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Give the NAME and |
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SOCIAL SECURITY |
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| For this type of account: | number of: | |||
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1.
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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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Custodial 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 disregarded entity owned by an individual | The owner(3) | ||
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Give the NAME and |
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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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Disregarded entity not owned by an individual | The owner(4) | ||
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7.
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A valid trust, estate, or pension trust | The legal entity(5) | ||
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8.
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Corporation (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 | ||
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| (1) | List first and circle the name of the person whose number you furnish. If only one person on a joint account has a social security number, that person’s number must be furnished. |
| (2) | Circle the minor’s name and furnish the minor’s social security number. |
| (3) | You must show your individual name, but you may also enter your business name or “doing business as” name. Use either the individual’s social security number or the business’ employer identification number (if it has one). |
| (4) | You must show the owner’s name on the “Payee’s Name” line and use the owner’s taxpayer identification number. You must show the disregarded entity’s name on the “Payee’s Business Name” line. Do not enter the disregarded entity’s taxpayer identification number. |
| (5) | List first and circle the name of the legal trust, estate or pension trust. (Do not furnish the taxpayer identification number of the personal representative or trustee unless the legal entity itself is not designated in the account title.) |
| • | A corporation. | |
| • | A financial institution. | |
| • | An organization exempt from tax under section 501(a), or an individual retirement plan, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2). | |
| • | The United States or any agency or instrumentality thereof. | |
| • | A state, the District of Columbia, a possession of the United States, or any subdivision or instrumentality thereof. | |
| • | A foreign government, a political subdivision of a foreign government, or any agency or instrumentality thereof. | |
| • | An international organization or any agency or instrumentality thereof. | |
| • | A dealer in securities or commodities registered in the United States or a possession of the United States. | |
| • | A real estate investment trust. | |
| • | A common trust fund operated by a bank under section 584 (a). | |
| • | An exempt charitable remainder trust, or a non-exempt trust described in section 4947. | |
| • | An entity registered at all times under the Investment Company Act of 1940. | |
| • | A foreign central bank of issue. | |
| • | A middleman known in the investment community as a nominee or custodian or listed in the most recent publication of the American Society of Corporate Secretaries, Inc., Nominee List. | |
| • | Payments of dividends and patronage dividends not generally subject to backup withholding include the following: | |
| • | Payments to nonresident aliens subject to withholding under section 1441. | |
| • | Payments to partnerships not engaged in a trade or business in the U.S. and which have at least one nonresident alien partner. | |
| • | Payments of patronage dividends where the amount received is not paid in money. | |
| • | Payments made by certain foreign organizations. | |
| • | Section 404(k) distributions made by an ESOP. |
| • | Payments of interest on obligations issued by individuals. Note: You may be subject to backup withholding if this interest is $600 or more and is paid in the course of the payor’s trade or business and you have not provided your correct taxpayer identification number to the payor. | |
| • | Payments of tax-exempt interest (including exempt interest dividends under section 852). | |
| • | Payments described in section 6049(b)(5) to nonresident aliens. | |
| • | Payments on tax-free covenant bonds under section 1451. | |
| • | Payments made by certain foreign organizations. |