|
Form W-9 (Rev, 1 1-2017J Page 4
<br />lF the payment is for
<br />lnterest and dividend payments
<br />Broker transactions
<br />Bafter exchange transactions and
<br />patronago dividends
<br />Payments over required to be
<br />reporled and direct sales over
<br />$s,0001
<br />THEN the payment is exempt
<br />for. . .
<br />AII exempt payees except
<br />lor 7
<br />Exempt payees 1 through 4 and 6
<br />through 1 l and all C corporations
<br />S corporations must not ent€r an
<br />exempt payee code because they
<br />are exempt only for sales of
<br />noncovered securities acquired
<br />prior to 2012.
<br />Exempt payees 1 through 4
<br />Generally, exempt payees
<br />1 through 52
<br />- The following chart shows types of paymonts that may be exempt
<br />from backup withholding. The chart applies io the exempt payees iisted
<br />above, l through 13.
<br />M-A tax exempt trust under a section 403(b) plan or section 4S7(g)
<br />plan
<br />Note: You may wish to consult with the financial institution requesting
<br />this form io determine whether the FATCA code and/or exempt paye6
<br />code should be completed.
<br />Line 5
<br />Enter your address (number, street, and apanment or suite number).
<br />This is where the requester ol this Form W-9 will mail your information
<br />returns. lf this address differs from the one the requester already has on
<br />file, writ€ NEW at the top. lf a new address is provided, there is still a
<br />chance the old address will be used until the payor changes your
<br />address in their records.
<br />Line 6
<br />Enter your city, siate, and ZIP code.
<br />Part l. Taxpayer ldentification Number fflN)
<br />Enter your TIN in the appropriate box. lf you are a resident alien and
<br />you do not have and aro not eligible to get an SSN, yourTlN is your IRS
<br />individual taxpayer identification number (lTlN). Enter it in the social
<br />security number box, lf you do not have an lTlN, see How to get a TIN
<br />below.
<br />lf you are a sole proprietor and you have an ElN, you rnay enter either
<br />your SSN or ElN.
<br />lf you are a single-member LLC that is disrogarded as an entity
<br />separate from its owner, enter the owner's SSN (or ElN, if the owner has
<br />one). Do not enter the disregarded entity's ElN. lf the LLC is classified as
<br />a corporation or partnership, enter the entily's ElN.
<br />Note: See What Name and Number To Give the Eeguesler, later, for
<br />fufiher clarification of name and TIN combinations.
<br />How to get a TlN. lf you do not have a TlN, apply for one immediately.
<br />Io apply for an SSN, get Form SS-5, Application for a Social Security
<br />Card, from your local SSA office or get this form online at
<br />www,SSA.gov. You may also get this form by calling 1-AOO-772-1213.
<br />Use Form W-7, Application for IRS lndividual Taxpayer ldentijication
<br />Number, to apply for an lTlN, or Form SS-4, Application for Employer
<br />ldentification Number, to apply for an ElN. You can apply for an EIN
<br />online by accessing ihe IRS website al www.irs.govlBusrnesses and
<br />clicking on Employer ldentification Number (ElN) under Starting a
<br />Business. Go to www.irs.gov/Forms to view, download, or prinl Form
<br />W-7 and/or Form SS-4. Or, you can go to www.irs,govlOrderForms lo
<br />place an order and have Form W-7 and/or SS-4 mailed to you within 1O
<br />business days,
<br />_ lf you are asked to complete Form W-9 but do not have a TlN, apply
<br />for a TIN and write "Applied For" in the space for the TlN, sign and daie
<br />the form, and give it to the requester. For interest and dividend
<br />payments, and certain payments made with respect io readily tradable
<br />instruments, generally you will have 60 days to get a TIN and give it to
<br />the requester before you are subject to backup withholding on
<br />payments. The 60-day rule does nol apply to other types of payments.
<br />You will be subject to backup withholding on all such paymenls until
<br />you provide your TIN to the requester.
<br />Note: Entering "Applied For" means that you have already applied for a
<br />TIN or that you intend to apply for one soon.
<br />Gaution: A disregarded U.S. entity that has a foreign owner must use
<br />the appropriate Form W-8.
<br />Part ll. Cedification
<br />To establish to the withholding agent that you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requested to sign by the
<br />withholding agent even i{ item 1, 4, or 5 below indicates otherwise.
<br />For a joint account, only the person whose TIN is shown in part I
<br />should sign {when required). ln the case of a disregarded entity, the
<br />person identified on line 1 must sign. Exempt payees. see Exempt payee
<br />codq eadier.
<br />Signature requirements. Complete the csrtification as indicated in
<br />items-l through 5 below.
<br />Paymenls made jn settlement of Exempt payees 1 through 4
<br />payment card or third party
<br />transactions
<br />1 See Form 1099-M|SC, Miscellaneous lncome, and its instructions.
<br />2 Ho*ever, the following payments macte to a corooration andreportable on Form 1OSg-MISC ar€ not exsmpt fiom backup
<br />withhoJding: medical and health care paymenls, attorn€ys'fees, gross
<br />proceeds paid to an attorney reportable under section 6045(0, and
<br />payments for services paid by a federal executive agency.
<br />Exemption from FATCA repo*ing code. The following codes identify
<br />payees that are exempt trom reporting under FATCA. These codes
<br />apply to persons submitting this form for accounts maintained outside
<br />of the United States by certain foreign financial institutions. Therefore, if
<br />you are only submitting this form for an accouni you hold in the United
<br />States, you may leave this field blank. Consult with the person
<br />requesting this form if you are uncedain if the tinancial institution is
<br />subject to these requirements. A requester may indicate that a code is
<br />not required by providing you with a Form W-9 wilh ,,Not Applicable', (or
<br />any similar indication) written or printed on the line for a FATCA
<br />exemption code.
<br />A-An organization exempt from tax under section S01{a) or any
<br />individual retirement plan as defined in section 7701(a)(Jl)
<br />B-The United States or any of its agencies or instrumenlalities
<br />C-A staie, the District of Columbia, a U.S. commonwealth or
<br />possession, or any of their political subdivisions or instrumentalities
<br />D-A corporation the stock of which is regularly traded on one or
<br />more establish6d securities markets, as described in Regulations
<br />section 1.1 472-1 (cX lXi)
<br />E-A corporalion that is a member of the same expanded affiliated
<br />group as a corporation described in Regulations section 1.1472-1(c){1)(i}
<br />F-A dealer in securities, commodities, or derivative financial
<br />instruments (including notional principal contracts, lutures, foruvards,
<br />and options) lhat is registered as such under the laws of the United
<br />States or any staie
<br />G-A real estate investment irusl
<br />H-A regulated investment company as defined in section g51 or an
<br />entity regist€red at all times during the tax year under the lnvestment
<br />Company Act of 1940
<br />l-A common trust fund as defined in section 584(a)
<br />J-A bank as defined in section 581
<br />K-A broker
<br />L-A trust exempt from tax under section 664 or described in section
<br />as47(al(1)
|