Request
for Taxpayer
Identification
Number
and
Certification
Give Form
to
the
W-9
Fann
requester.
Do not
(Rev.
October
2018)
Department
of
the
Treas11ry
send
to
the
IRS.
Internal
Revenue
Service
►
Go
to
www.irs.gov/FormW9
for
instructions
and
the
latest
information.
1
Name
(as
shown
on
your
income
tax
return).
Name
is
required
on
this
line;
do
not
leave
this
line
blank.
M
&
Ill
Q.
§
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•
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BOSSIER PARISH COMMUNITY
COLLEGE
2
Business
name/disregarded
entity
name,
if
different
from
above
3
Check
appropriate
box
for
federal
tax
classification
of
the
person
whose
name
is
entered
on
line
1.
Check
only
one
of
the
4
Exemptions
(codes
apply only to
following
seven
boxes.
0
lndividuaVsole
proprietor or
D C
Corporation
D S corporation
D
Partnership
D
Trust/estate
single-member
LLC
0
Limited
liability
company.
Enter
the
tax
classification
{C=C
corporation,
S=S
corporation,
P=Partnership)
►
certain
entities,
not
i
ndividuals;
see
instructions
on
page
3):
Exempt
payee
code
(if
any)
Note:
Check
the
appropriate
box
in
the
line
above
for
the
tax
classification
of
the
single-member
owner.
Do
not
check
Exemption
from
FATCA
report
i
ng
LLC
if
the
LLC
is
classified
as
a
single-member
LLC
that
is
disregarded
from
the
owner
unless
the
owner
of
the
LLC
is
code
(if
any)
another
LLC
that
is
not
disregarded
from
the
owner
for
U.S.
federal
tax
purposes.
Otherwise,
a
single-member
LLC
that
is
disregarded
from
the
owner
should
check
the
appropriate
box
for
the
tax
classification
of
its
owner.
~!0-ISmain--llNIU.5.)
0
Other
(see
instructions)
►
5
Address
(number,
street,
and
apt.
or
suite
no.)
See
instructions.
Requester's
name
and
address
(optionaO
6220 EAST TEXAS STREET
6
City,
state,
and
ZIP
code
BOSSIER CITY LA 71111
7
List
account
number(s)
here
(optionaO
Taxpayer
Identification
Number
CTIN)
ma
Enter
you~
TIN
in_
the app!o~ri~te box.
'!h~
TIN provided
must_
match t~e name given on line 1
to
avoid
backup withholding. For
1nd1v1duals,
this
Is
generally your social security number
(SSN).
However,
for
a
resident alien, sole proprietor,
or
disregarded entity, see the instructions
for
Part
I,
later. For other
I
Social
aecurlty
number
I
ITO
[D
I I I I I
- -
entities,
it
is your employer identification number (EIN). If you
do
not have a number, see
How
to
get
a .____._..__ ... __.
TIN, later.
or
Note:
If
the
account is in more than one name, see
the
instructions for line 1. Also see What Name
and
!i'-E=-m-""'pl,..oy_e_r_ld_e_n_tifi-,c-•-ti-on-nu_m_b_e_r
___
_,
Number
To
Give the Requester
for
guidelines
on
whose number
to
enter.
72-1380259
Certification
Under penalties of perjury, I certify 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); and
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;
and
3.
I am a U.S. citizen
or
other U.S. person (defined below); and
4.
The FATCA code(s) entered on this form
Qf
any) indicating that I am exempt from FATCA reporting is correct.
Certification
instructions. 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, item 2 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.
See
the instructions for Part II, later.
Sign ISlgnatureof . .
..
7/~
Here . U.S.
person
►
~
Date
►
General Instructions
Section references
are
to
the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related
to
Form W-9 and
its
instructions, such as legislation enacted
after they were published, go
to
www.irs.gov/FormW9.
Purpose
of
Form
Ari individual
or
entity (Form
W-9
requester)
who
is
required
to
file an
information return with
the
IRS must obtain your correct taxpayer
identification number
(TIN)
which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN),
or
employer identification number
(EIN),
to
report on an information return the amount paid
to
you,
or
other
amount reportable on an information return. Examples
of
information
returns include, but are
not
limited to,
the
following.
• Form 1099-INT (interest
earned
or
paid)
• Form 1099-DIV (dividends. including those from stocks
or
mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards,
or
gross
proceeds)
• Form 1099-B (stock
or
mutual fund sales and certain other
transactions
by
brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
• Form 1098 {home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition
or
abandonment
of
secured property)
Use Form W-9 only
if
you
are
a U.S. person (including a resident
alien),
to
provide your correct TIN.
If
you
do
not
retum Form W-9 to the requester with a TIN, you
might
be subject to backup withholding. See What
is
backup withholding,
later.
Form
W-9
(Rev
. 10-
20
18)
Cat
.
No.
10231X
