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Form W -9 (Rev. 12 -2011)
<br />Other entities. Enter your business name as shown on required federal
<br />tax documents on the "Name" line. This name should match the name
<br />shown on the charter or other legal document creating the entity. You
<br />may enter any business, trade, or DBA name on the "Business name/
<br />disregarded entity name" line.
<br />Exempt Payee
<br />If you are exempt from backup withholding, enter your name as
<br />described above and check the appropriate box for your status, then
<br />check the "Exempt payee" box in the line following the "Business name/
<br />disregarded entity name," sign and date the form.
<br />Generally, individuals (including sole proprietors) are not exempt from
<br />backup withholding. Corporations are exempt from backup withholding
<br />for certain payments, such as interest and dividends.
<br />Note. If you are exempt from backup withholding, you should still
<br />complete this form to avoid possible erroneous backup withholding.
<br />The following payees are exempt from backup withholding:
<br />1. An organization exempt from tax under section 501(a), any IRA, or a
<br />custodial account under section 403(b)(7) if the account satisfies the
<br />requirements of section 401(f)(2),
<br />2. The United States or any of its agencies or instrumentalities,
<br />3. A state, the District of Columbia, a possession of the United States,
<br />or any of their political subdivisions or instrumentalities,
<br />4. A foreign government or any of its political subdivisions, agencies,
<br />or instrumentalities, or
<br />5. An international organization or any of its agencies or
<br />instrumentalities.
<br />Other payees that may be exempt from backup withholding include:
<br />6. A corporation,
<br />7. A foreign central bank of issue,
<br />8. A dealer in securities or commodities required to register in the
<br />United States, the District of Columbia, or a possession of the United
<br />States,
<br />9. A futures commission merchant registered with the Commodity
<br />Futures Trading Commission,
<br />10. A real estate investment trust,
<br />11. An entity registered at all times during the tax year under the
<br />Investment Company Act of 1940,
<br />12. A common trust fund operated by a bank under section 584(a),
<br />13. A financial institution,
<br />14. A middleman known in the investment community as a nominee or
<br />custodian, or
<br />15. A trust exempt from tax under section 664 or described in section
<br />4947.
<br />The following chart shows types of payments that may be exempt
<br />from backup withholding. The chart applies to the exempt payees listed
<br />above, 1 through 15.
<br />IF the payment is for ...
<br />THEN the payment is exempt
<br />for...
<br />Interest and dividend payments
<br />All exempt payees except
<br />for 9
<br />Broker transactions
<br />Exempt payees 1 through 5 and 7
<br />through 13. Also, C corporations.
<br />Barter exchange transactions and
<br />Exempt payees 1 through 5
<br />patronage dividends
<br />Payments over $600 required to be
<br />Generally, exempt payees
<br />reported and direct sales over
<br />1 through 7'
<br />$5,000'
<br />See Form 1099 -MISC, Miscellaneous Income, and its instructions.
<br />However, the following payments made to a corporation and reportable on Form
<br />1099 -MISC are not exempt from backup withholding: medical and health care
<br />payments, attorneys' fees, gross proceeds paid to an attorney, and payments for
<br />services paid by a federal executive agency.
<br />Paqe 3
<br />Part I. Taxpayer Identification Number (TIN)
<br />Enter your TIN in the appropriate box. If you are a resident alien and
<br />you do not have and are not eligible to get an SSN, your TIN is your IRS
<br />individual taxpayer identification number (ITIN). Enter it in the social
<br />security number box. If you do not have an ITIN, see How to get a TIN
<br />below.
<br />If you are a sole proprietor and you have an EIN, you may enter either
<br />your SSN or EIN. However, the IRS prefers that you use your SSN.
<br />If you are a single- member LLC that is disregarded as an entity
<br />separate from its owner (see Limited Liability Company (LLC) on page 2),
<br />enter the owner's SSN (or EIN, if the owner has one). Do not enter the
<br />disregarded entity's EIN. If the LLC is classified as a corporation or
<br />partnership, enter the entity's EIN.
<br />Note. See the chart on page 4 for further clarification of name and TIN
<br />combinations.
<br />How to get a TIN. If you do not have a TIN, apply for one immediately.
<br />To apply for an SSN, get Form SS -5, Application for a Social Security
<br />Card, from your local Social Security Administration office or get this
<br />form online at www.ssa.gov. You may also get this form by calling
<br />1- 800 - 772 -1213. Use Form W -7, Application for IRS Individual Taxpayer
<br />Identification Number, to apply for an ITIN, or Form SS -4, Application for
<br />Employer Identification Number, to apply for an EIN. You can apply for
<br />an EIN online by accessing the IRS website at www.irs.gov /businesses
<br />and clicking on Employer Identification Number (EIN) under Starting a
<br />Business. You can get Forms W -7 and SS -4 from the IRS by visiting
<br />IRS.gov or by calling 1- 800 -TAX -FORM (1- 800 -829- 3676).
<br />If you are asked to complete Form W -9 but do not have a TIN, write
<br />"Applied For" in the space for the TIN, sign and date the form, and give
<br />it to the requester. For interest and dividend payments, and certain
<br />payments made with respect to readily tradable instruments, generally
<br />you will have 60 days to get a TIN and give it to the requester before you
<br />are subject to backup withholding on payments. The 60 -day rule does
<br />not apply to other types of payments. You will be subject to backup
<br />withholding on all such payments until you provide your TIN to the
<br />requester.
<br />Note. Entering "Applied For" means that you have already applied for a
<br />TIN or that you intend to apply for one soon.
<br />Caution: A disregarded domestic entity that has a foreign owner must
<br />use the appropriate Form 1/1-8.
<br />Part II. Certification
<br />To establish to the withholding agent that you are a U.S. person, or
<br />resident alien, sign Form W -9. You may be requested to sign by the
<br />withholding agent even if item 1, below, and items 4 and 5 on page 4
<br />indicate otherwise.
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign (when required). In the case of a disregarded entity, the
<br />person identified on the "Name" line must sign. Exempt payees, see
<br />Exempt Payee on page 3.
<br />Signature requirements. Complete the certification as indicated in
<br />items 1 through 3, below, and items 4 and 5 on page 4.
<br />1. Interest, dividend, and barter exchange accounts opened
<br />before 1984 and broker accounts considered active during 1983.
<br />You must give your correct TIN, but you do not have to sign the
<br />certification.
<br />2. Interest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considered inactive during
<br />1983. You must sign the certification or backup withholding will apply. If
<br />you are subject to backup withholding and you are merely providing
<br />your correct TIN to the requester, you must cross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the certification. You may
<br />cross out item 2 of the certification.
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