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HomeMy WebLinkAboutAttachment Hor ram W -9 U e- January 2003) tec.mmer/i a Int 1;e wn ar„m„- INarnr. a▪ I I Request for Taxpayer Identification Number and Certification ATTACHMENT H Give form to the Do not send to the IRS. = I ausmess nameit o,flc eat from above o 0 0 O c � a`� u u ▪ J L+st accourn numoer(s1 hose lopuonaq Indwdual/ Cnr_-A appropriate Sox. ! J Sole rsopr,eta ❑ Cor2oratan f_J Partno-ship ❑ Ctne ► ........... ,emot horn oxxu,o J +YMno+0m9 Aooress fnumbe:. street. and apt or sune no. Garyslate, ano ZIP cafe Reques:e 1 namb enG aooress Iopi octal) ran Taxpayer identification Number (TIN) Enter your TIN in the appropriate box 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, n is your employer identification number (EIN). I1 you do not have a number, see How to get a TIN on page 3. Note: 1f the account is in more than one name. see the chart on page 4 for guidelines on whose number to enter. Part ll Certification Soaal security number 1 1. 1'1 4 1 1 or Employer identification rx.niber - 111111 Under penalties of perjury, I certify that . T- The number shown on ttus 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) ! have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a resull of a failure to report all interest or dividends. or lc) the IRS has notified me that I am no longer subject 10 backup withholding, and 3. I am a U.S. person (including a U.S. resident alien). Certification instructions. You must cross out 'tern 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 retum. For real estate transactions, nem 2 does not apply For mortgage interest paid, acquisition or abandonment of secured property, cancellation or 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 I Signature of Here u.s. perso. Purpose of Form A person who is required- to file an information return with the IRS, must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or. contributions you made to an IRA. 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 person requesting a (the requester) and, when applicable, to: - 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), Z. Certify that you are not subject to backup withholding, 3. Claim exemption from backup withholding if you are a U.S. exempt payee. Note: 11a requester gives you a form other than Form W-9 to request your TIN, you must use the reque..-er s form if it is substantially similar to this Form W-9, Foreign person. If you are a foreign person, use the • appropriate Form W-8 (see Pub. 515, Wahholdine of Tax on Nonresident Aliens and Foreign Entities). Date V Nonresident alien who becomes a resident afien- Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income, However, most tax treaties contain a provision known as a 'saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for cenain types of income even after the recipient has otherwise become a U.S. resident alien' for tax purposes. Ifyou are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement that specifies the following five' items: 1. The treaty country Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien 2. The Ueaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving 'clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts tojustify the exemption from tax under the terms of the treaty article. Cat. No. )0231x form W-9 !Re+. I.30031 f crrn W.9 iPev. 1 "2022) 2 Example. Article 20 of the U.S.-China incorre tax weary allows an exemptio,rf from tax for scholarship income tecerven by a Chinese student temporarily present in the United States. Under U.S. law• this student will become a resident alien for tax ourpeses if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30. 1984) allows the provisions of Article 20 to continue to apply even aher the Chinese student becomes a residem alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exempton from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. if you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the iRS 30% of such payments (29% after December 31, 2003; 28% after December 31, 2005). This is called "backup withholding." Payments that may be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royafties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding On payments you receive if you give the requester your correct TIN. make the"proper certifications, and report all 'your taxable interest . and dividends on your tax return. Payments you receive will be subject to backup withholding if 1. You do not furnish your TIN to the requester, or 2. You do not certify your TIN when required (see the Part 11 instructions on page 4 for details/,.or 3. The IRS tells the requester that you furnished an incorrect TIN, or • 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5, You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9. Penalties . Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty, of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. r Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINS in violation of Federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name if you are an individual, you must generally enter the name shown on your sweat security card. However, il voo rave. changed your last name. for instance. due to n-,a;riaae without informing the Social Securrty Administraoon of the - name change. enter your first name, the last name shown on your social security card, and your .new last name. if the account is in joint names. list first, and then circle, the name of the person or entity whose number you entered in - Part I of the form. Sole proprietor. Enter your individual name as -shown on your social security card on the "Name" line. You may enter your business, trade. or "doing business as (DBA)" name on the "Business name'" line. Limited liability company (LLC). If you. are a single -member LLC (including a foreign LLC with a domeetl owner) that is disregarded as an entity separate from its owner under. Treasury regulations section 301.7701-3, enter the owner's name on the "Name" line. Enter the LLC's name on the "Business name" line. Other entities. Enter your business name as shown on • required Federal tax documents on the "Name" line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or D8A name On the "Business name" line. Note: You are requested to check the appropriate box- for your status (individual/sole proprietor, corporation, etc.). Exempt 'From Backup Withholding if you are exempt, enter your name as described above and check the appropriate box for your status, then check the "Exempt from backup withholding" box in the line following the business name, sign and date the form. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt •from backup withholding for certain payments, such as •interest and dividends. Note: If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding, Exempt payees. Backup withholding is not required on any payments made to the following payees: 1. An organization exempt from tax under section 501(a), any iRA, or a custodial account under section 403(b)(7) if the account. satisfies the requirements of section 40102): 2. The United States or any of its agencies or instrumentalities; 3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions,or instrumentalities; 4. A foreign government or any of its political subdivisions, agencies, or instrumentalities; or 5. An international organization or any of its agencies or instrumentalities. Other payees that may be exempt from backup withholding include: E. A corporation; 7. A foreign central bank of issue: 8. A dealer in securities or commodities required to register in the United States. the District of Columbia, or a possession of the United States; rcr-n w-9 (Rev 1-2003) p3,-, 3 9. A futures commission merchant fe stered with the Coi mmodity Futures Trading Commsslon, 10. A. real estate investment trust. 11. .An entity registered a: ail UmeS during Ind :ax year under the Investment Company Act of 1940; 12, A common trust fund operated by a bank under section 584(a); 13. A Financial msttution; 14. A middleman known in the investment community as a nominee or custodian; or 15. A trust exempt from tax under section 66-4 or described in section 4947. The chart below shows types of payments that may he exempt from backup withholding. The chart applies to the exempt recipients listed above, 1 through 15. If the payrnerrt is for... THEN the payment is exempt for... Interest and dividend payments All exempt recipients except for 9 Broker transactions Exempt recipients 1 through 13. Also. a person registered under the investment Advisers Act of 1940 who regularly acts as a broker Barter exchange transactions and patronage dividends Exempt recipients 1 through 5 Payments over 1600 required to be reported and direct sales over S5.000' Generally. exempt recipients 1 through 7 2 'See Form 1099-MISC. Miscellaneous income. and as Instructions. 'However, the following payments made to a corporation (including gross proceeds paid to an attorney under section 6045(p. even it the attorney is a corporation) and reportable on Form 1099-MISC are not exempt from backup withholding: medlcai and health care payments, attorneys' tees, and payments for services paid by a Federal executive agency. Part 1. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and ,-ou do not have and are not eh0iele to oct an' SS1.1, your TIN !s Your IRS Individual taxpayer identrfice:ion number (ITN'). Enter it in the social set -wiry number box. If you do not have an (TIN. see. How to get a TIN below. If you are a sole proprietor and you have an EIN. you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single -owner LLC that is disregarded as an entity separate from its owner (see limited liability company (LLC) on page 2). ertter your SSN (or ON. if you . have one). If the LLC is a corporation. partnership. etc., enter the entity's EIN, Note: See the chart on page 4 for further clarification or name and TIN combinations. How to get a TiN. if you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form on-line at www.ssa-gov/online/ss5.html. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identifrcadon Number, to apply for an ITN, or Form SS-4, Application for Employer Identification Number, to apply for an EFN. You can get Forms W-7 and SS-4 from the iRS by calling 1-800-TAX-FORM (1-800-829-3676) or from the iRS Web Site at www-irs.gov. - If you are asked to complete Form W-9 but do not have a TiN, write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made With'respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup- withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note: Writing "Applied For- means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has e foreign - owner must use the appropriate Form W-8. • for., Re, 1-20031 p:y? 4 Part 11. Certification To establish to the wcnhol.ding agent that you are a U.S - person, or resident alien, sign Form VJ•9. You may be requested to sign by the wtthholdinq agent even if items 1. 3. and 5 below indicate otherwise. For ajoini account. only the person t. -ose TIN is shown in Part I should sion (when required). Exempt recipients. see Exempt from backup withholding on page 2. Signature requirements. Complete the ceriificauon as indicated in 1 through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after '1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3, Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. • 4. Other payments. You must give -your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. ••'Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to - attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA or Archer MSA contributions or distributions, and pension distributions- You must give your correct TIN, but you do not have to sign the certification. What 'Name and Number To Give the Requester For dos ryDe or ace Lane Gire rvirne and SSrr oi. lncliotd;zi 2. Two or more indnitdcaIs (mint aCCOunlf 3. Custodian account of 2 minor {Uniform Gift to Minors Act.) 4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account !hails not a legal or valid tnrSt under state law 5. Sole proprietorship or single -owner LLC The irdrrid�-al The acmai ovine' c; tnn a0r0uct or, if combined funds. the rest individual Orthe account The minor The grantor -trustee The actual owner The owner ' For this type of account: Give name and EIN or: 6. Sole proprietorship or single -ovine( LLC 7. A valid trust. estate, or pension trust 8. Corporate or LLC elecung corporate status on form 8832 9. Association. club, religious. charitable, educational, or other tax-exempt organization 10. Partnership or multi -member LLC 11. A broker or registered nominee 12. Account with the Department of Agricutture in the name of a public entity (such as e state or local government, school district, or prison) that receives agricultural program payments The owner' Legal entity The corporation The organization The partnership The broker or nominee The public entity 'List first and circle'the name of the_ person whose number you furnish. If only one person on a joint account has an SSN, that person s number must be furnished. 'Circle the minor's name and runtish the minor's SSN. 'You must show your individual name, but you may alto enter your business or -DIM- Warne. you may use etcher your SSN or EIN or you have one). . "List first and code the name of the legal trust. estate, cr pension trust. (Do not furnish the TIN of the personal repiesentauve or trustee unless the legal entry itself is not designated in the account title.), Note: 1l no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns wrth the IRS to report iriterest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA or Archer MSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of justice for civil and criminal litigation, and to cities, states, end the District of Columbia to carry out their tax laws. We may also disclose this information to other coumr)es under a tax treaty, or to Federal and state agencies to enforce Federal nontax cnminal lags and to combat -terrorism. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhcld 30%io of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payee Certain penalties may also apply.