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<br />Form W 58 9
<br />
<br />'Request for Taxpayer
<br />Identification Number and Certification
<br />
<br />Give Form to the
<br />requester.. Do not
<br />send to the IRS.
<br />
<br />(Rev. January 2011)
<br />Department o/tha TraastMY
<br />Internal Reve~e Service
<br />Name (:'3 shown on your Income tax return) .
<br />
<br />Action Labor Management of Florida, Inc.
<br />N Business name/dlsregarded entity name. If different from above
<br />cD
<br />Cl
<br />III
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<br />en
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<br />en
<br />
<br />Check appropriate box for fedeniI tax
<br />c1asslt1catlon (required): 0 IndMduallsole proprietor
<br />
<br />. 0 C Corporation
<br />
<br />o S corporation
<br />
<br />o Partnership D. Trust/estate
<br />
<br />[{] Umlted JlabDlty company. Enter the tax cfassifJcatlon (C=C corporatlon, S=S corporation, p,.partnel'llhlpJ ~
<br />
<br />o Exempt payaa
<br />
<br />o Other (see instructions) I>-
<br />Address (number, street, and apt or suite no.)
<br />624 Nottingham Blvd,
<br />CIty, s1ate, and ZIP code
<br />West Palm Beach, FL 33405
<br />Ust account number(s) here (optlon~
<br />
<br />Requester'S name and address (optlonaQ
<br />
<br />Taxpayer Identiflcation Number IN
<br />
<br />Enter your TIN In the appropriate box. The TIN provlded must match the name given on the "Name" /lne
<br />to avoid backup wiihho/dlng. For Individuals, this Is your social security number (SSN). However, 10r a
<br />residant ailan, Sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other
<br />entitles. It Is your employer Identification number (EIN). If you do not have a number, see How to get a
<br />TIN on page 3. . .
<br />
<br />Note. If the account Is In more than one name, see the chart on page 4 forguldel1nes on whose
<br />number to enter.
<br />
<br />
<br />Soclal security number
<br />
<br />[IJ] -OJ -DID.
<br />
<br />
<br />
<br />Certification
<br />Under penaitfes of perjury, I certify that
<br />,. The n~mber shown on this fonn Is my correGt taxpayer Identification num?er (or I am waiting f9r a number to be Issued .to me), and
<br />
<br />2. I am not sUbJeGt'to backup wlthholdlng because: (8) I am exemp1 from backup withholding. or (b) I have not been notlfled by the Internal Revenue
<br />ServIce PRS) that I am subjeGt to backup wlthholdlng as a result of a failure to report aU interest or dfvldends, or (c) the IRS has notified me that I am
<br />no longer subject to backup w1thh?ld~g, and
<br />
<br />3. I. am a U.S. cItlzen or other U.S. person (defined below). .
<br />Cert:l1lcatlon Instructlons~ You must cross out Item 2 above If y. ave be"k notlfled by the IRS that you are currently subject to backup. withholding
<br />because you have faRed to.report ail Interest and dlvl~ends on our t~~erum. For reai estate transactions, Item 2 does not apply. For mortgage
<br />Interest paid, acquIsition or abandonment of secured R arty, canc ~ratlon of debt, contributions to an Indlvfdu~1 retirement arrangement ORAl, and
<br />generally, payments other than Irrterest a d divide , you are equlred to sign the certification, but you must provide your correct TIN. See the
<br />Instnrctions on page 4.
<br />
<br />. ign SIgn re of
<br />Here u.s. erson~' Date ~
<br />
<br />
<br />
<br />.ons
<br />
<br />Section references are to the Intern8l Revenue Code unless otherwise
<br />noted.
<br />
<br />Purpose..of Form
<br />
<br />A person who Is required to file an Information return with the IRS must
<br />obtain your correqt taxpayer Identification number (TIN) to report, for
<br />exarriple, Income paId to you. real estate transactlons, mortgage Interest
<br />you paid, acquisition or abandonment of secured property, cancellation
<br />of ~ebt. or contributions you made to an IRA.
<br />. Use Form W-9 only I( you are a U.S. person Oncludlng a resIdent
<br />alien), 10 provlde your correct TIN to the person requesting It (the
<br />requesteQ SI1d..when applicable, to:
<br />1. Certlfy.that the TIN you are giving Is correct (or you are waltlng.for a
<br />number to be Issued),
<br />2. Certlfy that}ou are not subject to backup withholding, or
<br />3: Claim exemptl!?n from backup withholdIng if you are a U.S. exempt
<br />payee. If applicable, you are also certifying that.as a U.S. person, your
<br />allocable share of any partnership income from a U.S. trade or business
<br />Is not subject to the withholding lax on foreign partners' share of
<br />effectively conneGted Income.
<br />
<br />Note. 11 a requester gives you a form other thSl1 Form W-9 to request
<br />your'TlN, you must use the requester's form If it Is substantially similar
<br />to this Form W-9.
<br />
<br />Definition of a U.S. person. For federal tax purposes, you are
<br />considered l'! U.S. person If you are:
<br />
<br />o An Individual who Is a U.S; cltlzen or U.S. resident aUen,
<br />
<br />o A partnership, corporation, company, or assoclatfon created"or
<br />organized In lhetJnlted States or under the Jaws 01 the UnIted States.
<br />
<br />o An estate (other than a foreign estate), or
<br />
<br />. A domestlo trust (as d.efined In Regulatlons section 301.7701-7).
<br />
<br />Special rules for partnerships. Partnerships that conduct a trade or
<br />business In the United States are generally required to pay a withholding
<br />tax on !l"y foreign partners' share of Income 1rom such business.
<br />Further, In certain cases where a Fonn W-9 h!l3 not been receIved, a.
<br />partnership Is required to presume that a partner Is a foreign person,
<br />and pay the. withholding tax. Therefore, 11 you are a U.S. person that Is a
<br />partner In a partnershIp conducting a trade or busIness In the United .r
<br />States, provide Form W-9 to the partnership to establish your U.S.
<br />status and avoid withholdIng on your share of partnership Income.
<br />
<br />Cat No. 10231X
<br />
<br />Form W-9 (Rev.1-2011) .
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