|
Form W-9(Rev.1-2011) Page 4
<br /> 4.Other payments.You must give your correct TIN,but you do not Note.If no name is circled when more than one name is listed,the
<br /> have to sign the certification unless you have been notified that you number will be considered to be that of the first name listed.
<br /> have previously given an incorrect TIN."Other payments"include
<br /> payments made in the course of the requester's trade or business for Secure Your Tax Records from Identity Theft
<br /> rents,royalties,goods(other than bills for merchandise),medical and Identity theft occurs when someone uses your personal information
<br /> health care services(including payments to corporations),payments to such as your name,social security number(SSN),or other identifying
<br /> a nonemployee for services,payments to certain fishing boat crew information,without your permission,to commit fraud or other crimes.
<br /> members and fishermen,and gross proceeds paid to attorneys An identity thief may use your SSN to get a job or may file a tax return
<br /> (including payments to corporations). using your SSN to receive a refund.
<br /> 5.Mortgage interest paid by you,acquisition or abandonment of To reduce your risk:
<br /> secured property,cancellation of debt,qualified tuition program
<br /> payments(under section 529),IRA,Coverdell ESA,Archer MSA or •Protect your SSN,
<br /> HSA contributions or distributions,and pension distributions.You •Ensure your employer is protecting your SSN,and
<br /> must give your correct TIN,but you do not have to sign the certification. .Be careful when choosing a tax preparer.
<br /> If your tax records are affected by identity theft and you receive a
<br /> What Name and Number To Give the Requester notice from the IRS,respond right away to the name and phone number
<br /> For this type of account Give name and SSN of: printed on the IRS notice or letter.
<br /> If your tax records are not currently affected by identity theft but you
<br /> 1.individual The individual think you are at risk due to a lost or stolen purse or wallet,questionable
<br /> 2.Two or more individuals Qoint The actual owner of the account or, credit card activity or credit report,contact the IRS Identity Theft Hotline
<br /> account) if combined funds,the first at 1-800-908-4490 or submit Form 14039.
<br /> individual on the account'
<br /> 3.Custodian account of a minor The minor' For more information,see Publication 4535,Identity Theft Prevention(Uniform Gift to Minors Act) and Victim Assistance.
<br /> 4.a.The usual revocable savings The grantor-trustee' Victims of identity theft who are experiencing economic harm or a
<br /> trust(grantor is also trustee) system problem,or are seeking help in resolving tax problems that have
<br /> b.So-called trust account that is The actual owner' not been resolved through normal channels,may be eligible for
<br /> not a legal or valid trust under Taxpayer Advocate Service(FAS)assistance.You can reach TAS by
<br /> state law calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
<br /> 5.Sole proprietorship or disregarded The owner' 1-800-829-4059.
<br /> entity owned by an individual Protect yourself from suspicious emails or phishing schemes.
<br /> 6.Grantor trust filing under Optional The grantor Phishing is the creation and use of email and websites designed to
<br /> Form 1099 Filing Method 1(see
<br /> Regulation section 1.671-4(b)(2)()(A)) mimic legitimate business emails and websites.The most common act
<br /> For this type of account Give name and EIN of: is sending an email to a user falsely claiming to be an established
<br /> legitimate enterprise in an attempt to scam the user into surrendering
<br /> 7.Disregarded entity not owned by an The owner private information that will be used for identity theft.
<br /> individual
<br /> 8.A valid trust,estate,or pension trust Legal entity' The IRS does not initiate contacts with taxpayers via emails.Also,the
<br /> 9.Corporation or LLC electing The corporation IRS does not request personal detailed information through email or ask
<br /> corporate status on Form 8832 or taxpayers for the PIN numbers,passwords,or similar secret access
<br /> Form 2553 information for their credit card,bank,or other financial accounts.
<br /> 10.Association,club,religious, The organization if you receive an unsolicited email claiming to be from the IRS,
<br /> charitable,educational,or other forward this message to phishing@irs.gov.You may also report misuse
<br /> tax-exempt organization of the IRS name,logo,or other IRS property to the Treasury Inspector
<br /> 11.Partnership or multi-member LLC The partnership General for Tax Administration at 1-800-366-4484.You can forward
<br /> 12.A broker or registered nominee The broker or nominee suspicious emails to the Federal Trade Commission at:seam @uce.gov
<br /> 13.Account with the Department of The public entity or contact them at www.ftc.gov/ialtheft or 1-877-IDTHEFT
<br /> Agriculture in the name of a public (1-877-438-4338).
<br /> entity(such as a state or local Visit IRS.gov to learn more about identity theft and how to reduce
<br /> government,school district,or your risk.
<br /> prison)that receives agricultural
<br /> program payments
<br /> 14.Grantor trust filing under the Form The trust
<br /> 1041 Filing Method or the Optional
<br /> Form 1099 Filing Method 2(see
<br /> Regulation section 1.671-4(b)(2)()(B))
<br /> 'Ust first and circle the name of the person whose number you furnish.If only one person on a
<br /> joint account has an SSN,that person's number must be furnished.
<br /> P Circle the minor's name and furnish the minor's SSN.
<br /> a You must show your individual name and you may also enter your business or"DBA"name on
<br /> the"Business nameldisregarded entity"name line.You may use either your SSN or EIN(if you
<br /> have one),but the IRS encourages you to use your SSN.
<br /> 'List first and circle the name of the trust,estate,or pension trust.(Do not furnish the TIN of the
<br /> personal representative or trustee unless the legal entity itself is not designated in the account
<br /> title.)Also see Special rules for partnerships on page 1.
<br /> *Note.Grantor also must provide a Form W-9 to trustee of trust.
<br /> Privacy Act Notice
<br /> 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
<br /> 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
<br /> of debt;or contributions you made to an IRA,Archer MSA,or HSA.The person collecting this forth uses the information on the form to file information returns with the IRS,
<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 District
<br /> of Columbia,and U.S.possessions for use in administering their laws.The Information also may be disclosed to other countries under a treaty,to federal and state agencies
<br /> 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
<br /> 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
<br /> TIN to the payer.Certain penalties may also apply for providing false or fraudulent information.
<br />
|