Form W-9 - Taxpayer Identification Number Request - Baruch College


Form W-9
Taxpayer Identification Number Request
(Use this to obtain TIN for payments other than interest, dividends, or Form 1099-B gross proceeds)
Vendor ID:
: _______________________________________
Please complete the following information. We are required by law to obtain this information from you when making a reportable payment to you. If you do not provide
us with this information, your payments may be subject to 28% federal income tax backup withholding. Also, if you do not provide us with this information, you may be
subject to a $50 penalty imposed by the Internal Revenue Service under section 6723.
Federal law on backup withholding preempts any state or local law remedies, such as any right to a mechanic’s lien. If you do not furnish a valid TIN, or if you
are subject to backup withholding, the payer is required to withhold 28% of its payment to you. Backup withholding is not a failure to pay you. It is an advanced tax
payment. You should report all backup withholding as a credit for taxes paid on your federal income tax return.
Use this form only if you are a U.S. person (including U.S. resident alien). If you are a foreign person, use the appropriate Form W-8.
1. Complete Part 1 by completing the one row of boxes that corresponds to your tax status.
2. Complete Part 2 if you are exempt from Form 1099 reporting.
3. Complete Part 3 to sign and date the form.
4. Return this completed form to: RFCUNY/OTPS Department (230 W. 41
Street, New York, NY 10036)
or fax to (212)-417-8489
Part 1 - Tax Status
(complete only one row of boxes)
Individual Name: (First name, middle initial, last name)
Individual’s social Security Number
(Fill out this row)
_________________ ____ ______________________________________
__ __ __ - __ __ - __ __ __ __
A sole proprietorship may have a “doing business as” trade name, but the legal name is the name of the business owner
Business owner’s Name: (REQUIRED)
Business Owner’s Social Security Number
Business or Trade Name (OPTIONAL)
Sole Proprietor:
______________________ ________
__ __ __ __ __ __ __ __ __
(Fill out this row)
(First Name)
(Middle Initial)
or Employer ID Number
__ __ __ __ __ __ __ __ __
(Last name)
Name of Partnership:
Partnership’s Employer Identification Number
Partnership’s Name on IRS records
(see IRS mailing label)
(Fill out this row)
__ __ - __ __ __ __ __ __ __
A corporation may use an abbreviated name or it’s initials, but its legal name is the name on the articles of incorporation.
Name of Corporation or Entity:
Employer Identification Number
Are You incorporated?
D.B.A or T.A.
Exempt charity,
Or other entity:
Attach all of the
__ __ - __ __ __ __ __ __ __
(Fill out this row)
business names.
Part 2 - Exemption:
If exempt from Form 1099 reporting, check here
AND circle our qualifying exemption reason below:
(Individuals do not complete Part 2)
1. Corporation
. Tax Exempt
3. The United States
4. A state, the District of
5. A foreign government
or any of its agencies
Columbia, a possession of
or any of its political
except there is no
Charity under
exemption for medical
501(a) includes
or instrumentalities
the United States, or any of
and healthcare
501 (c) (3), or IRA
their political subdivisions
payments or payments
for legal services
Part 3 – Signature
I am a U. S. person (including a U.S. resident alien)
Person completing this form: ______________________________________________
Title: _________________________________________________________________
If address for payments is different, please list
Signature: ___________________________________ Date: _____________________
payment remit address below.
Tax correspondence address: ______________________________________________
City: ______________________________State: __________ ZIP: ________________
Phone: (_______) ________________________________________________________
Revised 2/25/05


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