Student School And Activity Fund Application - Union Public Schools, Form W-9 - Request For Taxpayer Identification Number And Certification Page 3

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W-9
Request for Taxpayer
Give form to the
Form
requester. Do not
(Rev. January 2005)
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, if different from above
Individual/
Exempt from backup
Check appropriate box:
Sole proprietor
Corporation
Partnership
Other
withholding
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)
Taxpayer Identification Number (TIN)
Part I
Social security number
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 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
or
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.
Certification
Part II
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. person (including a U.S. resident alien).
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
Purpose of Form
● Any estate (other than a foreign estate) or trust. See
A person who is required to file an information return with the
IRS, must obtain your correct taxpayer identification number
Regulations sections 301.7701-6(a) and 7(a) for additional
(TIN) to report, for example, income paid to you, real estate
information.
transactions, mortgage interest you paid, acquisition or
Foreign person. If you are a foreign person, do not use
abandonment of secured property, cancellation of debt, or
Form W-9. Instead, use the appropriate Form W-8 (see
contributions you made to an IRA.
Publication 515, Withholding of Tax on Nonresident Aliens
and Foreign Entities).
U.S. person. Use Form W-9 only if you are a U.S. person
(including a resident alien), to provide your correct TIN to the
Nonresident alien who becomes a resident alien.
person requesting it (the requester) and, when applicable, to:
Generally, only a nonresident alien individual may use the
terms of a tax treaty to reduce or eliminate U.S. tax on
1. Certify that the TIN you are giving is correct (or you are
certain types of income. However, most tax treaties contain a
waiting for a number to be issued),
provision known as a “saving clause.” Exceptions specified
2. Certify that you are not subject to backup withholding,
in the saving clause may permit an exemption from tax to
or
continue for certain types of income even after the recipient
3. Claim exemption from backup withholding if you are a
has otherwise become a U.S. resident alien for tax purposes.
U.S. exempt payee.
If you are a U.S. resident alien who is relying on an
Note. If a requester gives you a form other than Form W-9 to
exception contained in the saving clause of a tax treaty to
request your TIN, you must use the requester’s form if it is
claim an exemption from U.S. tax on certain types of income,
substantially similar to this Form W-9.
you must attach a statement to Form W-9 that specifies the
For federal tax purposes you are considered a person if you
following five items:
are:
1. The treaty country. Generally, this must be the same
● An individual who is a citizen or resident of the United
treaty under which you claimed exemption from tax as a
States,
nonresident alien.
● A partnership, corporation, company, or association
2. The treaty article addressing the income.
created or organized in the United States or under the laws
3. The article number (or location) in the tax treaty that
of the United States, or
contains the saving clause and its exceptions.
W-9
Cat. No. 10231X
Form
(Rev. 1-2005)

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