Fillable Please Return Your SELECT WHAT IS CHANGING AND (City of New York)

Fill Online, Printable, Fillable, Blank Please Return Your SELECT WHAT IS CHANGING AND (City of New York) Form

Use Fill to complete blank online CITY OF NEW YORK pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Please Return Your SELECT WHAT IS CHANGING AND (City of New York)

On average this form takes 14 minutes to complete

The Please Return Your SELECT WHAT IS CHANGING AND (City of New York) form is 2 pages long and contains:

  • 0 signatures
  • 21 check-boxes
  • 48 other fields

Country of origin: US
File type: PDF

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

BROWSE CITY OF NEW YORK FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
SELECT WHAT IS CHANGING AND COMPLETE THIS FORM FOR ALL CHANGES
Mailing Address
Supply corresponding City of NY Substitute W9 Form
Managing Agent
Supply a copy of the Management Agreement
If address is also changing, supply a Substitute W9 Form. Include any C/O in desired address field of W9
If the IRS TIN/EIN is also changing, complete a Change of Ownership Request Package instead
1099 Address ONLY
Supply corresponding City of NY Substitute W9 Form
HPD ASSISTED ADDRESS (ES)
Street/Suite: _______________________________________________City: ________________________ State: _______________Zip :____________
Additional:
I WOULD LIKE ALL FUTURE CHECKS AND CORRESPONDENCE TO BE SENT TO:
Landlord Name__________________________________________________________________________________________________________________
Street/Suite: ________________________________________________ City: ________________________ State: ____________Zip______________
Contact Person (Print)_____________________________________________
Phone____________________________________________Email:________________________________________________________________________
REQUIRED FOR ALL ADDRESS CHANGES
Prior Address For: Landlord Managing Agent 1099 Mailing
Street/Suite: _______________________________________________City: ________________________ State: _______________Zip :____________
Owner Address or Agent Change Request Form
Please Return Your
Request Via:
Mail:
HPD Division of Tenant Resources
Owner Registration Unit
100 Gold Street, Room 1-0 New York,
NY 10038
Email:
S8landlords@hpd.nyc.gov
Fax: (212) 863-8526
Questions regarding this form:
Call the Owner Registration Unit
at (917)-286-4300
STATEMENT OF UNDERSTANDING (REQUIRED)
I understand that by supplying this information, my address and payment information will be updated with the NYC Department of
Housing Preservation & Development (HPD). I further understand that if I have payments issued through the NYC Department of
Finance (DOF) Electronic Funds Transfer (EFT) Program, commonly known as direct deposit, and wish to change the bank account
associated with those payments, I must contact DOF immediately to provide them with updated account information and request
deactivation of the old account. If I fail to notify DOF, I understand that DOF may continue to make rental subsidy payments into the
prior account and it will be my responsibility to reclaim such funds from the holder of that account.
Direct Deposit Contact: 212-857-1777
Signature________________________________________ Date pip@fisa-opa.nyc.gov
www.nyc.gov/hpd
Office of Neighborhood Strategies
Division of Tenant Resources
100 Gold Street New York, N.Y. 10038
DO NOT SUBMIT TO THE IRS -
SUBMIT FORM TO THE
NEW YORK CITY AGENCY
11/14 REVISION
THE CITY OF NEW YORK, HOUSING PRESERVATION & DEVELOPMENT AGENCY
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):
VENDOR CODE:
1. 1099 Address:
CANNOT BE P.O. BOX
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:
CANNOT BE P.O. BOX
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
PLEASE SUBMIT SUBSTITUTE W9 FORM TO:
NEW YORK CITY DEPARTMENT OF HOUSING PRESERVATION & DEVELOPMENT AGENCY, 100 GOLD STREET, NEW YORK, NY 10038
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.
Corporation/
LLC
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
rietor
Non-Profit
Corporation
Joint Venture
City of New York
Employee
Church or Church-Controlled Organization
Government
Number, Street, and Apartment or Suite Number
Number, Street, and Apartment or Suite Number City, State,and Nine Digit Zip Code or Country
The City of New York
Substitute Form W-9 Instructions
* Backup Withholding - According to IRS Regulations, ACS must withhold 28% of all payments if a vendor or payee fails to provide ACS its certified TIN.
The Substitute Form W-9 certifies a vendor/payee's TIN.
Page 1 of 2 10/14 Revision
The New York City Housing Preservation and Development Agency, like all organizations that file an information return
with the IRS, must obtain your correct Taxpayer Identification Number (TIN) to report income paid to you or your
organization. The NYC Housing Preservation and Development Agency uses Substitute Form W-9 to obtain certification
of your TIN in order to ensure accuracy of information contained in its payee/vendor database and to avoid Backup
Withholding as mandated by the IRS.* We ask for the information on the Substitute Form W-9 to carry out the Internal
Revenue laws of the United States (Rev. Proc. 84-65 §11.01). You are required to give us the information.
Any vendor or other payee who wishes to do business with the NYC Housing Preservation and Development Agency
must complete the Substitute Form W-9.
Part I: Vendor Information
1. Legal Business Name: An organization should enter the name in IRS records, IRS Letter CP575 or IRS Letter 147C.
For individuals, enter the name of the person who will do business with the City of New York as it appears on the Social
Security card, or other required Federal tax documents. Do not abbreviate names.
2. DBA (Doing Business As): Enter your DBA in designated line, if applicable.
3. Entity Type: Mark the Entity Type of the individual or organization that will do business with the City of New York.
Part II: Taxpayer Identification Number and Taxpayer Identification Type
1. Taxpayer Identification Number: Enter your nine-digit TIN. See the table and Special Note below for instructions on
the type of taxpayer number you should report.
2. Taxpayer Identification Type: Mark the appropriate option.
The following table gives the Taxpayer Identification Type that is appropriate for each Entity Type.
Entity Type Taxpayer Identification Type
Church or Church-Controlled Organization
Personal Service Corporation
Non-Profit Corporation
Corporation / LLC
Government
Individual/Sole Proprietor who has employees other than him or herself
Trust
Joint Venture
Partnership / LLC
Single Member LLC who has employees other than him or herself
Estate
Employer Identification Number
City of New York Employee
Individual/Sole Proprietor who does not have employees other than him or herself
Single Member LLC who does not have employees other than him or herself
Social Security Number
Resident Alien/Non-Resident
Individual Tax Identification Number
Non-United States Business Entity
N/A
Custodian account of a minor
The minor's Social Security Number
Part III: Vendor Addresses
1. List the locations for tax reporting purposes, administrative and where payments should be delivered.
Part IV: Backup Withholding and FATCA Exemptions
If you are exempt from Backup Withholding and/or FATCA reporting, enter in the Exemptions box, any code(s) that may
apply to you.
B
ackup Withholding Exemption Codes: Generally, Individuals (including Sole Proprietors) are not exempt from
Backup Withholding. Additionally, Corporations are not exempt from Backup Withholding when supplying legal or
medical services. If you do not fall under the categories below, leave this field blank.
T
he following codes identify payees that are exempt from Backup Withholding:
The City of New York
Substitute Form W-9 Instructions
* Backup Withholding - According to IRS Regulations, ACS must withhold 28% of all payments if a vendor or payee fails to provide ACS its certified TIN.
The Substitute Form W-9 certifies a vendor/payee's TIN.
Page 2 of 2 10/14 Revision
1: An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the
account satisfies the requirements of section 401(f)(2)
2: The United States or any of its agencies or instrumentalities
3: A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or
Instrumentalities
4: A foreign government or any of its political subdivisions, agencies, or instrumentalities
5: A corporation
6: A dealer in securities or commodities required to register in the United States, the District of Columbia, or a
possession of the United States
7: A futures commission merchant registered with the Commodity Futures Trading Commission
8: A real estate investment trust
9: An entity registered at all times during the tax year under the Investment Company Act of 1940
10: A common trust fund operated by a bank under section 584(a)
11: A financial institution
12: A middleman known in the investment community as a nominee or custodian
13: A trust exempt from tax under section 664 or described in section 4947
FATCA Exemption Codes: The following codes identify payees that are exempt from reporting under FATCA. These
codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign
financial institutions. If you are only submitting this form for an account you hold in the United States, leave this
field blank.
The following codes identify payees that are exempt from FATCA Reporting:
A: An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section
7701(a)(37)
B: The United States or any of its agencies or instrumentalities
C: A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or
instrumentalities
D: A corporation the stock of which is regularly traded on one or more established securities markets, as described in
Reg. section 1.1472-1(c)(1)(i)
E: A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section
1.1472-1(c)(1)(i)
F: A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures,
forwards, and options) that is registered as such under the laws of the United States or any state
G: A real estate investment trust
H: A regulated investment company as defined in section 851 or an entity registered at all times during the tax year
under the Investment Company Act of 1940
I: A common trust fund as defined in section 584(a)
J: A bank as defined in section 581
K: A broker
L: A trust exempt from tax under section 664 or described in section 4947(a)(1)
M: A tax exempt trust under a section 403(b) plan or section 457(g) plan
Part V: Certification
Please sign and date form in appropriate space. Provide preparer's name, telephone number, and e-mail address.
Preparer should be employed by organization.
Please Note:
Effective March 15 2019, the NYC Department of Finance (DOF) will no longer process Electronic Funds Transfer
(EFT) enrollment paper applications. Landlords should enroll for EFT or make changes to their existing bank account
information through the Payee Information Portal (PIP): www.nyc.gov/pip.
Should you have any questions, please contact the FISA Help Center at 212.857.1777 or pip@fisa-opa.nyc.gov for
assistance.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Please Return Your SELECT WHAT IS CHANGING AND (City of New York)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 15 December 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document