Fillable Part I: Vendor Information THE CITY OF NEW (City of New York)

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Part I: Vendor Information THE CITY OF NEW (City of New York)

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U.S.A. forms for City of New York

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DO NOT SUBMIT TO THE IRS -
SUBMIT FORM TO THE
NEW YORK CITY AGENCY
10/14 REVISION
THE 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, IRS Letter CP575,
IRS Letter 147C -or- Social Security Administration Records, Social Security Card)
TYPE OR PRINT INFORMATION NEATLY. PLEASE REFER TO INSTRUCTIONS FOR MORE INFORMATION.
2. If you use DBA, please list below:
Part I: Vendor Information
Part II: Taxpayer Identification Number & Taxpayer Identification Type
Part III: Vendor Addresses
1. Enter your TIN here: (DO NOT USE DASHES)
2. Taxpayer Identification Type (check appropriate box):
1. 1099 Address:
3. Billing, Ordering & Payment Address:
Phone Number
Phone Number
Part V: Certification
Sign
Here:
SignatureSignature
Print Preparer's Name
DateDate
Contact's E-Mail Address:
Social Security Number (SSN) Individual Taxpayer ID Number (ITIN) N/A (Non-United States Business Entity)
Exemption Code for Backup Withholding
Exemption Code for FATCA Reporting
Part IV: Exemption from Backup Withholding and FATCA Reporting (See Instructions)
2. Account Administrator Address:
Number, Street, and Apartment or Suite Number City, State,and Nine Digit Zip Code or Country
Number, Street, and Apartment or Suite Number City, State,and Nine Digit Zip Code or Country
Number, Street, and Apartment or Suite Number City, State,and Nine Digit Zip Code or Country
Employer ID Number (EIN)
Estate
Trust
FOR SUBMITTING AGENCY USE ONLY
Submitting
A
g
enc
y
Code:
Contact's E-
Mail Address:
Payee/Vendor Code:
Telephone
Number:
( )
DO NOT FORWARD W-9 TO COMPTROLLER'S OFFICE. AGENCIES MUST ATTACH COMPLETED W-9 FORMS TO THEIR FMS DOCUMENTS.
Contact
Person:
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct Taxpayer Identification Number, 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 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 US citizen or other US person, and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
3. Entity Type (Check one only):
Church or Church-Controlled Organization
Personal Service Corporation
Partnership/
LLC
Single Member LLC
(Individual)
Resident/Non-
Resident Alien
Non-United States
Business Entit
y
Individual/
Sole Pro
p
rietor
Non-Profit
Corporation
Joint Venture
City of New York
Employee
Corporation/
LLC
Government
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Part I: Vendor Information THE CITY OF NEW (City of New York)

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Completed 10 February 2022

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