Form W-9 (Rev. 12-2000) Page 2
What Name and Number To
Give the Requester
Give name and SSN of:For this type of account:
The individual1. Individual
The actual owner of the
account or, if combined
funds, the first individual
on the account
1
2. Two or more
individuals (joint
account)
The minor
2
3. Custodian account of
a minor (Uniform Gift
to Minors Act)
The grantor-trustee
1
4. a. The usual
revocable savings
trust (grantor is
also trustee)
1. Interest, dividend, and barter exchange
accounts opened before 1984 and broker
accounts considered active during 1983. You
must give your correct TIN, but you do not have
to sign the certification.
The actual owner
1
b. So-called trust
account that is not
a legal or valid trust
under state law
2. Interest, dividend, broker, and barter
exchange accounts opened after 1983 and
broker accounts considered inactive during
1983. You must sign the certification or backup
withholding will apply. If you are subject to
backup withholding and you are merely providing
your correct TIN to the requester, you must
cross out item 2 in the certification before
signing the form.
The owner
3
5. Sole proprietorship
Give name and EIN of:For this type of account:
3. Real estate transactions. You must sign
the certification. You may cross out item 2 of the
certification.
A valid trust, estate, or
pension trust
6.
Legal entity
4
4. Other payments. You must give your
correct TIN, but you do not have to sign the
certification unless you have been notified that
you have previously given an incorrect TIN.
“Other payments” include payments made in the
course of the requester’s trade or business for
rents, royalties, goods (other than bills for
merchandise), medical and health care services
(including payments to corporations), payments
to a nonemployee for services, payments to
certain fishing boat crew members and
fishermen, and gross proceeds paid to attorneys
(including payments to corporations).
The corporationCorporate
7.
The organizationAssociation, club,
religious, charitable,
educational, or other
tax-exempt
organization
8.
5. Mortgage interest paid by you,
acquisition or abandonment of secured
property, cancellation of debt, qualified state
tuition program payments, IRA or MSA
contributions or distributions, and pension
distributions. You must give your correct TIN,
but you do not have to sign the certification.
The partnershipPartnership
9.
The broker or nomineeA broker or registered
nominee
10.
The public entityAccount 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
11.
Privacy Act Notice
1
List first and circle the name of the person whose
number you furnish. If only one person on a joint
account has an SSN, that person’s number must be
furnished.
2
Circle the minor’s name and furnish the minor’s SSN.
3
You must show your individual name, but you may also
enter your business or “DBA” name. You may use either
your SSN or EIN (if you have one).
4
List first and circle the name of the legal trust, estate,
or pension trust. (Do not furnish the TIN 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 more than one
name is listed, the number will be considered to
be that of the first name listed.
Sole proprietor. Enter your individual name
as shown on your social security card on the
“Name” line. You may enter your business,
trade, or “doing business as (DBA)” name on the
“Business name” line.
Sole proprietorship The owner
3
12.
Note: Writing “Applied For” means that you have
already applied for a TIN or that you intend to
apply for one soon.
Part I—Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box.
Part II—For U.S. Payees Exempt From Backup
Withholding
Individuals (including sole proprietors) are not
exempt from backup withholding. Corporations
are exempt from backup withholding for certain
payments, such as interest and dividends. For
more information on exempt payees, see the
separate Instructions for the Requester of
Form W-9.
Part III—Certification
For a joint account, only the person whose
TIN is shown in Part I should sign (when
required).
If you are exempt from backup withholding,
you should still complete this form to avoid
possible erroneous backup withholding. Enter
your correct TIN in Part I, write “Exempt” in
Part II, and sign and date the form.
If you are a nonresident alien or a foreign
entity not subject to backup withholding, give
the requester the appropriate completed Form
W-8.
Other entities. Enter your business name as
shown on required Federal tax documents on
the “Name” line. This name should match the
name shown on the charter or other legal
document creating the entity. You may enter any
business, trade, or DBA name on the “Business
name” line.
How to get a TIN. If you do not have a TIN,
apply for one immediately. To apply for an SSN,
get Form SS-5, Application for a Social Security
Card, from your local Social Security
Administration office. Get Form W-7, Application
for IRS Individual Taxpayer Identification
Number, to apply for an ITIN or Form SS-4,
Application for Employer Identification Number,
to apply for an EIN. You can get Forms W-7 and
SS-4 from the IRS by calling 1-800-TAX-FORM
(1-800-829-3676) or from the IRS’s Internet Web
Site at www.irs.gov.
If you do not have a TIN, write “Applied For”
in the space for the TIN, sign and date the form,
and give it to the requester. For 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
If the account is in joint names, list first and
then circle the name of the person or entity
whose number you enter in Part I of the form.
If you are a sole proprietor and you have an
EIN, you may enter either your SSN or EIN.
However, the IRS prefers that you use your SSN.
You must provide your TIN whether or not you
are required to file a tax return. Payers must
generally withhold 31% 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.
If you are a resident alien and you do not
have and are not eligible to get an SSN, your
TIN is your IRS individual taxpayer identification
number (ITIN). Enter it in the social security
number box. If you do not have an ITIN, see
How to get a TIN below.
If you are an LLC that is disregarded as an
entity separate from its owner (see Limited
liability company (LLC) above), and are owned
by an individual, enter your SSN (or “pre-LLC”
EIN, if desired). If the owner of a disregarded
LLC is a corporation, partnership, etc., enter the
owner’s EIN.
Limited liability company (LLC). If you are a
single-member LLC (including a foreign LLC with
a domestic owner) that is disregarded as an
entity separate from its owner under Treasury
regulations section 301.7701-3, enter the
owner’s name on the “Name” line. Enter the
LLC’s name on the “Business name” line.
Caution: A disregarded domestic entity that has
a foreign owner must use the appropriate
Form W-8.
To establish to the withholding agent that you
are a U.S. person, or resident alien, sign Form
W-9. You may be requested to sign by the
withholding agent even if items 1, 3, and 5
below indicate otherwise.
Section 6109 of the Internal Revenue Code
requires you to give your correct TIN to persons
who must file information returns with the IRS to
Note: See the chart on this page for further
clarification of name and TIN combinations.
Specific Instructions
Name. If you are an individual, you must
generally enter the name shown on your social
security card. 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 your new last name.
such payments until you provide your TIN to the
requester.
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 MSA. 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.
