Form W-9 Taxpayer Identification Number Request (Response to first

By Eddie Howard,2014-05-07 21:07
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Form W-9 Taxpayer Identification Number Request (Response to first


     FOR OFFICE USE ONLY Please complete and return to: (requester’s return address) (Requester enters name, address, and account as they appear in requester’s records.) _______________________________________________ _______________________________________________ Name __________________________________________________ _______________________________________________ Locator ID ______________________________________________ _______________________________________________________

    Step 1. (Check ONE box only and provide your complete name and Taxpayer Identification Number.) ? U.S. Resident Individual/Sole Proprietor (Form 1099 reportable)


    If you are a sole proprietor, name the owner of the business:

    Social Security Employer Number ___ ___ ___ --___ ___--___ ___ ___ ___ Identification Number ___ ___-- ___ ___ ___ ___ ___ ___ ___

    ? U.S. Partnership, Limited Liability Company (“LLC”), or Trust (Form 1099 reportable)

    Name (as shown on your tax return) Employer Identification Number ___ ___-- ___ ___ ___ ___ ___ ___ ___

    ? U.S. Corporation (exempt from Form 1099 reporting except for medical or legal services)

     (If an LLC electing corporate status for U.S. tax purposes, please attach a copy of your U.S. tax election on IRS Form 8832, Entity Classification Election) Name (as shown on your tax return) Employer Identification Number ___ ___-- ___ ___ ___ ___ ___ ___ ___

    ? U.S. Tax-Exempt Organization or Federal, State, or Local Government Agency (exempt from Form 1099 reporting)

    Name (as shown on your tax return) Employer Identification Number ___ ___-- ___ ___ ___ ___ ___ ___ ___

Step 2. Certification/Signature (Complete the following) Under penalties of perjury my signature certifies that:

    1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me).

    2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the

    Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends,

    or (c) the IRS has notified me that I am no longer subject to backup withholding. 3. I am a U.S. person (including a U.S. resident alien).

     - You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, number 2 above does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. Signature: Phone: ( )

    Print Name: Title: Date:

    Address: City: State: ZIP:

Instructions for U.S. Tax Persons

    As a business, federal income tax law requires us to report certain payments we make to you if you are not exempted from this reporting responsibility. In order for us to properly meet the federal tax law requirements, we need certain information from you. Please complete the information requested above and return this form to the address shown above. If you do not provide us with your correct taxpayer identification number, you may be subject to a $50 penalty imposed by the Internal Revenue Service. In addition, you may be subject to 28% backup withholding on reportable payments we make to you. If you have any questions, please call us at _________________________________ (provide requester’s telephone number).

Are you a U.S. person? The IRS defines a U.S. person as:

     a U.S. citizen;

     an entity (company, corporation, trust, partnership, estate, etc.) created or organized in, or under the laws of, the United States; a state; or the District of Columbia;

     a U.S. resident (someone who has a “green card” or has passed the IRS “substantial-presence test.” For an explanation of the substantial-presence test, please see IRS Pub. 515 or 519, available at

    If your answer is NO, please do not complete this form and contact us at (insert requester’s phone number here) __________________________.

    If your answer is YES, please complete the form.

    See page 2 for additional information.

    ? Balance Consulting LLC Revised 041006

    Enter your TIN in the appropriate box. If you are a resident alien and you do If you are a non-U.S. resident or a corporation, partnership or other entity formed not have and are not eligible to get an SSN, your TIN is your IRS individual outside the U.S. and you are receiving payments as beneficial owner, IRS taxpayer identification number (ITIN). Enter it in the social security number box. If procedures require you to submit one of the following forms for use in you do not have an ITIN, see How to get a TIN below. determining the correct course of tax withholding on and information reporting If you are a sole proprietor and you have an EIN, you may enter either your SSN or of payments made to you. These forms are available at EIN. However, the IRS prefers that you use your SSN. ?If you are a single-owner LLC that is disregarded as an entity separate from its ?IRS Form 8233, Exemption From Withholding on Compensation for Independent (and owner, enter your SSN (or EIN, if you have one). If the LLC is a corporation, Certain Dependent) Personal Services of a Nonresident Alien Individual OR partnership, etc., enter the entity’s EIN. ??IRS Form W-8ECI, Certificate of Foreign Person’s Claim for Exemption from Note. See the chart on page 4 of the instructions for the IRS Form W-9, available Withholding on Income Effectively Connected with the Conduct of a Trade or Business in at, for further clarification of name and TIN combinations. the United States, OR

    ??IRS Form W-8BEN, Certification of Foreign Status of Beneficial Owner for United How to get a TIN. If you do not have a TIN, apply for one immediately. To States Tax Withholding. apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at If you are not a beneficial owner, but instead acting in an agency capacity for a You may also get this form by calling 1-800-772-1213. beneficial owner, you may be required to submit: Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to ??IRS Form W-8IMY, Certificate or Foreign Intermediary, Foreign Flow-Through apply for an ITIN, or Form SS-4, Application for Employer Identification Number, Entity, or Certain U.S. Branches for United States Tax Withholding. to apply for an EIN. You can apply for an EIN online by accessing the IRS website at and clicking on Employer ID Numbers under Related If you need assistance in completing one of the above forms, please consult your Topics. You can get Forms W-7 and SS-4 from the IRS by visiting or U.S. tax advisor for the appropriate help in determining which of these forms by calling 1-800-TAX-FORM (1-800-829-3676). should be submitted and in correct completion of the form. We require your If you are asked to complete Form W-9 but do not have a TIN, write “Applied For” provision of this information to assist us for tax purposes in correctly in the space for the TIN, sign and date the form, and give it to the requester. For withholding and reporting payments we make to you for your services. interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Name. If you are an individual, you must generally enter the name shown on your income tax return. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and Note. Writing “Applied For” means that you have already applied for a TIN or your new last name. If the account is in joint names, list first, and then circle, the that you intend to apply for one soon. name of the person or entity whose number you entered on the form. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Sole proprietor. Enter your individual name as shown on your income tax return. You may also enter your business, trade, or “doing business as (DBA)” name. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such Limited liability company (LLC). If you are a single-member LLC payments. This is called “backup withholding.” Payments that may be subject to (including a foreign LLC with a domestic owner) that is disregarded as an entity backup withholding include interest, dividends, broker and barter exchange separate from its owner under Treasury regulations section 301.7701-3, enter the transactions, rents, royalties, nonemployee pay, and certain payments from owner’s name and the LLC’s name on the form. fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you Other entities. Enter your business name as shown on required federal tax receive if you give the requester your correct TIN, make the proper certifications, documents on the “Name” line. This name should match the name shown on the and report all your taxable interest and dividends on your tax return. charter or other legal document creating the entity.

    Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, or Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, 2. You do not certify your TIN when required, or you are subject to a penalty of $50 for each such failure unless your failure is due 3. The IRS tells the requester that you furnished an incorrect TIN, or to reasonable cause and not to willful neglect. 4. The IRS tells you that you are subject to backup withholding because you did Civil penalty for false information with respect to withholding. If not report all your interest and dividends on your tax return (for reportable you make a false statement with no reasonable basis that results in no backup interest and dividends only), or withholding, you are subject to a $500 penalty. 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts Criminal penalty for falsifying information. Willfully falsifying opened after 1983 only). certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Certain payees and payments are exempt from backup withholding. See the instructions for the IRS Form W-9, available at, under “Exempt from Misuse of TINs. If the requester discloses or uses TINs in violation of federal Backup Withholding” for more information. law, the requester may be subject to civil and criminal penalties.

Privacy Act Notice

    Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA, or Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Columbia to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.

? Balance Consulting LLC Revised 041006

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