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Form W-91Rev- 1-2005)
<br />4. The type and amount of income that qualifies for the
<br />exemption from tax.
<br />5. Sufficient facts to justify the exemption from tax under
<br />the terms of the treaty article.
<br />Example. Article 20 of the U.S.-China income tax treaty
<br />allows an exemption from tax for scholarship income
<br />received by a Chinese student temporarily present in the
<br />United States. Under U.S. law, this student will become a
<br />resident alien for tax purposes if his or her stay in the United
<br />States exceeds 5 calendar years. However, paragraph 2 of
<br />the first Protocol to the U.S.-China treaty (dated April 30,
<br />1984) allows the provisions of Article 20 to continue to apply
<br />even after the Chinese student becomes a resident alien of
<br />the United States. A Chinese student who qualifies for this
<br />exception (under paragraph 2 of the first protocol) and is
<br />relying on this exception to claim an exemption from tax on
<br />his or her scholarship or fellowship income would attach to
<br />Form W-9 a statement that includes the information
<br />described above to support that exemption.
<br />If you are a nonresident alien or a foreign entity not subject
<br />to backup withholding, give the requester the appropriate
<br />completed Form W-8.
<br />What is backup withholding? Persons making certain
<br />payments to you must under certain conditions withhold and
<br />pay to the IRS 28% of such payments (after December 31,
<br />2002). This is called "backup withholding." Payments that
<br />may be subject to backup withholding include interest,
<br />dividends, broker and barter exchange transactions, rents,
<br />royalties, nonemployee pay, and certain payments from
<br />fishing boat operators. Real estate transactions are not
<br />subject to backup withholding.
<br />You will not be subject to backup withholding on payments
<br />you receive if you give the requester your correct TIN, make
<br />the proper certifications, and report all your taxable interest
<br />and dividends on your tax return.
<br />Payments you receive will be subject to backup
<br />withholding if:
<br />1. You do not fumish your TIN to the requester, or
<br />2. You do not certify your TIN when required (see the Part
<br />II instructions on page 4 for details), or
<br />3. The IRS tells the requester that you furnished an
<br />incorrect TIN, or
<br />4. The IRS tells you that you are subject to backup
<br />withholding because you did not report all your interest and
<br />dividends on your tax return (for reportable interest and
<br />dividends only), or
<br />5. You do not certify to the requester that you are not
<br />subject to backup withholding under 4 above (for reportable
<br />interest and dividend accounts opened after 1983 only).
<br />Certain payees and payments are exempt from backup
<br />withholding. See the instructions below and the separate
<br />Instructions for the Requester of Form W-9.
<br />Penalties
<br />Failure to furnish TIN. If you fail to furnish your correct TIN
<br />to a requester, you are subject to a penalty of $50 for each
<br />such failure unless your failure is due to reasonable cause
<br />and not to willful neglect.
<br />Civil penalty for false information with respect to
<br />withholding. If you make a false statement with no
<br />reasonable basis that results in no backup withholding, you
<br />are subject to a $500 penalty.
<br />Criminal penalty for falsifying information. Willfully
<br />falsifying certifications or affirmations may subject you to
<br />criminal penalties including fines and/or imprisonment.
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<br />Misuse of TINS. If the requester discloses or uses TINS in
<br />violation of federal law, the requester may be subject to civil
<br />and criminal penalties.
<br />Specific Instructions
<br />Name
<br />If you are an individual, you must generally enter the name
<br />shown on your social security card. However, if you have
<br />changed your last name, for instance, due to marriage
<br />without informing the Social Security Administration of the
<br />name change, enter your first name, the last name shown on
<br />your social security card, and your new last name.
<br />If the account is in joint names, list first, and then circle,
<br />the name of the person or entity whose number you entered
<br />in Part I of the form.
<br />Sole proprietor. Enter your individual name as shown on
<br />your social security card on the "Name" line. You may enter
<br />your business, trade, or "doing business as (DBA)" name on
<br />the "Business name' line.
<br />Limited liability company (LLC). If you are a single -member
<br />LLC (including a foreign LLC with a domestic owner) that is
<br />disregarded as an entity separate from its owner under
<br />Treasury regulations section 301.7701-3, enter the owner's
<br />name on the "Name" line. Enter the LLC's name on the
<br />"Business name" line. Check the appropriate box for your
<br />filing status (sole proprietor, corporation, etc.), then check
<br />the box for "Other" and enter "LLC" in the space provided.
<br />Other entities. Enter your business name as shown on
<br />required Federal tax documents on the "Name" line. This
<br />name should match the name shown on the charter or other
<br />legal document creating the entity. You may enter any
<br />business, trade, or DBA name on the "Business name" line.
<br />Note. You are requested to check the appropriate box for
<br />your status (individual/sole proprietor, corporation, etc.).
<br />Exempt From Backup Withholding
<br />If you are exempt, enter your name as described above and
<br />check the appropriate box for your status, then check the
<br />"Exempt from backup withholding" box in the line following
<br />the business name, sign and date the form.
<br />Generally, individuals (including sole proprietors) are not
<br />exempt from backup withholding. Corporations are exempt
<br />from backup withholding for certain payments, such as
<br />interest and dividends.
<br />Note. If you are exempt from backup withholding, you
<br />should still complete this form to avoid possible erroneous
<br />backup withholding.
<br />Exempt payees. Backup withholding is not required on any
<br />payments made to the following payees:
<br />1. An organization exempt from tax under section 501(a),
<br />any IRA, or a custodial account under section 403(b)(7) if the
<br />account satisfies the requirements of section 401(f)(2),
<br />2, The United States or any of its agencies or
<br />instrumentalities,
<br />3. A state, the District of Columbia, a possession of the
<br />United States, or any of their political subdivisions or
<br />instrumentalities,
<br />4. A foreign government or any of its political subdivisions,
<br />agencies, or instrumentalities, or
<br />5. An international organization or any of its agencies or
<br />instrumentalities.
<br />Other payees that may be exempt from backup
<br />withholding include:
<br />6. A corporation,
<br />
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