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FormW-9(Rev.11-99)Page

2

2

Theminor

The

Interest,dividend,broker,and

barter exchange accounts opened after

1983 and broker accounts considered

1

grantor-trustee

1

Theactualownerofthe

accountor,ifcombined

funds,thefirstindividual

Two or more

individuals(joint

account)

Custodianaccountof

aminor(UniformGift

toMinorsAct)

a.Theusual

revocablesavings

trust(grantoris

alsotrustee)

b.So-calledtrust

accountthatisnot

alegalorvalidtrust

understatelaw

Sole proprietorship

during1983.

TIN,butyou

certification.

2.

ontheaccount

Youmustgiveyourcorrect

donothavetosignthe

crossoutitem

signingthe

3

2

form.

inthecertificationbefore

For this type of account:nameand

Theowner

Give

Youmustsignthe

withholdingwill

inactiveduring1983.

certificationorbackup

apply.Ifyouare

Theactualowner

subjecttobackup

withholdingandyouaremerelyproviding

yourcorrectTINtotherequester,youmust

1

EINof:

Ifyouareanindividual,youmust

Name.

Specific Instructions

IndividualTheindividual

1.

2.

3.

4.

5.

generallyenterthenameshownonyour

socialsecuritycard.However,ifyouhave

changedyourlastname,forinstance,due

tomarriage,withoutinformingtheSocial

SecurityAdministrationofthename

change,enteryourfirstname,thelast

nameshownonyoursocialsecuritycard,

andyournewlastname.

Iftheaccountisinjointnames,listfirst

andthencirclethenameofthepersonor

entitywhosenumberyouenterinPartIof

theform.

3. Real estate transactions.

signthecertification.Youmay

2

ofthecertification.

Youmust

crossout

item

4.

6.

7.

8.

9.

10.

11.

12.

entity

pensiontrust

CorporateThe

Youmustgiveyour

nothavetosign

pensiondistributions.

correctTIN,butyoudo

thecertification.

PrivacyActNotice

Section6109ofthe

4

Youmustgiveyour

donothavetosign

thecertificationunlessyouhavebeen

notifiedthatyouhavepreviouslygivenan

incorrect TIN.“Otherpayments”include

paymentsmadeinthecourseofthe

requester’stradeorbusinessforrents,

royalties,goods(otherthanbillsfor

merchandise),medicalandhealthcare

services(includingpaymentsto

corporations),paymentstoanonemployee

forservices,paymentstocertainfishing

boatcrewmembersandfishermen,and

grossproceedspaidtoattorneys(including

paymentstocorporations).

5.Mortgageinterestpaidbyyou,

acquisition or abandonment of secured

property, cancellation of debt, qualified

statetuitionprogrampayments,IRAor

MSAcontributionsordistributions,and

corporation

Association,club,Theorganization

religious,charitable,

educational,orother

tax-exempt

organization

PartnershipThepartnership

AbrokerorregisteredThebrokerornominee

nominee

AccountwiththeThepublicentity

Departmentof

Agricultureinthename

ofapublicentity(such

asastateorlocal

government,school

district,orprison)that

receivesagricultural

program payments

Otherpayments.

correctTIN,butyou

IdentificationNumber,toapply

ApplicationforIRSIndividual

InternalRevenueCode

requiresyoutogiveyourcorrectTINto

foranITINor

Employer

IdentificationNumber,toapply

foranEIN.YoucangetFormsW-7and

SS-4fromtheIRSbycalling

1-800-TAX-FORM(1-800-829-3676)or

fromtheIRS’sInternetWebSiteat

www.irs.gov.

IfyoudonothaveaTIN,write“Applied

For”inthespacefortheTIN,signand

datetheform,andgiveittotherequester.

Forinterestanddividendpayments,and

certainpaymentsmadewithrespectto

readilytradableinstruments,generallyyou

willhave60daystogetaTINandgiveit

totherequester.Otherpaymentsare

subjecttobackupwithholding.

Applicationfor

FormSS-4,

thatofthefirstnamelisted.

Applicationfor

yourlocal

FormSS-5,

SecurityCard,from

SocialSecurityAdministrationoffice.Get

Note:

name

be

Ifnonameiscircledwhenmorethanone

islisted,thenumberwillbeconsideredto

FormW-7,

Taxpayer

Note:

you

Writing“Applied For”meansthat

Circletheminor’snameandfurnishtheminor’sSSN.

Youmustshowyourindividualname,butyoumayalso

enter your business or“doing businessas”name.You

mayuseeitheryourSSNorEIN(ifyouhaveone).

orpensiontrust.(DonotfurnishtheTINofthepersonal

representativeortrusteeunlessthelegalentityitselfis

notdesignatedintheaccounttitle.)

Listfirstandcirclethenameofthelegaltrust,estate,

4

1

OR

that

Listfirstandcirclethenameofthepersonwhose

2

3

numberyoufurnish.Ifonlyonepersononajoint

accounthasanSSN,thatperson’snumbermustbe

furnished.

havealreadyappliedforaTIN

youintendtoapplyforonesoon.

individual

security

below.

youareasoleproprietorandyouhave

TIN

If

an

nameas

EIN,youmayentereitheryourSSNor

EIN.However,usingyourEINmayresultin

unnecessarynoticestotherequester.

PartII—ForPayeesExemptFrom

Backup Withholding

Individuals(includingsoleproprietors)are

card.Youmayenteryour

business, trade, or“doing businessas”

Corporationsareexemptfrombackup

withholdingforcertainpayments,suchas

interestanddividends.Formore

informationonexemptpayees,seethe

separateInstructionsfortheRequesterof

FormW-9.

Ifyouareexemptfrombackup

withholding,youshouldstillcompletethis

formtoavoidpossibleerroneousbackup

withholding.EnteryourcorrectTINinPart

I, write“Exempt”inPartII,andsignand

datetheform.

Ifyouareanonresidentalienoraforeign

entitynotsubjecttobackupwithholding,

givetherequesteracompletedFormW-8

(certificationofforeignstatus).

PartIII—Certification

Forajointaccount,onlythepersonwhose

TINisshowninPartIshouldsign(when

required).

1.Interest,dividend,andbarter

exchange accounts opened before 1984

and broker accounts considered active

Soleproprietor.

Youmustenteryour

shownonyoursocial

exemptfrombackupwithholding.

How to get a

donothaveanITIN,see

not

nameonthe

Other

clarificationofnameandTINcombinations.

onrequiredFederaltax

documents.Thisnameshouldmatchthe

nameshownonthecharterorotherlegal

documentcreatingtheentity.Youmay

enter any business, trade, or“doing

businessas”nameonthebusinessname

line.

Part I—TaxpayerIdentification Number

(TIN)

YoumustenteryourTINintheappropriate

box.Ifyouarearesidentalienandyoudo

nothaveandarenoteligibletogetan

SSN,yourTINisyourIRSindividual

taxpayeridentificationnumber(ITIN).Enter

itinthesocialsecuritynumberbox.Ifyou

Enteryourbusiness

HowtogetaTIN.

TIN,applyforone

foranSSN,get

aSocial

immediately.Toapply

Ifyoudonothavea

entities.

nameasshown

Sole proprietorshipTheowner

Avalidtrust,estate,orLegal

line.

businessname

Note:

Seethechartonthispageforfurther

3

personswhomustfileinformationreturns

withtheIRStoreportinterest,dividends,

andcertainotherincomepaidtoyou,

mortgageinterestyoupaid,theacquisition

orabandonmentofsecuredproperty,

cancellationofdebt,orcontributionsyou

madetoanIRAorMSA.TheIRSusesthe

numbersforidentificationpurposesandto

helpverifytheaccuracyofyourtaxreturn.

TheIRSmayalsoprovidethisinformation

totheDepartmentofJusticeforciviland

criminallitigation,andtocities,states,and

theDistrictofColumbiatocarryouttheir

taxlaws.

YoumustprovideyourTINwhetheror

notyouarerequiredtofileataxreturn.

Payersmustgenerallywithhold31%of

taxableinterest,dividend,andcertainother

paymentstoapayeewhodoesnotgivea

TINtoapayer.Certainpenaltiesmayalso

apply.

What Name and Number To

Give the Requester

For this type of account:GivenameandSSNof:

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