|
25
<br /> Form W-9(Rev.10-2018) Page 5
<br /> 1.Interest,dividend,and barter exchange accounts opened For this type of account: Give name and EIN of:
<br /> before 1984 and broker accounts considered active during 1983. 14.Account with the Department of The public entity
<br /> You must give your correct TIN,but you do not have to sign the Agriculture in the name of a public
<br /> certification.
<br /> entity(such as a state or local
<br /> 2.Interest,dividend,broker,and barter exchange accounts government,school district,or
<br /> opened after 1983 and broker accounts considered inactive during prison)that receives agricultural
<br /> 1983.You must sign the certification or backup withholding will apply.If program payments
<br /> you are subject to backup withholding and you are merely providing
<br /> your correct TIN to the requester,you must cross out item 2 in the 15.Grantor trust filing under the Form The trust
<br /> certification before signing the form. 1041 Filing Method or the Optional
<br /> 3.Real estate transactions.You must sign the certification.You may Form 1099 Filing Method 2(see 4
<br /> Regulations section 1.671-4(b)(2)(i)(B))
<br /> cross out item 2 of the certification.
<br /> 4.Other payments.You must give your correct TIN,but you do not 'List first and circle the name of the person whose number you furnish.
<br /> have to sign the certification unless you have been notified that you If only one person on a joint account has an SSN,that person's number
<br /> have previously given an incorrect TIN."Other payments"include must be furnished.
<br /> payments made in the course of the requester's trade or business for 2 Circle the minor's name and furnish the minor's SSN.
<br /> rents,royalties,goods(other than bills for merchandise),medical and
<br /> health care services(including payments to corporations),payments to a You must show your individual name and you may also enter your
<br /> a nonemployee for services,payments made in settlement of payment business or DBA name on the"Business name/disregarded entity"
<br /> card and third party network transactions,payments to certain fishing name line.You may use either your SSN or EIN(if you have one),but the
<br /> boat crew members and fishermen,and gross proceeds paid to IRS encourages you to use your SSN.
<br /> attorneys(including payments to corporations). 4 List first and circle the name of the trust,estate,or pension trust.(Do
<br /> 5.Mortgage interest paid by you,acquisition or abandonment of not furnish the TIN of the personal representative or trustee unless the
<br /> secured property,cancellation of debt,qualified tuition program legal entity itself is not designated in the account title.)Also see Special
<br /> payments(under section 529),ABLE accounts(under section 529A), rules for partnerships,earlier.
<br /> IRA,Coverdell ESA,Archer MSA or HSA contributions or *Note:The grantor also must provide a Form W-9 to trustee of trust.
<br /> distributions,and pension distributions.You must give your correct Note:If no name is circled when more than one name is listed,the
<br /> TIN,but you do not have to sign the certification, number will be considered to be that of the first name listed.
<br /> What Name and Number To Give the Requester Secure Your Tax Records From Identity Theft
<br /> For this type of account: Give name and SSN of:
<br /> Identity theft occurs when someone uses your personal information
<br /> 1.Individual The Individual such as your name,SSN,or other identifying information,without your
<br /> 2.Two or more individuals(Joint The actual owner of the account or,if permission,to commit fraud or other crimes.An identity thief may use
<br /> account)other than an account combined funds,the first individual on your SSN to get a job or may file a tax return using your SSN to receive
<br /> maintained by an FFIthe account' a refund.
<br /> 3.Two or more U.S.persons Each holder of the account To reduce your risk:
<br /> (Joint account maintained by an FFI) •Protect your SSN,
<br /> 4.Custodial account of a minor The minor2 •Ensure your employer is protecting your SSN,and
<br /> (Uniform Gift to Minors Act) •Be careful when choosing a tax preparer.
<br /> 5.a.The usual revocable savings trust The grantor-trustee' If your tax records are affected by identity theft and you receive a
<br /> (grantor is also trustee) notice from the IRS,respond right away to the name and phone number
<br /> b.So-called trust account that is not The actual owner printed on the IRS notice or letter.
<br /> a legal or valid trust under state law
<br /> If your tax records are not currently affected by identity theft but you
<br /> 6.Sole proprietorship or disregarded The owner3 think you are at risk due to a lost or stolen purse or wallet,questionable
<br /> entity owned by an individual credit card activity or credit report,contact the IRS Identity Theft Hotline
<br /> 7.Grantor trust filing under Optional The grantor* at 1-800-908-4490 or submit Form 14039.
<br /> Form 1099 Filing Method 1(see For more information,see Pub.5027, Identity Theft Information for
<br /> Regulations section 1.671-4(b)(2)(i) Taxpayers.
<br /> (A)) Victims of identity theft who are experiencing economic harm or a
<br /> For this type of account: Give name and EIN of: systemic problem,or are seeking help in resolving tax problems that
<br /> s.Disregarded entity not owned by an The owner have not been resolved through normal channels,may be eligible for
<br /> individual Taxpayer Advocate Service(TAS)assistance,You can reach TAS by
<br /> calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
<br /> 9.A valid trust,estate,or pension trust Legal entity°
<br /> 1-800-829-4059.
<br /> 10.Corporation or LLC electing The corporation Protect yourself from suspicious emails or phishing schemes.
<br /> corporate status on Form 8832 or Phishing is the creation and use of email and websites designed to
<br /> Form 2553 mimic legitimate business emails and websites.The most common act
<br /> 11.Association,club,religious, The organization is sending an email to a user falsely claiming to be an established
<br /> charitable,educational,or other tax- legitimate enterprise in an attempt to scam the user into surrendering
<br /> exempt organization private information that will be used for identity theft.
<br /> 12.Partnership or multi-member LLC The partnership
<br /> 13.A broker or registered nominee The broker or nominee
<br /> 1
<br />
|