h. Group name
i. Percentage share of net income
(if applicable)
j. Stage name
k. Marital status
Married
Single
Athlete/Entertainer
AE-ID
G-ID
(nonresident alien)
(IRS Use Only)
(IRS Use Only)
a. Legal Name
c. U.S. Taxpayer ID (SSN)
(last, first, middle initial)
b. Address
d. Date of birth
e. Country of residence
f. Country of citizenship
g. Applying as
Athlete
Entertainer
h. Group name
i. Percentage share of net income
(if applicable)
j. Stage name
k. Marital status
Married
Single
13930
Catalog Number 50991Q
Form
(Rev. 12-2012)

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