Substitute W-9
Request for Taxpayer Identification Number (TIN)
And Certification
PART I – PERSONAL or BUSINESS INFORMATION
1-NAME OF INDIVIDUAL, business name, or sole proprietor’s name (as registered with the IRS-Internal Revenue Service)
2-BUSINESS NAME (DBA-doing business as), if different from above.
3-CHECK ONE BOX to identify the type of business named above.
Individual/Sole Proprietor Partnership Corporation Non-Profit 501(c) Associations/Estate or Trust
Government Entity (Exempt under section 501(a)) Medical or Legal Corporation Foreign Entity(fill out appropriate W-form)
LLC-Limited Liability Company (If business listed on line 2 is an LLC, must also select an LLC type from below)
Disregarded entity Partnership Corporation
Individual/Sole Proprietor (enter owner/individual’s name on line 1 above, business/DBA name on line 2)
4-WITHOLDING (Optional) Already subject to backup withholding Exempt from backup withholding
5-PROTECTED STATUS – Florida Statute 119.071(4)(d)
Are you a member of law enforcement (active or former), a firefighter, judge or any other protected status as defined by Florida
Statute 119.071(4)(d)? Yes No
6-MAILING ADDRESS – Street (include apt # or suite number)
Street Address City State ZIP
___________________________________________ __________________________________________
(Area Code) Phone Number (Area Code) Fax Number
E-mail Address
7-REMIT ADDRESS - Street (include apt # or suite number) Same as mailing address? YES
Street Address City State ZIP
PART II – TAXPAYER IDENTIFICATION NUMBER (TIN)
Enter your TIN in the Appropriate box. The TIN provided must match the name given on the Line 1 to avoid backup withholding. For
Individuals, this is your social security number (SSN). For other entities, it is your employee identification number (EIN).
PART III -- CERTIFICATION
Under penalties of perjury, I certify that:
The number shown on this form is my correct TIN (tax payer identification number) or I am waiting for a number to be issued to me, and
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
I am a U.S. citizen or other U.S. person (see definition below).
The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding
Florida Statute 119.07 (5) and the Federal Privacy Act of 1974; Collection of Social Security Numbers
The City of Tampa collects your social security number for the purposes of tax reporting to the Department of the Treasury, Internal Revenue Service (IRS)
and for identity verification purposes. Florida Statute 119.07 (5) and the Federal Privacy Act of 1974 require the City to notify you in writing of the reason for
collecting this information which will be used for no other purpose than herein stated.
GENERAL INSTRUCTIONS (section references are to the Internal Revenue Code unless otherwise noted).
Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,
• An estate (other than a foreign estate), or
•
A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any
foreign partners’ share of the income from such business. Further, in certain cases where a form W-9 has not been received, a partnership is required to
presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade
or business in the United States, provide Form W-
9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income.
