|
Form W-9 (Rev. 8-2013) Page 4
<br />What Name and Number To Give the Requester
<br />For this type o1 account
<br />Give name and SSN of:
<br />1. Individual
<br />The individual
<br />2. Two or more Individuals (joint
<br />The actual owner of the account or,
<br />account)
<br />if combined funds, the first
<br />Individual on the account'
<br />3, Custodian account of a minor
<br />The minor`
<br />(Uniform Gift to Minors Act)
<br />4. a. The usual revocable savings
<br />The grantor -trustee'
<br />trust (grantor is also trustee)
<br />b. So-called trust account that is
<br />The actual owner'
<br />not a legal or valid trust under
<br />stale law
<br />S. Sete proprietorship or disregarded
<br />The owner'
<br />entity owned by an Individual
<br />6. Grantor trust filing under Optional
<br />The grantor'
<br />Form 1099 Filing Method 1 (see
<br />Regulation section 1.6714(b)(2)(t)(A))
<br />For this typo of account
<br />Give name and EIN of.
<br />7. Disregarded entity not owned by an
<br />The owner
<br />Individual
<br />B.A valid trust, estate, or pension trust
<br />Legal entity'
<br />9. Corporation or LLC electing
<br />The corporation
<br />corporate status on Form 8832 or
<br />Form 2553
<br />10. Associa0on, club, religious,
<br />The organization
<br />charitable, educational, or other
<br />tax-exempt organization
<br />11. Partnership or multi -member LLC
<br />The partnership
<br />12. A broker or registered nominee
<br />The broker or nominee
<br />13. Account with the Department of
<br />The public entity
<br />Agriculture In the name of a public-
<br />entity (such as a state or local
<br />government, school district, or
<br />prison) that receives agricultural -
<br />-
<br />program payments
<br />14. Grantor trust filing under the Form
<br />The trust
<br />1041 Filing Method or the Optional
<br />Form 1099 Filing Method 2 (see
<br />Regulation section 1.671-4(b)(2)(ii(B))
<br />' list first and circle the name of the parson whose number you furnish. If only one person on a
<br />Joint account has an SSN, that person's number must be furnished.
<br />' Circle the minors name and fumish the minor's SSN.
<br />c You must show your Individual name and you may also enter your business or °DBA" name on
<br />the 'Business naraddisregarded entity" name line. You may use either your SSN or GIN Of you
<br />have one), but the IRS encourages you to use your SSN.
<br />' Ust first and circle the name of the best, estate, or penslon fust. (Da not fumish the TIN of the
<br />personal representative or trustee unless the legal evilly Itself is not designated in the account
<br />filo.) Also sea Special rules lorpartnerships on pogo 1.
<br />'Nota. Grantor also must provide a Form W-9 to trustee of trust.
<br />Privacy Act Notice
<br />Section 6100 of the Internal
<br />Note. If no name Is circled when more than one name Is listed, the number will be
<br />considered to be that of the first name listed.
<br />Secure Your Tax Records from Identity Theft
<br />Identity theft occurs when someone uses your personal Information such as your
<br />name, social security number (SSN), or other identifying information, without your
<br />permission, to commit fraud or other crimes. An Identity thief may use your SSN to
<br />get a job or may file a tax return using your SSN to receive a refund.
<br />To reduce your risk:
<br />• Protect your SSN,
<br />• Ensure your employer Is protecting your SSN, and
<br />• Be careful when choosing atax preparer.
<br />If your tax records we affected by identity theft and you receive a notice from
<br />the IRS, respond right away to the name and phone number printed on the IRS
<br />notice or letter.
<br />If your tax records are not currently affected by Identity theft but you think you
<br />are at risk due to a lost or stolen purse or wallet, questionable credit card activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
<br />Form 14039.
<br />For more Information, see Publication 4535, Identity Theft Prevention and Victim
<br />Assistance.
<br />Victims of Identity theft who are experiencing economic harm or a system
<br />problem, or are seeking help in resolving tax problems that have not been resolved
<br />through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
<br />assistance, You can reach TAS by calling the TAS toll-free was intake line at
<br />1-877-7774778 or TTY/TDD 1-800-829-4059.
<br />Protect yourself from suspicious emails or phishing schemes, Phishing Is the - -
<br />creation and use of email and websites designed to mimic legitimate business
<br />smells and websites. The most common act Is sending an email to a user falsely
<br />claiming to be an established legitimate enterprise in an attempt to scam the user
<br />into surrendering private Information that will be used for Identity theft.
<br />The IRS does not initiate contacts with taxpayers via entails. Also, the IRS does
<br />not request personal detailed information through email or ask taxpayers for the
<br />PIN numbers,passwords, or similar secret access information for their credit card, - -
<br />bank,orotherfinancialaccounts. -
<br />If you receive an unsolicited email claiming to be from the IRS, forward this
<br />message to phishing®irs.gov. You may also report misuse of the IRS name, 1090, _
<br />or other IRS property to the Treasury Inspector General for Tax Administration at
<br />1-800-366-4484. You can forward suspicious emails to the Federal Trude
<br />Commission at spam®uce.gov or contact them at www.Ragovlldtheft or 1-877-
<br />IDTHEFT (1-877-438-4338).
<br />Visit RS.gov to learn more about identity theft and how to reduce your risk
<br />are
<br />of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person col [acting this form uses the Information on the form to file Information returns with the I
<br />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 DI
<br />of Columbia, and U.S. commonwealths and possessions for use In administering their laws, The information also may be disclosed to other countries under a treaty, to
<br />federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terodsm. You must provide your TIN
<br />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
<br />payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.
<br />
|