Form W-9 - Taxpayer Identification Number Request - University Of Florida

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W-9 Form University of Florida
You may fill these forms out on-line, print them, and send them by mail, fax or email to Vendor Maintenance:
Mail: University of Florida, Attn: Vendor Maintenance, PO Box 115350, Gainesville, FL, 32611-5350
Fax: 352-392-0081 Email:
If you need assistance with these forms you can contact us via email at
Form W-9
Taxpayer Identification Number Request Rev. 10/2003ּ For payments other than interest, dividends, or Form 1099-B gross proceeds
Substitute Form FA-PDS-W9
Please complete the following information. We are required by law to obtain
Use this form only if you are a U.S. person (including U.S. resident alien). If
this information from you when making a reportable payment to you. If you
you are a foreign person, use the appropriate Form W-8. If you were a
do not provide us with this information, your payments may be subject to
nonresident alien and have now become a resident alien, read the note
28% federal income tax backup withholding. Also, if you do not provide us
below and attach a statement, if necessary
with this information, you may be subject to a $50.00 penalty imposed by the
Internal Revenue Service under section 6723.
Note to U.S. Resident Aliens who formerly were Nonresident Aliens:
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 payor is required
If there is a tax treaty between the U.S. and your country, and it contains a
to withhold 28% of its payment to you. Backup withholding is not a failure to
“saving clause” to exempt certain types of income from U.S. tax even after
pay you. It is an advance tax payment. You should report all backup
you have become a Resident Alien, and you want to claim that exemption,
withholding as a credit for taxes paid on your federal income tax return.
fill out all of this form AND attach a page showing:
1. The treaty country
1. Complete Part 1 by completing the one row of boxes that corresponds to
2. The treaty article about the income
your tax status.
3. The article number for the “saving clause”
2. Complete Part 2 if you are exempt from Form 1099 reporting.
4. The type and amount of income that qualified for the saving clause.
5. Facts that provide a sufficient explanation of why the saving clause
3. Complete Part 3 by filling in all lines.
4. Return this completed form to us in the enclosed envelope.
Part 1 – Tax Status:
(complete only one row of boxes)
(Fill out this row)
Individual Name: First name
Middle initial
Last name
Individual’s Social Security Number
A sole proprietorship may have a “doing business as” trade name, but the legal name is the name of the business owner.
Business or Trade Name (OPTIONAL)
Sole Proprietor
Business Owner’s Name: (REQUIRED)
Business Owner’s Social Security Number
(or an LLC with one
(Fill out this row)
(First Name)
(Middle initial)
or Employer ID Number
(Last Name)
Partnership’s Name on IRS records
Name of Partnership
Partnership’s Employer Identification Number
(see IRS mailing label)
(or an LLC with
multiple owners):
(Fill out this row)
A corporation may use an abbreviated name or its initials, but its legal name is the name on the articles of incorporation.
Corporation or tax
Legal Name of Corporation or Entity:
Employer Identification Number
exempt entity:
(Fill out this row)
Part 2 – Exemption:
If exempt from Form 1099 reporting, check your qualifying exemption reason below:
Tax Exempt Entity
The United States or
A state, the District of
A foreign government or
any of its agencies or
Columbia, a possession
any of its political subdivisions
Note that there is no
under 501(a) (includes
of the United States, or
or an international
corporate exemption
501 (c) (3), or IRA)
any of their political
organization in which the
for medical and
subdivisions or agencies
United States participates
healthcare payments
under a treaty or Act of
or payments for legal
Part 3 – Certification:
Person completing this form (please print): _______________________________________
Under penalties of perjury, I certify that:
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
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 failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
I am a U.S. Person (including a U.S. resident Alien).
Signature of U.S. Person: _____________________________________________________
Date: ___________________________________
Remit address if different:
Tax Correspondence Address:
Telephone: (
) _____________________________________________


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