|
Farm
<br />YY=9
<br />Bequest for Taxpayer
<br />Give Form to the
<br />(Rev. December 2014)
<br />Identification Number and Certification
<br />requester. no not
<br />Depadment
<br />of the Treasury
<br />send to the IFS.
<br />Internal Revenue Service
<br />1 Name (as shown on your Income tax return). Name Is required on this lino; do not leave this line blank
<br />J Lee Engineering, Inc.
<br />N
<br />P. Business name/disregarded entity name, If different from above
<br />m
<br />n
<br />3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
<br />4 Exemptions (nodes apppply only to
<br />w
<br />❑ Individual/sole ro rletor or
<br />proprietor ❑ 0 Corporation ❑✓ 8 Corporation ❑ Part roverlp ❑ Trust/estate
<br />Instructions an page 3) vauale; sea
<br />v
<br />single -member LLC
<br />[] Limped liability company. Enter the tax classification (C=C corporation, S=S corporation, P -partnership) 0 -
<br />Exempt payee code (if any)
<br />Note.
<br />Note. For a single -member LLC that Is disregarded, do not check LLC; check the appropriate box In the Ilne above fen
<br />Exemption from FATCA reporting
<br />the tax classification of the single -member owner.
<br />code (if any)
<br />p, 0
<br />❑ Other (see Instructions) h
<br />K11W mIN ash
<br />!F
<br />5 Address (number, street, and apt, or suite no.)
<br />Requester's name and address (optional)
<br />0
<br />"o.
<br />430 S. Garfield Ave, Suite 301
<br />m
<br />e City, state, and ZIP code
<br />Alhambra, CA 91801
<br />7 List account numbers) here (optional)
<br />Taxpayer Identification Number IN)
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number j
<br />4 withholding. For individuals, this Is generally your social Security number (SSN). However, fora _ m _
<br />resident ellen, sole proprietor, u disregarded entity, see the part I Instructions onpage 3. For other
<br />entities, it is your employer Identification number (EIN). If you do not have a number, see How to get e
<br />TIN on page 3. or
<br />Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for I( Employer Identifiast(en number
<br />guidelines on whose number to enter,
<br />Under penalties of poijury, I certify that:
<br />1. The number shown on this form is my correct taxpayer Identification number (or I am waiting for a number to be issued to me); and
<br />2. 1 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
<br />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
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below); and
<br />4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
<br />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
<br />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
<br />interest paid, acquisition or abandonment of secured properly, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
<br />generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
<br />Instructions on page 3. r
<br />Arun Signature of r ,r7
<br />Nere U.S. person h ,/� Date P � %� //
<br />General Instruct on
<br />Section references era to the nal Revenue Code unless otherwise noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release It) Is at wwwJra.gov/7w9,
<br />Purpose of Form
<br />An individual or entity (Form W-0 requester) who Is required to file an Information
<br />return with the IRS must obtain your correct taxpayer identification number (TIN)
<br />which may be your social security number ISSN), individual taxpayer Identification
<br />number (ITIN), adoptlon taxpayer Identification number (ATIN), or employer
<br />Identification number (EN), to report on an information return the amount paid to
<br />you, or other amount reportable on an Information return. Examples of Information
<br />returns include, but are not limited to, the following:
<br />• Form 1099 -INT (Interest earned or paid)
<br />• Form 1099 -DIV (dividends, Including those from stocks or mutual funds)
<br />• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
<br />• Form 1099-6 (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Form 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T
<br />(tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only If you are a US. person (Including a resident alien), to
<br />provide your correct,nN.
<br />If you do not return Form W-9 to the requester with a TIN, you might be subject
<br />to backup withholding, See What is backup withholding7 on page 2.
<br />By signing the tilled -out form, you:
<br />1. Certify that the TIN you are giving is correct (or you am waiting for a number
<br />to be issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
<br />applicable, you are also certifying that as a U.S. person, your allocable share of
<br />any partnership income from a U.S. trade or business is not subject to the
<br />withholding tax on foreign partners' share of effectively connected Income, and
<br />4. Certify that FATCA code(a) entered on this form (If any) Indicating that you are
<br />exempt from the FATCA reporting, is correct. Sae Who( s FATCA reporting? on
<br />page 2 for further information.
<br />Cat. No, 10231X Form W-9 (Rev, 12-2014)
<br />
|