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Give the SOCIAL |
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SECURITY number |
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| For this type of account: | of — | ||||
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1.
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An individual | The individual | |||
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2.
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Two or more individuals (joint account) | The actual owner of the account or, if combined funds, the first individual on the account(1) | |||
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3.
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Custodian account of a minor (Uniform Gift to Minors Act) | The minor(2) | |||
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4.
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a. The usual revocable savings
trust (grantor is also trustee)
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The grantor-trustee(1) | |||
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b. So-called trust account
that is not a legal or valid trust under state law
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The actual owner(1) | ||||
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5.
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Sole proprietorship or single-owner LLC | The owner(3) | |||
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Give the EMPLOYER |
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IDENTIFICATION |
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| For this type of account: | number of — | ||||
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6.
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Sole proprietorship or single-owner LLC | The owner(3) | |||
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7.
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A valid trust, estate or pension trust | The legal entity(4) | |||
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8.
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Corporate or LLC electing corporate status on Form 8832 | The corporation | |||
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9.
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Association, club, religious, charitable, educational or other tax-exempt organization | The organization | |||
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10.
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Partnership or multi-member LLC | The partnership | |||
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11.
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A broker or registered nominee | The broker or nominee | |||
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12.
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Account with the Department of Agriculture in the name of a public entity (such as a state or local government, school district or prison) that receives agricultural program payments | The public entity | |||
| (1) | List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished. | |
| (2) | Circle the minor’s name and furnish the minor’s SSN. | |
| (3) | You must show your individual name and you may also enter your business or “DBA” name on the second name line. You may use either your SSN or EIN (if you have one). If you are a sole proprietor, the IRS encourages you to use your SSN. | |
| (4) | List first and circle the name of the legal trust, estate or pension trust. (Do not furnish the identifying number of the personal representative or trustee unless the legal entity itself is not designated in the account title.) |
| NOTE: | If no name is circled when there is more than one name listed, the number will be considered to be that of the first name listed. |
| • | Payments to nonresident aliens subject to withholding under section 1441 of the Code. |
| • | Payments to partnerships not engaged in a trade or business in the United States and that have at least one non-resident alien partner. |
| • | Payments of patronage dividends not paid in money. |
| • | Payments made by certain foreign organizations. |
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THEN the payment is exempt |
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IF the payment is for ... |
for ... | ||
| Interest and dividend payments | All exempt recipients except for 9 | ||
| Broker transactions | Exempt recipients 1 through 13; also, a person who regularly acts as a broker and who is registered under the Investment Advisers Act of 1940 | ||
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(1)
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Penalty for Failure to Furnish Taxpayer Identification Number — If you fail to furnish your correct taxpayer identification number to a payor, 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. | |
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(2)
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Civil Penalty for False Information With Respect to Withholding — If you make a false statement with no reasonable basis which results in no imposition of backup withholding, you are subject to a penalty of $500. | |
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(3)
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Criminal Penalty for Falsifying Information — Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. |