|
Under penalties of perjury, I certify that:
|
|
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
|
|
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 and 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); and
|
|
4. The FATCA code(s) entered on this form (if any) indicating
that I am exempt from FATCA reporting is correct.
|
|
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 tom report all interest and dividends
on your tax return. For real estate transaction, items 2 does not apply. For mortgage interest paid,
|
|
acquisition or abandonment of secure property, cancellation of debt,
contributions to an individual retirement arrangement (IRA), and generally, payments
|
|
other than interest and dividends, you are not require to sign certification,
but you must provide your correct TIN. See the instruction for Part II, later.
|
|
|
General Instructions
|
|
Section references are to the Internal Revenue Code unless otherwise noted.
|
|
Future developments.
|
For the latest information about developments
|
|
|
related to Form W-9 and its instructions, such as legislation enacted
|
|
after they were published, go to www.irs.gov/FormW9.
|
|
Purpose of Form
|
|
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not limited to, the following.
|
|
• Form 1099-INT (interest earned or paid)
|
|
By signing the filled-out form, you:
|
|
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, and
|
|
4. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting, is correct. See What is
FATCA reporting, later, for further information.
|
|
Note:
If you are a U.S. person and 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 under section 1446 on any foreign partners’ share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
require a partnership to presume that a partner is a foreign person, and
pay the section 1446 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 section 1446 withholding on your share of
partnership income.
|
|
In the cases below, the following person must give 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.
|
|
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the entity;
|
|
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the trust; and
|
|
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
|
|
Foreign person.
If you are a foreign person or the U.S. branch of a
|
|
foreign bank that has elected to be treated as a U.S. person, do not use
Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
|
|
Nonresident alien who becomes a resident alien.
Generally, only a
|
|
nonresident alien individual 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 as 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.
|
|
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
|
|
Line 1
|
|
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
|
|
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
|
|
Generally, enter the name shown on your tax return. If
|
|
you have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
|
|
Note: ITIN applicant:
Enter your individual name as it was entered on
|
|
your Form W-7 application, line 1a. This should also be the same as the
name you entered on the Form 1040/1040A/1040EZ you filed with your application.
|
|
b. Sole proprietor or single-member LLC.
Enter your individual
|
|
name as shown on your 1040/1040A/1040EZ on line 1. You may enter
your business, trade, or “doing business as” (DBA) name on line 2.
|
|
c. Partnership, LLC that is not a single-member LLC, C
|
|
corporation, or S corporation.
Enter the entity's name as shown on the
|
|
entity's tax return on line 1 and any business, trade, or DBA name on line 2.
|
|
d. Other entities.
Enter your name as shown on required U.S. federal
|
|
tax documents on line 1. 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 line 2.
|
|
e. Disregarded entity.
For U.S. federal tax purposes, an entity that is
|
|
disregarded as an entity separate from its owner is treated as a
“disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter
the owner's name on line 1. The name of the entity entered on line 1
should never be a disregarded entity. The name on line 1 should be the
name shown on the income tax return on which the income should be
reported. For example, if a foreign LLC that is treated as a disregarded
entity for U.S. federal tax purposes has a single owner that is a U.S.
person, the U.S. owner's name is required to be provided on line 1. 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 line 2, “Business name/disregarded entity
name.” If the owner of the disregarded entity is a foreign person, the
owner must complete an appropriate Form W-8 instead of a Form W-9.
This is the case even if the foreign person has a U.S. TIN.
|
|
Line 2
|
|
If you have a business name, trade name, DBA name, or disregarded
entity name, you may enter it on line 2.
|
|
Line 3
|
|
Check the appropriate box on line 3 for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3.
|
|
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 13.
|
| IF the payment is for . . . |
THEN the payment is exempt for . . . |
| Interest and dividend payments |
All exempt payees except for 7 |
| Broker transactions |
Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012. |
| Barter exchange transactions and patronage dividends |
Exempt payees 1 through 4
|
| Payments over $600 required to be
reported and direct sales over
$5,0001 |
Generally, exempt payees 1 through 52 |
| Payments made in settlement of
payment card or third party network
transactions |
Exempt payees 1 through 4 |
|
|
1 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 reportable under section 6045(f), and
payments for services paid by a federal executive agency.
|
|
Exemption from FATCA reporting code.
The following codes identify
|
|
payees that are exempt from reporting under FATCA. These codes
apply to persons submitting this form for accounts maintained outside
of the United States by certain foreign financial institutions. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with “Not Applicable” (or
any similar indication) written or printed on the line for a FATCA
exemption code.
|
|
A—An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37)
|
|
B—The United States or any of its agencies or instrumentalities
|
|
C—A state, the District of Columbia, a U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
|
|
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations section 1.1472-1(c)(1)(i)
|
|
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)(i)
|
|
F—A dealer in securities, commodities, or derivative financial
instruments (including notional principal contracts, futures, forwards,
and options) that is registered as such under the laws of the United States or any state
|
|
G—A real estate investment trust
|
|
H—A regulated investment company as defined in section 851 or an
entity registered at all times during the tax year under the Investment Company Act of 1940
|
|
I—A common trust fund as defined in section 584(a)
|
|
J—A bank as defined in section 581
|
|
K—A broker
|
|
L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
|
|
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
|
|
cross out item 2 of the certification.
|
|
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 made in settlement of payment
card and third party network transactions, payments to certain fishing
boat crew 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), ABLE accounts (under section 529A),
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
|
| this type of account: |
Give name and SSN of: |
| 1. Individual |
The individual |
| 2. Two or more individuals (joint
account) other than an account
maintained by an FFI |
The actual owner of the account or, if
combined funds, the first individual on
the account1 |
| 3. Two or more U.S. persons (joint account maintained by an FFI) |
Each holder of the account |
| 4. Custodial account of a minor (Uniform Gift to Minors Act) |
The minor2 |
| 5. 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 |
The grantor-trustee1
The actual owner1
|
| 6. Sole proprietorship or disregarded entity owned by an individual |
The owner3 |
| 7. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulations section 1.671-4(b)(2)(i) (A)) |
The grantor* |
| For this type of account: |
Give name and EIN of: |
| 8. Disregarded entity not owned by an individua |
The owner |
| 9. A valid trust, estate, or pension trust |
Legal entity4 |
| 10. Corporation or LLC electing corporate status on Form 8832 or Form 2553 |
The corporation |
| 11. Association, club, religious, charitable, educational, or other taxexempt organization |
The organization |
| 12. Partnership or multi-member LLC |
The partnership |
| 13. A broker or registered nominee |
The broker or nominee |
|
|
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 accunts.
|
|
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (TIGTA) at 1-800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.IdentityTheft.gov and Pub. 5027.
|
|
Visit www.irs.gov/IdentityTheft to learn more about identity theft and how to reduce your risk.
|
|
• Form 1099-DIV (dividends, including those from stocks or mutual funds)
|
|
• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
|
|
• Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)
|
|
• Form 1099-S (proceeds from real estate transactions)
|
|
• Form 1099-K (merchant card and third party network transactions)
|
|
• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition)
|
|
• Form 1099-C (canceled debt)
|
|
• Form 1099-A (acquisition or abandonment of secured property)
|
|
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.
|
|
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
|
|
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, give the requester the
appropriate completed Form W-8 or Form 8233.
|
|
Backup Withholding
|
|
What is backup withholding?
Persons making certain payments to you
|
|
must under certain conditions withhold and pay to the IRS 24% 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, payments made in settlement of payment card and
third party network transactions, 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 instructions for Part II 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 Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
|
|
Also see Special rules for partnerships, earlier.
|
|
What is FATCA Reporting?
|
|
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all United States
account holders that are specified United States persons. Certain
payees are exempt from FATCA reporting. See Exemption from FATCA
reporting code, later, and the Instructions for the Requester of Form
W-9 for more information.
|
|
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.
|
| IF the entity/person on line 1 is a(n) . . . |
THEN check the box for . . . |
| • Corporation |
Corporation |
| • Individual
• Sole proprietorship, or
• Single-member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes. |
Individual/sole proprietor or singlemember LLC |
| • LLC treated as a partnership for
U.S. federal tax purposes,
• LLC that has filed Form 8832 or
2553 to be taxed as a corporation,
or
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
purposes. |
Limited liability company and enter
the appropriate tax classification.
(P= Partnership; C= C corporation;
or S= S corporation)
|
| • Partnership |
Partnership |
| • Trust/estate |
Trust/estate |
|
|
Line 4, Exemptions
|
|
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to you.
|
|
Exempt payee code.
|
|
• Generally, individuals (including sole proprietors) are not exempt from backup withholding.
|
|
• Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dividends.
|
|
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third party network transactions.
|
|
• Corporations are not exempt from backup withholding with respect to
attorneys’ fees or gross proceeds paid to attorneys, and corporations
that provide medical or health care services are not exempt with respect
to payments reportable on Form 1099-MISC.
|
|
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space in line 4.
|
|
1—An organization exempt from tax under section 501(a), any IRA, or
a custodial 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 U.S. commonwealth or
possession, or any of their political subdivisions or instrumentalities
|
|
4—A foreign government or any of its political subdivisions, agencies, or instrumentalities
|
|
5—A corporation
|
|
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or possession
|
|
7—A futures commission merchant registered with the Commodity Futures Trading Commission
|
|
8—A real estate investment trust
|
|
9—An entity registered at all times during the tax year under the Investment Company Act of 1940
|
|
10—A common trust fund operated by a bank under section 584(a)
|
|
11—A financial institution
|
|
12—A middleman known in the investment community as a nominee or custodian
|
|
13—A trust exempt from tax under section 664 or described in section 4947
|
|
M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
|
|
Note:
You may wish to consult with the financial institution requesting
|
|
this form to determine whether the FATCA code and/or exempt payee code should be completed.
|
|
Line 5
|
|
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, write NEW at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
|
|
Line 6
|
|
Enter your city, state, and ZIP code.
|
|
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.
|
|
If you are a single-member LLC that is disregarded as an entity
separate from its owner, 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 What Name and Number To Give the Requester, later, 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 SSA 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. Go to www.irs.gov/Forms to view, download, or print Form
W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to
place an order and have Form W-7 and/or SS-4 mailed to you within 10
business days.
|
|
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and 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.
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Note:
Entering “Applied For” means that you have already applied for a
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TIN or that you intend to apply for one soon.
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Caution:
A disregarded U.S. entity that has a foreign owner must use
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the appropriate Form W-8.
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Part II. Certification
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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, 4, or 5 below indicates otherwise.
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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 line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
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Signature requirements.
Complete the certification as indicated in
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items 1 through 5 below.
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Give name and EIN of: |
| 14. 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 |
The public entity |
| 15. Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B)) |
The trust |
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1
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.
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2 Circle the minor’s name and furnish the minor’s SSN.
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3 You 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 EIN (if you have one), but the IRS encourages you to use your SSN.
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4 List first and circle the 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
rules for partnerships, earlier.
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*Note:
The grantor also must provide a Form W-9 to trustee of trust.
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Note:
If no name is circled when more than one name is listed, the
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number will be considered to be that of the first name listed.
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Secure Your Tax Records From Identity Theft
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Identity theft occurs when someone uses your personal information
such as your name, 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.
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To reduce your risk.
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• Protect your SSN,
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• Ensure your employer is protecting your SSN, and
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• Be careful when choosing a tax preparer.
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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.
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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.
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For more information, see Pub. 5027, Identity Theft Information for Taxpayers.
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Victims of identity theft who are experiencing economic harm or a
systemic 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.
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Protect yourself from suspicious emails or phishing schemes.
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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.
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Privacy Act Notice
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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. commonwealths and 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 intelligence
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.
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