Loading...
HomeMy WebLinkAboutExhibitNational. Trust for Historic Preser'vatton Save the past, Enrich the future. April 29, 2015 Mrs. Alice Bravo Deputy City Manager City of Miami 350o Pan American Drive Miami, Florida 33133 American Express National Treasures Grant 1. Grant and Budget. The National Trust for Historic Preservation in the United States (the "Grantor") has awarded a Grant to the City of Miami (the "Grantee") in the amount of $8o,00o for the purposes stated in paragraph 2 (the "Grant"). In accepting this Grant, Grantee agrees to all of the terms and conditions of this Grant Agreement. 2. Use of Grant Funds. Grantee shall use the Grant solely for the following purposes (the "Project"): Perform extended investigation of the piles, seawall, and other under water structures of the Miami Marine Stadium. Grant funds may not be used to cover administrative costs or to subsidize staff salaries. Any changes in the purposes of the Grant must be approved by Grantor in advance, in writing. Grantee should contact the grants office at the National Trust for Historic Preservation to discuss any proposed changes to the project. 3. Schedule. The terms of this Grant Agreement will commence upon execution by both parties. Administration of the Grant will follow the process described herein. A FINAL REPORT and FINANCIALL STATEMENT must be submitted by the Grantee no later than May 31, 2016. The report must be submitted online. See the "Find Funding" section of our website (www.PreservationNation.org/funding) for the link to our online grant system. Extensions beyond that deadline shall be issued only for extraordinary circumstances beyond the control of the Grantee, subject to the approval of Grantor. Upon receipt of the FINAL REPORT, the Grantor will verify that satisfactory progress has been made on the project and that the Grantee is in compliance with the terms of this Agreement. Reporting forms will be made available in electronic form through the National Trust's grant management system. 4. Acknowledgement of Support. Grantee agrees to acknowledge the support of American Express in all print, audio, electronic, and film/video media that it produces concerning the Project, as well as any media outreach that occurs, by including the following statement: "This Project is supported by a grant from American Express as the Presenting Partner of the National Treasures program of the National Trust for Historic Preservation." 2600 Virginia Avenue NW, Suite 1000 Washington, DC 20037 r info@savingplaces,org P 202.688,6000 r 202.588.6038 www.PreservationNation,org 36, J)i?F7 Grantee also agrees, to the best of its ability, to participate in public events sponsored by the National Trust or American Express relating to this grant. 5. Inspections. Grantee agrees to submit above specified documents and provide related attachments completed to describe the work on the Project and all expenditures made from Grant funds, and to demonstrate Grantee's compliance with the terms of this Agreement. It is understood that the reports will be submitted by the Grantor to the American Express Foundation. Grantee agrees to permit representatives of the Grantor, with reasonable notice, to inspect the Project to ensure that the work is progressing as planned and that the Grant funds are being used for the purposes stated. Grantee also agrees to allow reasonable access to consultants and contractors engaged by the Grantee for the Project. 6. Representations and Warranties. Grantee hereby represents and warrants the following: a) it is a governmental entity; b) if it has previously received Grantor financial assistance, all grant requirements were satisfied or are current as of the date of this Agreement; c) that the representative executing this Agreement has the power and authority to bind the Grantee to the terms stated herein; and d) that the Project will be carried out in compliance with the Secretary of the Interior's Standards for the Treatment of Historic Properties. 7, Breach. Failure to comply with the terms and conditions of this Grant Agreement, including, without limitation, any failure to: a) meet the deadlines and submittal of related forms as specified in paragraph 3; b) obtain the Grantor's written approval of any proposed changes in use of Grant funds before implementation; or c) complete the Project as described shall nullify the Grant with the expectation that all funds paid to the Grantee shall be returned, along with reasonable accrued interest. In the event that Grantee violates or fails to carry out any provision of this Agreement, including, without limitation, failure to submit reports when due, Grantor may, in addition to any other legal remedies it may have, refuse to make any future grants or installment payments of this Grant to Grantee and require the repayment of any funds that have already been paid. Grantee agrees, in the event of breach, upon the request of Grantor, to return any and all payments to Grantor. 8. Lobbying and Political Activities. Grantee shall use no portion of the Grant to participate in any political campaign on behalf of or in opposition to any candidate for public office, or to support attempts to influence legislation of any governmental body other than through making available the results of non -partisan analysis, study and research, to induce or encourage violations of law or public policy, to cause any private inurnment or improper private benefit to occur, nor to take any other action inconsistent with its status as a governmental entity. 2 Di OF r 9. Non -Discrimination. Applicant agrees to not discriminate against any employee or applicant for,employment because of actual or perceived race, color, national origin, creed, age, gender, marital status, sexual orientation, religion, mental and physical disabilities, sex (including pregnancy), personal appearance, gender identity or expression, family responsibilities, genetic information, matriculation, political affiliation or veteran status. lo. Change in Status. Grantee shall notify Grantor immediately of any change in Grantee's executive staff or key staff responsible for achieving the Grant purposes. it, Indemnification and Hold Harmless. Grantee hereby irrevocably and unconditionally agrees, to the fullest extent permitted by law, to defend, indemnify and hold harmless the National Trust for Historic Preservation and the American Express Foundation, their officers, directors, trustees, employees, and agents, from and against any and all claims, liabilities, losses, and expenses (including reasonable attorney's fees), directly or indirectly, wholly or partially, arising from or in connection with any act or omission of Grantee, its officers, directors, employees, or agents, in applying for or accepting the Grant, in expending or applying the proceeds ofthe Grant, or in carrying out the Project. 12. Assignment, This Agreement may not be assigned by the Grantee without the prior written approval of the Grantor. 13. Entire Agreement. This Agreement supersedes any prior oral or written understandings or communications between the parties and constitutes the entire agreement of the parties with respect to the subject matter hereof. This Agreement may not be amended or modified except in a written document signed by both parties hereto. Please acknowledge your acceptance of this agreement by signing and returning the original of this letter to: Grants Office National Trust for Historic Preservation 260o Virginia Ave., NW Suite t000 Washington, DC 20037 Please direct questions regarding this Grant or your reporting requirements to the National Trust's grant office at grants Osavingplaces.org or 202.588.6277. By signing and returning this Agreement you acknowledge that these grant funds will be used expressly for the purposes described herein and are subject to the conditions contained in herein. \NZcerv7.' David J. Brown Executive Vice President and Chief Preservation Officer National Trust for Historic Preservation Agreed to on (date) 3 Signature Name Title Organization 4 Vendor Name \Dn ET National Trust for Historic Preservation Electronic Funds Transfer (EFT) & Direct Deposit Authorization Agreement For National Trust Vendors Daytime Telephone Email Address Vendor # (Required for payment notification) Please validate with your financial institution your BANK ROUTING NUMBERS and ACCOUNT NUMBER for direct deposit. Attach void check or copy (Please -no deposit slips for checking accounts) - NEW fl - CHANGE - CANCEL Bank Name City / State Bank ABA # Bank Telephone # (Routing number) Account # Payments cannot be split between multiple accounts. Authorization E - CHECKING E - SAVINGS I hereby authorize NTHP to deposit non -wage credits to the designated financial institutions(s) and account(s) listed above. I further authorize NTHP to debit account(s) as such financial institution(s) listed above, in the event of any error to any such deposit credits, I have read the above information and 1 understand my obligations in maintaining the account information. Vendor Signature Date It is the responsibility of the vendor to verify the above information for accuracy. Please contact the Finance Accounts Payable office immediately if you find a discrepancy or require account updates. Updated— /12/05 Form (Rev. Deoember 2011) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. c\i m m ro 0 0 N a O o ° C 0- v 0 5) w 0) 0) Name (as shown on your Income tax return) Business name/disregarded entity name, if different from above Check appropriate box for federal tax classification: ❑ Individual/sole proprietor ❑ 0 Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate ❑ Limited liability company. Enter the tax classification-(C=C corporation, S=S corporation, P=partnership) O- ❑ Other (see instructions) ra ❑ Exempt payee Address (number, street, and apt, or suite no.) City, state, and ZIP code Requester's name and address (optional) List aocount number(s) here (optional) Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on the "Name" line 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 your employer Identification number (EIN), If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4!for guidelines on whose number to enter. Social security number Employer identification number Certification Under penalties of perjury, I certify that: 1, The number shown on this form is my correct taxpayer identification number (or1 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, citizen or other U.S, person (defined below), 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 Here Signature of U.S. person 6. Date 61. General Instructions Section references are to the Internal Revenue Code unless otherwise noted, 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. 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 it (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), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership Income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected Income, Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if It is substantially similar to this Form W-9. Definition of a. U.S. person. For federal tax purposes, you are considered a U.S. person If you are: + An individual who is a U.S. citizen or U.S. resident alien, + A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, + An estate (other than a foreign estate), or + A domestic trust (as defined in Regulations section 301.7701-7), Special rules for partnerships, Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of Income from such business. Further, in oertain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that Is a partner In a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No. 10231X Form W-9 (Rev. 12-2011) Form W-9 (Rev. 12-2011) Page 2 The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net Income from the partnership conducting a trade or business in the United States is In the following oases: ® The U,S. owner of a disregarded entity and not the entity, The U.S. grantor or other owner of a grantor trust and not the trust, and • The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust, Foreign person. If you are a foreign person, do not use Form W-9, Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alienindividual 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 es a "saving clause," Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you 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 to Form W-9 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 treaty 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 to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China Income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States, Under U.S, law, this student will become a resident alien for tax purposes 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 after the Chinese student becomes a resident 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 exemption 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 a percentage of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt Interest, dividends, broker and barter exchange transactions, rents, royalties, 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, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 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. Also see Special rules for partnerships on page 1, Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt, In addition, you must furnish a new Form W-9 If the name or TIN changes for the account, for example, if the grantor of a grantor trust dies, 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. 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 income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration 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 income tax return on the "Name" line. You may enter your business, trade, or "doing business as (DBA)" name on the "Business name/disregarded entity name" line, Partnership, C Corporation, or S Corporation. Enter the entity's name on the "Name" line and any business, trade, or "doing business as (DBA) name" on the "Business name/disregarded entity name" line. Disregarded entity. Enter the owner's name on the "Name" line. The name of the entity entered on the "Name" line should never be a disregarded entity. The name on the "Name" line must be the name shown on the income tax return on which the income will be reported, For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name Is required to be provided on the "Name" line. If the direct owner of the entity Is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the "Business name/disregarded entity name" line, If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8, Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the "Name" line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate). Limited Liability Company (LLC). If the person identified on the "Name" line is an LLC, check the "Limited liability company" box only and enter the appropriate code for the tax classification In the space provided. If you are an LLC that is treated as a partnership for federal tax purposes, enter "P" for partnership, If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter "C" for 0 corporation or "S" for S corporation. If you are an LLC that is disregarded as an entity separate from Its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the "Name" line) is another LLC that is not disregarded for federal tax purposes. If the LLC is disregarded as an entity separate from Its owner, enter the appropriate tax classification of the owner identified on the "Name" line. DPW - Form W-9 (Rev. 12-201'1) Page 3 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 DBA name on the "Business name/ disregarded entity name" line. Exempt Payee If you are exempt from backup withholding, enter your name as described above and check the appropriate box for your status, then check the "Exempt payee" box In the line following the "Business name/ disregarded entity 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. The following payees are exempt from backup withholding: 1. An organization exempt from tax under section 501(a), any IRA, or a oustodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2), 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: 6, 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, 9. A futures commission merchant registered with the Commodity Futures Trading Commission, 10, A real estate investment trust, 11. An entity registered at all times during the tax year under the Investment Company Act of 1940, 12, A common trust fund operated by a bank under section 584(a), 13. A financial institution, 14, A middleman known in the investment community as a nominee or custodian, or 15. A trust exempt from tax under section 664 or described in section 4947, The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15. IF the payment is for ... THEN the payment Is exempt for... Interest and dividend payments All exempt payees except for9 Broker transactions Exempt payees 1 through 5 and 7 through 13. Also, C corporations, Barter exchange transactions and patronage dividends Exempt payees 1 through 5 Payments over $600 required to be reported and direct sales over $5,000' Generally, exempt payees 1 through 7 2 ' See Form 1099-MISC, Miscellaneous Income, and Its instructions, 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS Individual taxpayer Identification number (ITIN). Enter it in the social security number box, If you do not have an ITIN, 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 -member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLG) on page 2), enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN, If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note. See the chart on page 4 for further clarification of 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 online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN, You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS,gov or by calling 1-800-TAX-FORM (1-800-829-3676), 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. Entering "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 a foreign owner must use the appropriate Form W-8, Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, below, and Items 4 and 5 on page 4 Indicate otherwise. For a joint account, only the person whose TIN Is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the "Name" line must sign. Exempt payees, see Exempt Payee on page 3. Signature requirements. Complete the certification as indicated in items 1 through 3, below, and Items 4 and 5 on page 4, 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 Dross out Item 2 of the certification. Form W-9 (Rev, 12-2011) Page 4 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 Drew 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, Coverdell ESA, Archer MSA or HSA 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 this type of account: Give name and SSN of: 1, Individual 2. Two or more Individuals (joint account) 3. Custodian account of a minor (Uniform Gift to Minors Act) 4, a. The usual revocable savings trust (grantor is also trustee) b, So-called trust account that is not a legal or valid trust under state law 5. Sole proprietorship or disregarded entity owned by an individual 6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1.671-4(b)(2)@(A)) The individual The actual owner of the account or, if combined funds, the first Individual on the account ' The minor' The grantor -trustee' The actual owner' The owner' The grantor* For this type of account: Give name and EN of: 7, Disregarded entity not owned by an individual 8, A valid trust, estate, or pension trust 9, Corporation or LLC electing corporate status on Form 8832 or Form 2553 10. Association, club, religious, charitable, educational, or other tax-exempt organization 11, Partnership or multi -member LLC 12, A broker or registered nominee 13. Account with the Department of Agriculture In the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1,671-4(b)(2)(i)(B)) The owner Legal entity ° The corporation The organization The partnership The broker or nominee The public entity The trust '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. 2 Circle the minor's name and furnish the minor's SSN. 2You must show your Individual name and you may also enter your business or "DBA" name on the "Business name/disregarded entity" name line, You may use either your SSN or SIN (f you have one), but the IRS encourages you to use your SSN. 4. List first andcirclethe name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself Is not designated in the account title.) Also see Special pules for partnerships on page 1. *Note. Grantor also must provide a Form W-9 to trustee of trust. Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed, Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a Job or may file a tax return using your SSN to receive a refund. To reduce your risk: • Protect your SSN, ® Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter, If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Publication 4535, Identity Theft Prevention and Victim Assistanoe. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance, You can reach TAS by calling the TAS toll -free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user Into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@lrs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury inspector General for Tax Administration at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: spamcuce.gov or contact them at www.ftc.govlldtheft or 1-877-IDTHEFT (1-877-438-4338). Visit IRS.gov to learn more about identity theft and how to reduce your risk. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report Interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA, The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. possessions for use In administering their laws. The Information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and Intelligenoe agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return, Under section 3406, payers must generally withhold a percentage of taxable Interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent Information.