Fill - Free fillable SUBSTITUTEW9FORM REQUESTFORTAXPAYERIDENTIFICATIONNUMBERANDCERTIFICATION ,State,Zi Cit SelecttheApplicableAccountTypeBelow(PleaseselectONLYone) (Millsaps College) PDF form

SUBSTITUTEW9FORM

REQUESTFORTAXPAYERIDENTIFICATIONNUMBERANDCERTIFICATION

Name:_____

_______________________________________PhoneNumber:__________________________ 

DBAName:_______________________________________________________________________________

TaxFilingAddress:__________________________________________________________________________

Cit

,State,Zi

Code:

__________________

____________

__________________________________________

SelecttheApplicableAccountTypeBelow(PleaseselectONLYone)

1) Individual(notanactualbusiness)

2) SoleProprietororSingle‐MemberLLCwithnootheremployees(SSNbelow)

3) SoleProprietorwith1ormoreemployees(EINbelow)

4) CCorporation

5) SCorporation

6) Association,club,religious,charitable,educationalorothertaxexemptorganization

7) Partnership

8) Trust/estate

9) LimitedLiabilityCompany(LLC).

Enterthetaxclassification(C=CCorporation,S=SCorporation,P=Partnership):_______

Note:Checktheappropriateboxinthelineaboveforthetaxclassificationofthesingle‐memberowner.DonotcheckLLCiftheLLCis

classifiedasasingle0memberLLCthatisdisregardedfromtheownerunlesstheowneroftheLLCisanotherLLCthat isnotdisregardedfrom

theownerforUS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.

Ifyoucircled1–2above,fillinyourSocialSecurityNumber:

__________________‐____________‐________________________

Ifyoucircled3–9above,fillinyourEmployerI.D.Number:

____________‐__________________________________________

Exemption:

Exemptpayeecode(ifany)__________ExemptionfromFATCAreportingcode(ifany)__________

Certification:

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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;and

4. TheFATCAcode(s)enteredonthisform(ifany)indicatingthatIamexemptfromFATCAreportingiscorrect.

SignatureofU.S.person:__________________________________________Date:___________________

Revised 01/18

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SUBSTITUTEW9FORM REQUESTFORTAXPAYERIDENTIFICATIONNUMBERANDCERTIFICATION ,State,Zi Cit SelecttheApplicableAccountTypeBelow(PleaseselectONLYone) (Millsaps College)

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