9/07 Revision
DO NOT SUBMIT FORM TO IRS - SUBMIT
FORM TO REQUESTING AGENCY
FOR SUBMITTING AGENCY USE ONLY
CITY OF NEW YORK
SUBSTITUTE FORM W-9:
REQUEST FOR TAXPAYER IDENTIFICATION NUMBER & CERTIFICATION
1. Legal Business Name:(As it appears on IRS EIN records, CP575, 147C - or -
Social Security Admin records, Social Security Card, certified Form SSA7028)
TYPE OR PRINT INFORMATION NEATLY. PLEASE REFER TO INSTRUCTIONS FOR MORE INFORMATION.
2. If you use DBA, please list below:
Signature Phone Number
For payees exempt from Backup Withholding, check the box below. Valid explanation required for exemption. See instructions.
2. Remittance Address:1. Primary 1099 Vendor Address:
Part I: Vendor Information
Part II: Taxpayer Identification Number (TIN) & Taxpayer Identification Type
Part III: Primary 1099 Vendor & Remittance Address
City, State,and Nine Digit Zip Code or Country
Number, Street, and Apartment or Suite NumberNumber, Street, and Apartment or Suite Number
City, State,and Nine Digit Zip Code or Country
Part IV: Exemption from Backup Withholding
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup
withholding.
Under penalties of perjury, I certify that the number shown on this form is my correct Taxpayer Identification Number (TIN).
Part V: Certification
Sign
Here:
Submitting
Agency Code:
Contact's E-
Mail Address:
Payee/Vendor Code:
Telephone
Number:
( )
DO NOT FORWARD W-9 TO COMPTROLLER'S OFFICE. FAX COMPLETED W-9 FORM TO THE SCHOOL/REQUESTOR.
1. Enter your TIN here: (DO NOT USE DASHES)
Exempt from Backup Withholding
Contact's E-Mail Address:
Contact
Person:
Date
Print Preparer's Name Phone Number
2. Taxpayer Identification Type (check appropriate box):
N/A (Non-United United
States Business Entity)
Employer ID No.
(EIN)
Social Security No.
(SSN)
Individual Taxpayer
ID No. (ITIN)
Estate
3. Entity Type (Check one only):
Church or Church-Controlled Organization
Personal Service Corporation
Non-Profit
Corporation
Corporation/
LLC
Joint Venture
Partnership/
LLC
Government
Single Member LLC
(Individual)
City of New York
Employee
Resident/Non-
Resident Alien
Individual / Sole
Proprietor
Non-United States
Business Entity
Trust
