page3
Form W-9 (Rev. 12-2011)
Page
3
Other entities.
Enter your business name as shown on required federal
tax documents on the “Name” line. This name should match the name
shown on the charter or other legal document creating the entity. You
may enter any business, trade, or DBA name on the “Business name/
disregarded entity name” line.
Exempt Payee
If you are exempt from backup withholding, enter your name as
described above and check the appropriate box for your status, then
check the “Exempt payee” box in the line following the “Business name/
disregarded entity name,” sign and date the form.
Generally, individuals (including sole proprietors) are not exempt from
backup withholding. Corporations are exempt from backup withholding
for certain payments, such as interest and dividends.
Note.
If you are exempt from backup withholding, you should
still
complete this form to avoid possible erroneous backup
withholding.
The following payees are exempt from backup withholding:
1. An organization exempt from tax under section 501(a), any IRA, or a
custodial account under section 403(b)(7) if the account satisfies the
requirements of section 401(f)(2),
2. The United States or any of its agencies or instrumentalities,
3. A state, the District of Columbia, a possession of the United States,
or any of their political subdivisions or instrumentalities,
4. A foreign government or any of its political subdivisions, agencies,
or instrumentalities, or
5. An international organization or any of its agencies or
instrumentalities.
Other payees that may be exempt from backup withholding include:
6. A corporation,
7. A foreign central bank of issue,
8. A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a possession of the United
States,
9. A futures commission merchant registered with the Commodity
Futures Trading Commission,
10. A real estate investment trust,
11. An entity registered at all times during the tax year under the
Investment Company Act of 1940,
12. A common trust fund operated by a bank under section 584(a),
13. A financial institution,
14. A middleman known in the investment community as a nominee or
custodian, or
15. A trust exempt from tax under section 664 or described in section
4947.
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 15.
IF the payment is for . . .
THEN the payment is exempt
for . . .
Interest and dividend payments
All exempt payees except
for 9
Broker transactions
Exempt payees 1 through 5 and 7
through 13. Also, C corporations.
Barter exchange transactions and
patronage dividends
Exempt payees 1 through 5
Payments over $600 required to be
reported and direct sales over
$5,000
1
Generally, exempt payees
1 through 7
2
1
See Form 1099-MISC, Miscellaneous Income, and its instructions.
2
However, the following payments made to a corporation and reportable on Form
1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney, and payments for
services paid by a federal executive agency.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box.
If you are a resident
alien and
you do not have and are not eligible to get an SSN,
your TIN is your IRS
individual taxpayer identification number
(ITIN). Enter it in the social
security number box. If you do not
have an ITIN, see
How to get a TIN
below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN. However, the IRS prefers that you use your SSN.
If you are a single-member LLC that is disregarded as an entity
separate from its owner (see
Limited Liability Company
(LLC)
on page 2),
enter the owner’s SSN (or EIN, if the owner has one). Do not enter the
disregarded entity’s EIN. If the LLC is classified as a corporation or
partnership, enter the entity’s EIN.
Note.
See the chart on page 4 for further clarification of name
and TIN
combinations.
How to get a TIN.
If you do not have a TIN, apply for one
immediately.
To apply for an SSN, get Form SS-5, Application
for a Social Security
Card, from your local Social Security
Administration office or get this
form online at
www.ssa.gov
. You
may also get this form by calling
1-800-772-1213. Use Form
W-7, Application for IRS Individual Taxpayer
Identification
Number, to apply for an ITIN, or Form SS-4, Application for
Employer Identification Number, to apply for an EIN. You can
apply for
an EIN online by accessing the IRS website at
www.irs.gov/businesses
and clicking on Employer Identification
Number (EIN) under Starting a
Business. You can get Forms W-7
and SS-4 from the IRS by visiting
IRS.gov
or by calling
1-800-TAX-FORM (1-800-829-3676).
If you are asked to complete Form W-9 but do not have a TIN, write
“Applied For” in the space for the TIN, sign and date the form, and give
it to the requester. For interest and dividend payments, and certain
payments made with respect to readily tradable instruments, generally
you will have 60 days to get a TIN and give it to the requester before you
are subject to backup withholding on payments. The 60-day rule does
not apply to other types of payments. You will be subject to backup
withholding on all such payments until you provide your TIN to the
requester.
Note.
Entering “Applied For” means that you have already
applied for a
TIN or that you intend to apply for one soon.
Caution:
A disregarded domestic entity that has a foreign owner
must
use the appropriate Form W-8.
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, below, and items 4 and 5 on page 4
indicate otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on the “Name” line must sign. Exempt payees, see
Exempt
Payee
on page 3.
Signature requirements.
Complete the certification as indicated
in
items 1 through 3, below, and items 4 and 5 on page 4.
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not
have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983.
You must sign the certification or backup
withholding will apply. If
you are subject to backup withholding
and you are merely providing
your correct TIN to the requester,
you must cross out item 2 in the
certification before signing the
form.
3. Real estate transactions.
You must sign the certification.
You may
cross out item 2 of the certification.