|
Farm W-9 (Rev. 12-2014)
<br />Line 2
<br />If you have a business name, trade name, DBA name, or disregarded entity name,
<br />you may enter It on line 2.
<br />Line 3
<br />Check the appropriate box In line 3 for the U.S. federal tax classification of the
<br />person whose name Is entered an tine 1. Check only one box inline 3.
<br />Limited Liability Company (LLC), If the name on line 1 Is an LLC treated as a
<br />partnership for U,S. federal tax purposes, check the "Limited Liability Company"
<br />box and enter "P" in the space provided. If the LLC has Bled Form 8832 or 255310
<br />be taxed as a corporation, check the "Limited Liability Company' box and In the
<br />space provided enter "C" for C corporation or "S" for S corporation. If It Is a
<br />single -member LLC that is a disregarded entity, do not check the "Limited Liability
<br />Company" box; instead check the first box in line 3 "IndriduaUsole proprietor or
<br />single -member LLC."
<br />Line 4, Exemptions
<br />If you are exempt from backup withholding and/or FATCA reporting, enter In the
<br />appropriate apace In line 4 any code(s) that may apply to you.
<br />Exempt payee code.
<br />• Generally, Individuals (including sole proprietors) are not exempt from backup
<br />withholding.
<br />• Except as provided below, corporations are exempt from backup withholding
<br />for certain payments, including Interest and dividends.
<br />a Corporations are not exempt from backup withholding for payments made In
<br />settlement of payment card or third party network transactions,
<br />• Corporations are not exempt from backup withholding with respect to anameys'
<br />fees or gross proceeds paid to attorneys, and corporations that provide medical or
<br />health care services are not exempt with respect to payments reportable on Farm
<br />1099-MISC.
<br />The following codes Identify payees that are exempt from backup withholding.
<br />Enter the appropriate code In the space In line 4.
<br />1—An organization exempt from tax under section 50 Its), any IRA, or a
<br />custodial account under section 403(b)(7) If the account satinfles ins requirements
<br />of section 401((/(2)
<br />2—Tho United States or any of Its agencies or Instrumentalities
<br />3—A state, the Distant of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivisions or Instrumentalities
<br />4—A foreign government or any of its political subdivisions, agencies, or
<br />Instrumentalities
<br />5—A corporation
<br />6—A dealer In securities or commodities required to register In the United
<br />Stales, the District of Columbia, or a U.S. commonwealth or possession
<br />7—A futures win mission merchant registered with the GolTlmodlty Futures
<br />Trading Gommlsslon
<br />e—A real estate Investment trust
<br />9 —An entity mgletered at all times during the tax year under the Investment
<br />Company Act of 1940
<br />10—A common trust fund operated by a hank under section 51
<br />11—A financial institution
<br />12—A middleman known In the Investment community as a nominee or
<br />custodian
<br />13--A trust exempt from tax under section 664 or described In section 4947
<br />The following chart shows types of payments that may he exempt from backup
<br />withholding. The chart appllea to the exempt payees listed above, 1 through 13.
<br />IF the payment is for...
<br />THEN the payment is exempt for...
<br />Interest and dividend payments
<br />All exempt payees except
<br />for 7
<br />Broker transactlons
<br />Exempt payees I through 4 and 6
<br />through 11 and all C corporations. S
<br />corporations must not enter an exempt
<br />payee code because they are exempt
<br />only for sales of noncavared securities
<br />acquired prior to 2012.
<br />Parte) exchange transactions and
<br />Exempt payees 1 through 4
<br />patronage dividends
<br />Payments over $600 required to be
<br />Generally, exempt payees
<br />reported and direct &nice aver $5,0001
<br />1 through 5'
<br />Payments made In settlement of
<br />Exempt payees 1 through 4
<br />payment card or third party network
<br />transactions
<br />1 See Farm 1099-MISC, Mlseelleneous Income, and Its Instructions.
<br />'However, the following payments made to a corporation and reportable on Form
<br />I090-MISO are not exempt from backup withholding: medical and health care
<br />payments, attorneys' fees, gross proceeds paid to an attorney reportable under
<br />section 61 and payments for services paid by a federal executive agency.
<br />Exemption from FATCA reporting code, The following codes identify payees
<br />that are exempt from reporting under FATCA. These codes apply to persons
<br />submitting this farm for accounts maintained outside of the United States by
<br />certain foreign financial Institutions. Therefore, if you are only submitting this form
<br />for an account you hold In the United States, you may leave this field blank.
<br />Consult with the person requesting this form if you are uncertain if the financial
<br />institution is subject to these requirements. A requester may Indicate that acode is
<br />not required by providing you with a Form W-9 with "Not Applicable" (or any
<br />similar Indication) written or printed on the line for a FATCA exemption code.
<br />A—An organization exempt from tax under section 501(a) or any Individual
<br />retirement plan as defined in section 7701(a)(37)
<br />B—The United States or any of its agencies or Instrumentalities
<br />C—A state, the District of Columbia, a U.S, commonwealth or possession, or
<br />any of their political subdlvisions or instrumentalities
<br />D—A corporation the stock of which is regularly traded on one or more
<br />established securities markets, as described In Regulations section
<br />1.1472-1(c)(1)(I)
<br />E—A corporation that is a member of the same expanded affiliated group as a
<br />corporation descnbed in Regulations section IA472-1(c)(1)O
<br />F—A dealer In securities, commodities, or derivative financial Instruments
<br />(including notional principal contracts, futures, forwards, and options( that Is
<br />registered as such under the laws of the United States or any stale
<br />G—A real estate Investment trust
<br />H—A regulated Investment company as defined in section 851 or an entity
<br />registered at all times during the tax year under the Investment Company Act of
<br />1940
<br />I—A common trust fund as defined In section 584(a)
<br />J—A bank as defined In ...flan 581
<br />K—A broker
<br />L—A trust exempt from tax under section 664 or described In section 4947(a)(1)
<br />M—A tax exempt Gust under a section 403(b) plan or section 457(g) plan
<br />Note. You may wish to consult with the financial institution requesting this form to
<br />dommilne whether the FATCA code and/or exempt payee coda should be
<br />completed.
<br />Line 5
<br />Enter your address (number, street, and apartment or suite nunihary. This Is where
<br />the requester of this Form W-9 will mall your Information returns.
<br />Line 6
<br />Enter your city, state, and ZIP code.
<br />Part I. Taxpayer Identification Number (TIN)
<br />Enter your TIN In the op proprlsts box, If you are a resident alien and you do not
<br />have and era not eligible to get an $SN, your TIN Is your IRS individual taxpayer
<br />Iwritifioation number (ITIN). Enter it in the social security number box. If you do not
<br />have an ITIN, see How to gat a TIN below.
<br />If you are a sole proprietor and you have an FIN, you may enter either your SSN
<br />or FIN. However, the IRS prefers that you use your SSN.
<br />If you are a single -member LLC that Is disregarded as an entity separate from its
<br />owner (see Limited Liability Company (LLC) on this page), enter the owner's SSN
<br />(or EIN, if the owner has ane). Do not enter the disregarded ontlty's FIN. If the LLC
<br />is classified as a corporation or partnership, enter the entity's EIN.
<br />Note. See the chart on page 4 for further clarification of home and TIN
<br />combinations.
<br />How to get a TIN. If you do not have aTIN, apply for one immediately. To apply
<br />for an SSN, gat Form SS -5, Application for a Social Security Card, from your local
<br />SSA office or gat this farm online at www.ssa.gov. You may also get this form by
<br />calling 1-800-772-1213. Use Form W-7, Application for IRS individual Taxpayer
<br />Idehlification Number, la apply far an ITIN, or Form SS -4, Application for Employer
<br />Identification Number, to apply for an EIN. You can apply for an EIN online by
<br />accessing the IRS webslle at www.inogovlbuslaosses and clicking on Employer
<br />Identification Number (EIN) under Starting a Business. You can get Forms W-7 and
<br />SS -4 from the IRS by visiting IRS.gov or by calling 1 -800 -TAX -FORM
<br />(1-000-829-3670),
<br />If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN
<br />and write "Applied For" In the space for the TIN, sign and date the form, and give it
<br />to the requester. For Interest and dividend payments, and certain payments made
<br />with respect to readily bsuable instruments, generally you will have 60 days to gel
<br />a TIN and give It to the requester before you are subject to backup withholding on
<br />payments. The 60 -day rule does net apply to other types of payments. You will be
<br />subject to backup withholding on all such payments until you provide your TIN to
<br />the requester.
<br />Note, Entering "Applied For" means that you have already applied for a TIN or that
<br />you Intend to apply for one soon.
<br />Caution: A disregarded U.S. entity that has a Poreign owner most use the
<br />appropriate Farm W -a.
<br />75J-54
<br />
|