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Form W -9 (Rev.
<br />What Name and Number To Give the Requester
<br />For this type of account:
<br />Give name and SSN of:
<br />1. Individual
<br />The Indlvldual
<br />2. Two or more Individuals aolnt
<br />The actual owner of the account or,
<br />account)
<br />If combined funds, the first
<br />Individual on the account
<br />3. Custodian account of a minor
<br />The minor'
<br />(Uniform Gift to Mlncra Act)
<br />4. a. The usual revocable savings
<br />The grantor - trustee'
<br />trust (grantor Is also trustee)
<br />b. Se- called trust account that Is
<br />The actual owner'
<br />not a legal orvalld trust under
<br />state law
<br />6. Sole proprietorship or disregarded
<br />The owner'
<br />entity owned by an Individual
<br />6. Grantor trust filing under Colonel
<br />The grantor"
<br />Form 1099 Fling Method 1 (see
<br />Regulation section 1.671.4(b)(2)(I)(A))
<br />For this type of account:
<br />Give name and EIN at!
<br />7. Disregarded entity not owned by an
<br />The owner
<br />individual
<br />B. Avalld trust, estate, or pension trust
<br />Legal entity'
<br />9. Corporation or LLC electing
<br />The corporation
<br />corporate status on Farm 8832 or
<br />Form 2553
<br />10. Association, club, religious,
<br />The organization
<br />charitable, educational, or other
<br />tax - exempt organization
<br />11. Partnership or multi- member LLC
<br />The partnership
<br />12. A broker or registered nominee
<br />The broker or nominee
<br />13. Account with the Department of
<br />The public entity
<br />Agriculture In the name of a public
<br />entity (such as a skate or local
<br />government, school district, or
<br />prison) that receives agricultural
<br />program payments
<br />14.Gramortiustfiling under the Form
<br />The trust
<br />1041 Filing Method or the Optional
<br />Form 1099 Filing Method 2 (see
<br />Regulation section 1.071- 4(b)(2)(Ii
<br />List first end olrcla the name of the parson whose number you furnish. If only one pat rson on a
<br />joint account has an SSN, that person's number must be furnished.
<br />Clone the minor's name and furnish the minor's SSN.
<br />s YOU most show your Indlvldual name and you may also enter youi mistress or "DON' name on
<br />the "Buelhere name /disregarded entity" name Ilno, YOU may use anhor' your SSN or El IN Of you
<br />have oho), but hot IRS encourages you to use your SSN.
<br />4 List fact and alydc the nema of the trust, estate, or pension trust, P. not furnish the TIN of the
<br />personal representative or trustee unless the legal entity Itself Is not rose noted In the account
<br />title.) Also see Special rules forpadnershlies on page t.
<br />'Note. Grantor also most provide a Form W -9 to bsense of bust.
<br />Note. If no name Is circled when more than one name is listed, the number will be
<br />considered to be that of the first name listed.
<br />Secure Your Tax Records from Identity Theft
<br />Identity theft occurs when someone uses your personal Information such as your
<br />name, social security number (SSN), or other Identlfying Information, without your
<br />permission, to commit fraud or other orimes An Identity thief may use your SSN to
<br />got a job or may file a tax return using your SSN to receive a refund.
<br />To reduce your risk:
<br />* Protect your SSN,
<br />• Ensure your employer Is protecting your SSN, and
<br />* Ds careful when choosing a tax preparear.
<br />If your tax records ore affected by identity theft and you receive a notice from
<br />the IRS, respond right away to the name and phone number printed on the IRS
<br />notice or letter.
<br />If your tax recoils are not currently affected by Identity theft but you think you
<br />are at risk due to a lost or stolen purse or wallet, questionable credit card activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1 . 800.906 .4490 or submit
<br />Form 14039,
<br />For more Information, see Publication 4535, Identlty, Theft Prevention and Victim
<br />Assistance.
<br />Victims of Identity theft who are experiencing economic harm or a system
<br />problem, or are seeking help in resolving tax problems that have not been resolved
<br />through normal channels, may be el Is be for Taxpayer Advocate $itwIce (TAB)
<br />assistance. You can reach TAB by calling the TAB toll -free case Intake line at
<br />1 -877- 777.4778 or TTY/TDD 1. 800.829 -4059.
<br />Protect yourself from suspicious amalls or phlshing schemes. Phishing Is the
<br />creation and use of email and webaltes designed to mimic legitimate business
<br />emalls and websites. The most common act is sending an email to a user falsely
<br />claiming to be an established legitimate enterprise In an attempt to scam the user
<br />Into surrendering private Information that will be used for Identity theft.
<br />The IRS does not Initiate contacts with taxpayers via emalls, Also, the IRS does
<br />not request personal detailed information through email or ask taxpayers for the
<br />PIN numbers, passwords, or similar secret access Information for their credit card,
<br />bank, or other financial accounts.
<br />If you receive an unsolicited email claiming to be from the IRS, forward this
<br />message to phlshing @lm.gov, You may also report misuse of the IRS name, logo,
<br />or other IRS property to the Treasury Inspector General for Tax Administration at
<br />1- 800- 306 -4484. You can forward suspicious smalls to the Federal Trade
<br />Commission at: spident ,gov or contact them at www.Rc.gov /(dthaff of 1-877 -
<br />IDTHEFT (1- 877 - 438. 4338).
<br />Visit IRS.gov to learn more about identity theft and how to reduce your risk
<br />Privacy Act Notice
<br />Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons it ojuding federal agencies) who ere required to file Information returns with
<br />the IRS to report Interest, dividends, or certain Cartel' Income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation
<br />of debt or contdbutlons you made to an IRA, Archer MSA, or HSA. The person collecting this farm uses the Information on the form to file Information returns with the IRS,
<br />reporting the above Information. Routine uses of this Informatlon include giving It to the Department of Justice for civil and criminal litigation and to titles, states, the Distl'iet
<br />Of COhlmbla and LL& commonwealths and possessions for use In adminlstflOng lhelr laws, The Information also may be disclosed to other countries under treaty, to
<br />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
<br />whether or not you are required to file a tax return. Undel'section 3406, payers must generally withhold a percentage of taxable Interest, dlvlderd, and certain other
<br />payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent Information.
<br />251 -51
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