Reso 2010-1567 - Laserfiche WebLink

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Form W.9 (Rev. December 1996) Department of the Treasury Internal Revenue Service Name (If a Joint account or yoo changed your name. see Specific Instructions on page 2.) Request for Taxpayer Identification Number and Certification Give form to the requester. Do NOT send to the IRS. Q) Q.. '?:' .. o .. c .;: Q.. Q) en .. Q) a:: Business name. if different from above. (See Specific Instructions on page 2.) o Partnership Check appropriate box: 0 IndividuaVSole proprietor 0 Corporation Address (number. street. and apt. or suite no.) City. state, and ZIP code Tax a er Identification Number (TIN) Enter your TIN in the appropriate box. For individuals. this is your social security number (SSN). However, if you are a resident alien OR a sole proprietor, see the instructions on page 2. For other entities. it is your employer identification number (EIN). IF you do not have a number. see How To Get a TIN on page 2. Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number to enter. Certification o Other" ...................................... Requester's name and address (optionaQ List account number(s) here (optionaQ For Payees Exempt From Backup Withholding (See the instructions on page 2.) Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and Z. I 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 Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or Ie) the IRS has notified me that I am no longer subject to backup withholding. Certification Instructions.-You must cross out item Z above if you have been notified by the IRS that you are currently subject to backup withholding 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 interest paid, acquisition or abandonment of secured property, cancellation of debt. contributions to an individual retirement arrangement (IRA), and generally. payments other than interest and dividends. you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 2.) Sign I Here Signature ~ Purpose of Form.-A person who is required to file an information return with the IRS must get your correct taxpayer identification number (TIN) to report. for example. income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt. or contributions you made to an IRA. Use Form W-9 to give your correct TIN to the person requesting it (the requester) and, when applicable. to: 1. Certify the TIN you are giving is correct (or you are waiting for a number to be issued). 2. Certify you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are an exempt payee. Note: If a requester gives you a form other than a W-9 to request your TIN, you must use the requester's form if it is substantially similar co this Form W-9. What Is Backup Withholding?-Persons making certain payments to you must withhold and pay to the IRS 31% of such payments under certain conditions. This is called "backup withholding." Payments that may be subject to backup withholding include interest. dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. If you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return, payments you receive will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, or 2. The IRS tells the requester that you furnished an incorrect TIN, or 3. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 4. You do not certify to the requester that you are not subject to backup withholding under 3 above (for reportable interest and dividend accounts opened aFter 1983 only). or Date ~ 5. You do not certify your TIN when required. See the Part III instructions on page 2 for details. Certain payees and payments are exempt From backup withholding. See the Part II instructions and the separate Instructions for the Requester of Form W-9. Penalties Failure To Furnish TIN.-If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil Penalty for False Information With Respect to Withholding.-If you make a false statement with no reasonable basis that results in no backup withholding. you are subject to a $500 penalty. Criminal Penalty for Falsifying Information.- Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs.-lf the requester discloses or uses TINs in violation of Federal law, the requester may be subject to civil and criminal penalties. Cat. No. 10231X Form W-9 (Rev. 12-96)