County Of Alameda Substitute Irs Form W-9 - Request For Taxpayer Identification Number And Certification - 2009
ADVERTISEMENT
1
2110-W9
Rev 5-09
COUNTY OF ALAMEDA
1221 OAK STREET, ROOM 249, OAKLAND, CA 94612
Substitute IRS Form W-9
Request for Taxpayer Identification Number and Certification
The purpose of this form is to obtain or verify the accuracy of information regarding Alameda County’s payees. ALL, payees must have an accurate
W-9 on file in the Auditor-Controller’s office in order to be paid. If you fail to furnish your correct TIN, you could be subject to a penalty.
The form must be completed, even if the information shown at the bottom of the form is accurate.
Do not send to IRS. Return to Alameda County in the envelope provided.
Please print or type.
Name on record with IRS or Social Security Administration:
All DBA(s) or Invoice Name(s) (If different from above name) – use attachments if necessary:
Address for Correspondence or 1099 (we will take the remittance address if different, from the invoice)
TAX PAYER IDENTIFICATION NUMBER (TIN)
You may enter only one TIN and it must be the type of TIN (SSN or EIN) that is appropriate to your type of entity. If you do not have a TIN, or for further
information, see the instruction on the second page.
SOCIAL SECURITY NUMBER :
____ ____ ____ -- ____ ____ -- ____ ____ ____ ____
OR
ONLY ONE
NUMBER WILL
EMPLOYER ID NUMBER:
BE ACCEPTED
TIN MUST BE ENTERED REGARDLESS OF TYPE OF ENTITY (I.E., NON-PROFIT, RETAIL CORPORATION, ETC.)
Type of Entity (Please check only one)
INDIVIDUAL
SOLE PROPRIETOR
PARTNERSHIP
CORPORATION
GOVERNMENT OR TRUST (SPECIFY)
TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)
CHECK THE BOXES THAT APPLY TO Alameda County’s PAYMENT TO YOU:
GOODS ONLY
GOODS AND SERVICES
RENTS / LEASES
RENTS / LEASES PAID TO YOU AS THE AGENT
MEDICAL AND HEALTH CARE SERVICES
LEGAL SERVICES
SETTLEMENTS
OTHER SERVICES - DESCRIBE: Urban Planning
CHECK THIS BOX if you are exempt from backup withholding. Entities exempt from backup withholding are listed on the second page.
Certification – Under penalties of perjury, I certify that:
(1) The number shown on this form is my correct taxpayer information number (or I am waiting for a number to be issued to me).
(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 IRS that I am
subject to back up withholding as a result of failure to report all interest of dividends, or (c) the IRS has notified me that I am no longer subject
to backup withholding.
(3) I am a U.S. citizen or other U.S. person. For federal tax purposes, you are considered a U.S. person if you are: (a) an individual who is a U.S.
citizen or U.S. resident alien, (b) a partnership, corporation, company, or association created or organized in the United States or under the laws
of the United States, (c) an estate (other than a foreign estate), or (d) a domestic trust (as defined in Regulations section 301.7701-7).
Please sign here (required).
The purpose of this form is to verify the accuracy of the information we currently
Check if this signature applies to Certification (1) only
have on our records and to obtain your certification for our files. PLEASE DON’T
MARK THE LABEL BELOW; WE USE IT TO VERIFY THE ACCURACY OF
OUR CURRENT INFORMATION.
Signature
__________________________________________________
Print name
________________________________________________
Title
__________________________
Date
_________________
Phone Number
_______________________________
Fax Number
________________________________
e-mail address
_____________________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Financial