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Form W-9 (Rev. 12-2014)
<br />Note, If you are a U.S. person and a requester gives you a form other than Form
<br />W-9 to request your TlN, you must use the requester's form if it is substantially
<br />similar to this Form W-9,
<br />Definition of a U.S. person, For federal tax purposes, you are considered a U.S.
<br />person if you are:
<br />• An Individual who Is a U.S. citizen or U.S, resident alien;
<br />• A partnership, corporation, company, or association created or organized in the
<br />United States or under the laws of the United States;
<br />• An estate (other than a foreign estate); w
<br />• Adomestic trust (as defined In Regulations section 301.7701-7).
<br />Spa clal rules for partnerships. Partnerships that conduct a trade or business in
<br />the United States are generally required to pay a withholding tax under section
<br />1446 on any foreign partners' share of effectively connected taxable, Income from
<br />such business. Further, In certain cases where a Form W-9 has not been received,
<br />the rules under section 1446 require a partnership to presume that a ppartner Is a
<br />foreign person, and pay the section 1446 withholding tax. Tharstore, if you are a
<br />U.S. person that Is a partner In a partnership conducting a trade or business in the
<br />United States, provide Form W-9 to the partnership to establish your U.S, status
<br />and avoid section 1446 withholding on your share of partnership income.
<br />In the cases below, the following person must give Form W-9 to the partnership
<br />for purposes of establishing Its U.S. status and avoiding withholding on Its
<br />allocable share of net Income from the partnership conducting a trade or business
<br />In the United Staten:
<br />• In the case of a disregarded entity with a U.S. owner, the U.S. owner of the
<br />disregarded entity and not the entity;
<br />• In the case of a grantor trust with a U.S. grantor or other LLS, owner, generally,
<br />the U.S, grantor or other U.S. owner of the grantor trust and not the trust; and
<br />• In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a
<br />grantor trust) and not the beneficiaries of the trust.
<br />Foreign person. If you are a foreign person or the U.S. branch of aforeign bank
<br />that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use
<br />the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax
<br />on Nonresident Aliens and Foreign Entitles).
<br />Nonresident often who becomes a resident alien. Generally, only a nonresident
<br />alien Individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on
<br />certain types of Income, However, most tax treafles contain a provision known as
<br />a "saving clause." Exceptions specified In the saving clause may permit an
<br />exemption from tax to continua for certain types of Income even shot the payee
<br />has otherwise become a U.S. resident alien for tax purposes.
<br />If you are a PA. resident allen who Is relying an an exception contained In the
<br />saving clause of atax treaty to claim an exemption from U.S. tax on certain types
<br />of income, you must attach a statement to Form W-9 that specifies the following
<br />five items:
<br />1. The treaty country. Generally, this must be the same treaty under which you
<br />claimed exemption from tax in a nonresident alien.
<br />2. The treaty article addressing the income.
<br />3. The article number (or location) In the tax treaty that contains the saving
<br />clause and its exceptions.
<br />4. The type and amount of income that qualifies for the exemption from tax,
<br />S. Suglcieot facts to Justify the exemption from tax under the terms of the treaty
<br />article.
<br />example, Article 20 of the US: China Income tax treaty allows an exemption
<br />from tax for scholarship income received by a Chinese student temporarily present
<br />In the United States. Under U.S. law, this student will become aresident ellen for
<br />lax purposes If his or her stay in the United Stales exceeds 5 calendar years.
<br />However, paragraph 2 of the first Protocol to the U.S: China treaty (dated Apd130,
<br />1984) allows the provisions of Article 20 to continue to apply even after the
<br />Chinese student becomes a resident alien of the United States. A Chinese student
<br />who quallfias for this exception (under paragraph 2 of the first protocol) and Is
<br />relying on this exception to claim an exemption from tax on his or her scholarship
<br />or fellowship Income would attach to Form W-9 a statement that Includes the
<br />Information described above to support that exemption.
<br />If you are a nonresident alien or a !amigo anti ly, give the requester the
<br />appropriate completed Form W-8 or Farm 8233,
<br />Backup Withholding
<br />What Is backup withholding? Persona making certain payments to you must
<br />under certain conditions withhold and pay to the IRS 286/o of such payments. This
<br />Is called "backup withholding." Payments that may be subject to backup
<br />withholding include interest, tax-exempt Interest, dividends, broker and barter
<br />exchange transactions, rents, royalties, nonemployee pay, payments made in
<br />said Insured of payment card and third party network transactions, and certain
<br />payments from fishing boat operators. Ross estate transactions are net subject to
<br />backup withholding.
<br />You will not be subject to backup withholding on payments you receive If you
<br />give the requester your correct TIN, make the proper cedificatlans, and report all
<br />your taxable Interest and divldands on your tax return.
<br />Payments you receive will be sobleet to backup withholding if:
<br />1. You do not furnish your TIN to the requester,
<br />2. You do not certify your TIN when required (see the Part 11 Instructions on page
<br />3 for details),
<br />3. The IRS tells the requester that you furnished an Incorrect TIN,
<br />4. The IRS tells you that you are subject to backup withholding because you did
<br />not report all your Interest and dividends on your lax return (for reportable Interest
<br />and dividends only), or
<br />S. You do not certify to the requester that you are not subject to backup
<br />withholding under 4 above (for reportable Interest and dividend accounts opened
<br />after 1983 only-).
<br />Certain payees and payments are exempt fmm backup withholding. See Exempt
<br />payee code on page 3 and the separate Instructions for the Requester of Form
<br />W-9 for more Information.
<br />Also see Special rules forpartnerships above.
<br />What is FATCA reporting?
<br />The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign
<br />financial insiilullon to report all United States account holders that are specified
<br />United States persons. Certain payees are exempt from FATCA reporting. See
<br />Exemption from FATCA reporting code on page 3 and the Instruct one for the
<br />Requester of Form W-9 for more Information.
<br />Updating Your Information
<br />You must provide updated information to any person to whom you claimed to be
<br />an exempt payee If you are no longer an exempt payee and anticipator receiving
<br />reportable payments In the future from this person. For example, you may need to
<br />as updated Information If you are a C corporation that elects to he an S
<br />corporation, or if you no longer are tax exempt, in addition, you must furnish a new
<br />Form W-9 If the name or TIN changes for the account; for example, If the grantor
<br />of a grantor trust dlas.
<br />Penalties
<br />Failure to to relish TIN. If you fall to furnish your correct TIN to a requester, you are
<br />subject to a penally of $50 for each such failure unless your failure is due to
<br />reasonable cause and not to willful neglect.
<br />Civil penally ter false information with respect to withholding. If you make a
<br />false statement with no reasonable basis that results In no backup withholding,
<br />you are subject to a $500 penalty,
<br />Criminal penalty for falsifying Information. Willfully falsifying cedlflcatlons or
<br />affirmations may subject you to criminal penalties Including fines and/or
<br />Imprisonment.
<br />Mlsuse of TINs. If the requester discloses or uses TINS in violation of federal law,
<br />the requester may be subject to civil and criminal penalties,
<br />Specific Instructions
<br />Line Y
<br />You most enter ane of the following on this line; do not leave this line blank. The
<br />name should match the name on your tax return.
<br />If this Form W-9 Is for a joint account, list first, and then circle, the name of the
<br />person or entity whose number you entered in Part I of Form W-9.
<br />a. Individual. Generally, enter the name shown on your tax return. If you have
<br />changed your last name without informing the Social Security Administration (SSA)
<br />of the name change, elder your first name, the last name as Shown on your social
<br />security card, and your new last name.
<br />Note. ITIN applicant: Enter your individual name as It was entered on your Form
<br />W-7 application, line Ia. This should also be the same as the name you entered on
<br />the Farm 1040/104ON104DEZ you filed with your application.
<br />b. Solo proprietor or single -member I.I.C. Enter your Individual name as
<br />shown on your 1040/1 g40AM 040EZ on line 1, You may enter your business, trade,
<br />or "doing business as" (DOA) name on Ilse 2.
<br />c. Partnership, _bC that Is not a single -member LLC, C Corporation, or
<br />Corporation. Enter the entity's name as shown on the entity's tax return on line 1
<br />and any business, trade, or DBA name on line 2.
<br />d, Other entities. Ester your name as shown on required U.S. federal tax
<br />documents on line 1. This name should match the name shown on the charter or
<br />other legal document creating the entity. You may enter any business, trade, or
<br />DBA name on Ilne 2.
<br />e. Disregarded entlty. Far U.S. federal tax purposes, an eniftylhat is
<br />disregarded as an entity separate from Ito owner is treated as a "disregarded
<br />entity." See Regulations sections 301.7701-2(c)(2)(if). Enter the owner's name an
<br />line 1. The name of the entity entered on line 1 should never be a disregarded
<br />entity. The name on line 1 should be the name shown on the Income tax return on
<br />which the Income should be reported. For example, If a foreign LLC that is treated
<br />as a disregarded entity for U.S. federal tax purposes has a single owner that Is a
<br />U.S. person, the U.S. owner's name Is required to be provided on the 1. If the
<br />direct owner of the entity In also a disregarded entity, enter the first ownerthat is
<br />not dismgarded for federal tax purposes. Enter the disregarded entity's name on
<br />line 2, "Business name/disregarded entity name," If Be owner of the disregarded
<br />entity is a foreign person, the owner must complete an appropriate Form W-8
<br />Instead of a Form W-9. This is the case even If the foreign person has a U.S. TIN.
<br />75K-54
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