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Form W-9(Rev.12-2014) Page 4
<br /> Part II.Certification 3 You must show your individual name and you may also enter your business or DBA name on
<br /> the"Business name/disregarded entity"name line.You may use either your SSN or EIN(if you
<br /> To establish to the withholding agent that you are a U.S.person,or resident alien, have one),but the IRS encourages you to use your SSN.
<br /> sign Form W-9.You may be requested to sign by the withholding agent even if
<br /> list first and circle the name of the trust,estate,or pension trust.(Do not furnish the TIN of the
<br /> items 1,4,or 5 below indicate otherwise. personal representative or trustee unless the legal entity itself is not designated in the account
<br /> For a joint account,only the person whose TIN is shown in Part I should sign title.)Also see Special rules for partnerships on page 2.
<br /> (when required).In the case of a disregarded entity,the person identified on line 1 *Note.Grantor also must provide a Form W-9 to trustee of trust.
<br /> must sign.Exempt payees,see Exempt payee code earlier. Note.If no name is circled when more than one name is listed,the number will be
<br /> Signature requirements.Complete the certification as indicated in items 1 considered to be that of the first name listed.
<br /> through 5 below. Secure Your Tax Records from Identity Theft
<br /> 1.Interest,dividend,and barter exchange accounts opened before 1984
<br /> and broker accounts considered active during 1983.You must give your Identity theft occurs when someone uses your personal information such as your
<br /> correct TIN,but you do not have to sign the certification. name,SSN,or other identifying information,without your permission,to commit
<br /> 2.Interest,dividend,broker,and barter exchange accounts opened after fraud or other crimes.An identity thief may use your SSN to get a job or may file a
<br /> 1983 and broker accounts considered inactive during 1983.You must sign the tax return using your SSN to receive a refund.
<br /> certification or backup withholding will apply.If you are subject to backup To reduce your risk:
<br /> withholding and you are merely providing your correct TIN to the requester,you •Protect your SSN,
<br /> must cross out item 2 in the certification before signing the form.
<br /> •Ensure your employer is protecting your SSN,and
<br /> 3.Real estate transactions.You must sign the certification.You may cross out
<br /> item 2 of the certification. •Be careful when choosing a tax preparer.
<br /> 4.Other payments.You must give your correct TIN,but you do not have to sign If your tax records are affected by identity theft and you receive a notice from
<br /> the certification unless you have been notified that you have previously given an the IRS,respond right away to the name and phone number printed on the IRS
<br /> incorrect TIN."Other payments"include payments made in the course of the notice or letter.
<br /> requester's trade or business for rents,royalties,goods(other than bills for If your tax records are not currently affected by identity theft but you think you
<br /> merchandise),medical and health care services(including payments to are at risk due to a lost or stolen purse or wallet,questionable credit card activity
<br /> corporations),payments to a nonemployee for services,payments made in or credit report,contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
<br /> settlement of payment card and third party network transactions,payments to Form 14039.
<br /> certain fishing boat crew members and fishermen,and gross proceeds paid to For more information,see Publication 4535,Identity Theft Prevention and Victim
<br /> attorneys(including payments to corporations). Assistance.
<br /> 5.Mortgage interest paid by you,acquisition or abandonment of secured Victims of identity theft who are experiencing economic harm or a system
<br /> property,cancellation of debt,qualified tuition program payments(under problem,or are seeking help in resolving tax problems that have not been resolved
<br /> section 529),IRA,Coverdell ESA,Archer MSA or HSA contributions or through normal channels,may be eligible for Taxpayer Advocate Service(TAS)
<br /> distributions,and pension distributions.You must give your correct TIN,but you assistance.You can reach TAS by calling the TAS toll-free case intake line at
<br /> do not have to sign the certification. 1-877-777-4778 or TTY/TDD 1-800-829-4059.
<br /> What Name and Number To Give the Requester Protect yourself from suspicious emails or phishing schemes. Phishing is the
<br /> creation and use of email and websites designed to mimic legitimate business
<br /> For this type of account: Give name and SSN of: emails and websites.The most common act is sending an email to a user falsely
<br /> claiming to be an established legitimate enterprise in an attempt to scam the user
<br /> 1.Individual The individual into surrendering private information that will be used for identity theft,
<br /> 2.Two or more individuals(joint The actual owner of the account or, The IRS does not initiate contacts with taxpayers via emails.Also,the IRS does
<br /> account) if combined funds,the first not request personal detailed information through email or ask taxpayers for the
<br /> individual on the account' PIN numbers,passwords,or similar secret access information for their credit card,
<br /> 3.Custodian account of a minor The minor' bank,or other financial accounts.
<br /> (Uniform Gift to Minors Act) If you receive an unsolicited email claiming to be from the IRS,forward this
<br /> 4.a.The usual revocable savings The grantor-trustee' message to phishing@irs.gov.You may also report misuse of the IRS name,logo,
<br /> trust(grantor is also trustee) or other IRS property to the Treasury Inspector General for Tax Administration
<br /> b.So-called trust account that is The actual owner' (TIGTA)at 1-800-366-4484.You can forward suspicious emails to the Federal
<br /> not a legal or valid trust under Trade Commission at:spam@uce.gov or contact them at www.ftc.gov/idtheft or
<br /> state law 1-877-IDTHEFT(1-877-438-4338).
<br /> 5.Sole proprietorship or disregarded The owner' Visit IRS.gov to learn more about identity theft and how to reduce your risk.
<br /> entity owned by an individual
<br /> 6.Grantor trust filing under Optional The grantor* Privacy Act Notice
<br /> Form 1099 Filing Method 1 (see
<br /> Regulations section 1.671-4(b)(2)(i) Section 6109 of the Internal Revenue Code requires you to provide your correct
<br /> (A)) TIN to persons(including federal agencies)who are required to file information
<br /> returns with the IRS to report interest,dividends,or certain other income paid to
<br /> For this type of account: Give name and EIN of: you;mortgage interest you paid;the acquisition or abandonment of secured
<br /> 7.Disregarded entity not owned by an The owner property;the cancellation of debt;or contributions you made to an IRA,Archer
<br /> individual MSA,or HSA.The person collecting this form uses the information on the form to
<br /> 8.A valid trust,estate,or pension trust Legal entity' file information returns with the IRS,reporting the above information.Routine uses
<br /> of this information include giving it to the Department of Justice for civil and
<br /> 9.Corporation or LLC electing The corporation criminal litigation and to cities,states,the District of Columbia,and U.S.
<br /> corporate status on Form 8832 or commonwealths and possessions for use in administering their laws.The
<br /> Form 2553 information also may be disclosed to other countries under a treaty,to federal and
<br /> 10.Association,club,religious, The organization state agencies to enforce civil and criminal laws,or to federal law enforcement and
<br /> charitable,educational,or other tax- intelligence agencies to combat terrorism.You must provide your TIN whether or
<br /> exempt organization not you are required to file a tax return.Under section 3406,payers must generally
<br /> 11.Partnership or multi-member LLC The partnership withhold a percentage of taxable interest,dividend,and certain other payments to
<br /> a payee who does not give a TIN to the payer.Certain penalties may also apply for
<br /> 12.A broker or registered nominee The broker or nominee providing false or fraudulent information.
<br /> 13.Account with the Department of The public entity
<br /> Agriculture in the name of a public
<br /> entity(such as a state or local
<br /> government,school district,or
<br /> prison)that receives agricultural
<br /> program payments
<br /> 14.Grantor trust filing under the Form The trust
<br /> 1041 Filing Method or the Optional
<br /> Form 1099 Filing Method 2(see
<br /> Regulations section 1.671-4(b)(2)(i)
<br /> (B))
<br /> 'List first and circle the name of the person whose number you furnish.If only one person on a
<br /> joint account has an SSN,that person's number must be furnished.
<br /> 2 Circle the minor's name and furnish the minor's SSN.
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