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

W-9
Give Form to the
Request for Taxpayer
Form
requester. Do not
(Rev. December 2011)
Identification Number and Certification
send to the IRS.
Department of the Treasury
Internal Revenue Service
Name (as shown on your income tax return)
Business name/disregarded entity name, if different from above
Check appropriate box for federal tax classification:
C Corporation
S Corporation
Partnership
Trust/estate
Individual/sole proprietor
Exempt payee
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)
Other (see instructions)
Address (number, street, and apt. or suite no.)
Requester’s name and address (optional)
City, state, and ZIP code
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 the “Name” line
to avoid backup withholding. For individuals, this is 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 chart on page 4 for guidelines on whose
number to enter.
Part II
Certification
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).
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 4.
Sign
Signature of
Here
U.S. person
Date
Note. If a requester gives you a form other than Form W-9 to request
General Instructions
your TIN, you must use the requester’s form if it is substantially similar
Section references are to the Internal Revenue Code unless otherwise
to this Form W-9.
noted.
Definition of a U.S. person. For federal tax purposes, you are
Purpose of Form
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
A person who is required to file an information return with the IRS must
obtain your correct taxpayer identification number (TIN) to report, for
• A partnership, corporation, company, or association created or
example, income paid to you, real estate transactions, mortgage interest
organized in the United States or under the laws of the United States,
you paid, acquisition or abandonment of secured property, cancellation
• An estate (other than a foreign estate), or
of debt, or contributions you made to an IRA.
• A domestic trust (as defined in Regulations section 301.7701-7).
Use Form W-9 only if you are a U.S. person (including a resident
Special rules for partnerships. Partnerships that conduct a trade or
alien), to provide your correct TIN to the person requesting it (the
business in the United States are generally required to pay a withholding
requester) and, when applicable, to:
tax on any foreign partners’ share of income from such business.
1. Certify that the TIN you are giving is correct (or you are waiting for a
Further, in certain cases where a Form W-9 has not been received, a
number to be issued),
partnership is required to presume that a partner is a foreign person,
2. Certify that you are not subject to backup withholding, or
and pay the withholding tax. Therefore, if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the United
3. Claim exemption from backup withholding if you are a U.S. exempt
States, provide Form W-9 to the partnership to establish your U.S.
payee. If applicable, you are also certifying that as a U.S. person, your
status and avoid withholding on your share of partnership income.
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners’ share of
effectively connected income.
W-9
Form
(Rev. 12-2011)
Cat. No. 10231X

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