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Form w'9 <br />Request for Taxpayer <br />Give Form to the <br />the <br />Identification Number and Certification <br />requester. Do not <br />116,om"gest <br />Depart Tr <br />send to the IRS. <br />R. en e8awasury <br />Internal Revenue Service <br />Name (as shown on your income tax return) <br />City of Santa Ana <br />ni <br />Business name/disregarded entity name. If different from above <br />Check appropriate box for federal tax classification: <br />Exemptions (see Instructions): <br />o <br />❑Individual/sole proprietor 0Corporation ©S Corporation Partnership ❑Trust/estate <br />m <br />2 <br />Exempt payee code (If any) <br />❑ Limited liability company. Enter the tax classification (C=C corporation, 5=8 corporation, P=partnerahlp) 0. <br />Exemption from PATCA reporting <br />a <br />� <br />code (If any) <br />❑✓ Other (sea instructions) ► Government <br />S <br />Address (number, street, and apt, or suite no,) <br />Requester's name and address (optional) <br />OM <br />20 Civic Center Plaza <br />y <br />m <br />City, state, and ZIP code <br />m <br />� <br />Santa Ana, CA 92701 <br />List account number(s) here (optional) <br />JJ Taxpayer Identification Number TIN <br />Enter your TIN In the approprlate box. The TIN provided must match the name given on the "Name" line <br />Social security number <br />However, for a <br />resident ellen, sols proprietor, or disregarded entity, sae the Part I instructions on page 3. For other <br />re avoid backup le pr, withholding. For Individuals, this is your social security number n page <br />r <br />entitles, It Is your employer identification number (EIN). If you do not have a number, see How to get a <br />I IN an page 3. <br />Note. If the account Is in more than one name, see the chart on page 4 for guidelines on whose <br />number to enter. <br />v©oonnnooIR <br />Under penalties of perjury, I certify that: <br />1. The number shown an this form Is my correct taxpayer identification number (or I am walling 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 US, person (defined below), and <br />4. The FATCA code(s) entered on this form (if any) Indlcating 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 property, 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 pace 3. <br />Her Signature of //f /f. //. 1— �J <br />Here U.S. person► ���/ �f./�/j+ bete► <br />General Instructions <br />Section references are to the Internal Revenue Code unless otherwise noted. <br />Future developments. The IRS has created a page on IRS.gov for Information <br />about Form W,9, at www.lra.gov/w9. Information about any future developments <br />affecting Farm W�9 (such as legislation enacted after we release It) will be posted <br />on that page. <br />Purpose of Form <br />A person who Is required to file an information return with the IRS must obtain your <br />correct taxpayer Identification number (TIN) to report, for example, Income paid to <br />you, payments made to you in settlement of payment card and third party network <br />transactions, real estate transactions, mortgage Interest you paid, acquisition or <br />abandonment of secured property, cancellation of debt, or contributions you made <br />to an IRA. <br />Use Form W-9 only if you are a U.S, person (including a resident alien), to <br />provide your correct TIN to the person requesting It (the requester) and, when <br />applicable, to: <br />1. Certify that the TIN you are giving Is correct (or you are waiting for a number <br />to be issued), <br />2. Certify that you are not subject to bacli 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. porson, 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'%hare of effectively connected income, and <br />4, Certify that FATCA code(s) entered on this form (If any) Indicating that you are <br />exempt from the FATCA reporting, Is correct, <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 TIN, you must use the requester's form if It Is substantially <br />slmllar 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), or <br />• A domestic trust (as defined In Regulations section 301.7701-7). <br />Special rules for partnerships. partnerships that conduct a trade or business in <br />the United States aro generally required to pay a withholding tax under section <br />1446 on any foreign partnere' 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 ssctlon 1446 require a partnership to presume that a partner Is a <br />foreign person, and pay the section 1446 withholding tax. Therefore, If you are a <br />U.S. person that Is a partner In a partnership conduotinp a trade or business In the <br />United States, provide Form W-9 to the partnership to establish your U.S. statue <br />and avoid section 1446 withholding on your share of partnership Income. <br />Cat. No. 10231X Form W-9 (Rev. 6-2919) <br />