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Give the name and |
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SOCIAL SECURITY number |
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| For this type of account: | of — | ||||
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1.
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An individual’s account | 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 disregarded entity owned by an individual | The owner(3) | |||
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Give the EMPLOYER |
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IDENTIFICATION number |
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| For this type of account: | of — | ||||
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6.
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Disregarded entity not owned by an individual | 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 account | The corporation | |||
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9.
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Partnership or multi-member LLC account held in the name of the business | The partnership | |||
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10.
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Association, club, or tax-exempt organization account | The organization | |||
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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 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) | Show the name of the owner. You must show your individual name, but you may also enter your business or “doing business as” name. Either your social security number or employer identification number (if you have one) may be used. | |
| (4) | 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.) |
| Note: | If no name is circled when there is more than one name, the number will be considered to be that of the first name listed. |
| • | A corporation. | |
| • | A financial institution. | |
| • | An organization exempt from tax under Section 501(a) of the Internal Revenue Code of 1986, as amended (the “Code”), or an individual retirement account where the payor is the trustee or custodian, or a custodial account under Section 403(b)(7) of the Code if the account satisfies the requirements of Section 401(f)(2) of the Code. | |
| • | 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. | |
| • | An international organization or any agency or instrumentality thereof. | |
| • | A foreign government or any political subdivision, agency or instrumentality thereof. | |
| • | A dealer in securities or commodities required to register in the United States, the District of Columbia or a possession of the United States. | |
| • | A real estate investment trust. | |
| • | A common trust fund operated by a bank under Section 584(a) of the Code | |
| • | An entity registered at all times during the tax year under the Investment Company Act of 1940. | |
| • | A foreign central bank of issue. |