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Submitted URL: https://securew9form.pinnacleadvertising.com/
Effective URL: https://form.jotform.com/242705626846059
Submission: On November 05 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://form.jotform.com/242705626846059
Submission: On November 05 via automatic, source certstream-suspicious — Scanned from DE
Form analysis 1 forms found in the DOM
Name: form_242705626846059 — POST https://submit.jotform.com/submit/242705626846059
<form class="jotform-form" onsubmit="return typeof testSubmitFunction !== 'undefined' && testSubmitFunction();" action="https://submit.jotform.com/submit/242705626846059" method="post" name="form_242705626846059" id="242705626846059"
accept-charset="utf-8" autocomplete="off" novalidate="true"><input type="hidden" name="formID" value="242705626846059"><input type="hidden" id="JWTContainer" value=""><input type="hidden" id="cardinalOrderNumber" value=""><input type="hidden"
id="jsExecutionTracker" name="jsExecutionTracker" value="build-date-1730822670877=>init-started:1730825368168=>validator-called:1730825368221=>validator-mounted-false:1730825368222=>init-complete:1730825368225"><input type="hidden"
id="submitSource" name="submitSource" value="mounted"><input type="hidden" id="buildDate" name="buildDate" value="1730822670877"><input type="hidden" name="uploadServerUrl" value="https://upload.jotform.com/upload">
<div id="formCoverLogo" style="margin-bottom:32px" class="form-cover-wrapper form-has-cover form-page-cover-image-align-center">
<div class="form-page-cover-image-wrapper" style="max-width:752px"><img src="https://www.jotform.com/uploads/PinnacleSupport/form_files/LOGO_CITIES.66f5c5d0d2bc67.98063895.png" class="form-page-cover-image" width="690" height="43"
aria-label="Form Logo" style="aspect-ratio:690/43"></div>
</div>
<div role="main" class="form-all">
<ul class="form-section page-section">
<li id="cid_1" class="form-input-wide" data-type="control_head" data-css-selector="id_1">
<div class="form-header-group header-large">
<div class="header-text httal htvam">
<h1 id="header_1" class="form-header" data-component="header">Request for Taxpayer Identification Number and Certification</h1>
</div>
</div>
</li>
<li class="form-line jf-required" data-type="control_textbox" id="id_3" data-css-selector="id_3"><label class="form-label form-label-top form-label-auto" id="label_3" for="input_3" aria-hidden="false"> 1. Name of entity/individual. An entry is
required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded entity's name on line 2.<span class="form-required">*</span> </label>
<div id="cid_3" class="form-input-wide jf-required" data-layout="half"> <input type="text" id="input_3" name="q3_2Business" data-type="input-textbox" class="form-textbox validate[required]" data-defaultvalue="" autocomplete="nope"
style="width:20px" size="20" data-component="textbox" aria-labelledby="label_3" required="" value=""> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_4" data-css-selector="id_4"><label class="form-label form-label-top form-label-auto" id="label_4" for="input_4" aria-hidden="false"> 2. Business name/disregarded entity name, if different
from above. </label>
<div id="cid_4" class="form-input-wide" data-layout="half"> <input type="text" id="input_4" name="q4_2Business4" data-type="input-textbox" class="form-textbox" data-defaultvalue="" autocomplete="nope" style="width:20px" size="20"
data-component="textbox" aria-labelledby="label_4" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_checkbox" id="id_6" data-css-selector="id_6"><label class="form-label form-label-top form-label-auto" id="label_6" aria-hidden="false"> 3a. Check the appropriate box for federal tax
classification of the entity/individual whose name is entered on line 1. Checkonly one of the following seven boxes.<span class="form-required">*</span> </label>
<div id="cid_6" class="form-input-wide jf-required" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_6" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox"
class="form-checkbox validate[required]" id="input_6_0" name="q6_3aCheck[]" required="" value="Individual/sole proprietor"><label id="label_input_6_0" for="input_6_0">Individual/sole proprietor</label></span><span
class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox" class="form-checkbox validate[required]" id="input_6_1" name="q6_3aCheck[]" required=""
value="C corporation"><label id="label_input_6_1" for="input_6_1">C corporation</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox"
class="form-checkbox validate[required]" id="input_6_2" name="q6_3aCheck[]" required="" value="S corporation"><label id="label_input_6_2" for="input_6_2">S corporation</label></span><span class="form-checkbox-item"
style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox" class="form-checkbox validate[required]" id="input_6_3" name="q6_3aCheck[]" required="" value="Partnership"><label
id="label_input_6_3" for="input_6_3">Partnership</label></span><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox"
class="form-checkbox validate[required]" id="input_6_4" name="q6_3aCheck[]" required="" value="Trust/estate"><label id="label_input_6_4" for="input_6_4">Trust/estate</label></span><span class="form-checkbox-item"
style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_6" type="checkbox" class="form-checkbox validate[required]" id="input_6_5" name="q6_3aCheck[]" required=""
value="LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership)"><label id="label_input_6_5" for="input_6_5">LLC. Enter the tax classification (C = C corporation, S = S corporation, P =
Partnership)</label></span><span class="form-checkbox-item formCheckboxOther" style="clear:left"><input type="checkbox" class="form-checkbox-other form-checkbox validate[required]" name="q6_3aCheck[other]" id="other_6" tabindex="0"
aria-label="Other" value="other"><label id="label_other_6" style="text-indent:0" for="other_6">Other</label><span id="other_6_input" class="other-input-container is-none" style=""><input type="text"
class="form-checkbox-other-input form-textbox" name="q6_3aCheck[other]" data-otherhint="Other" size="15" id="input_6" data-placeholder="Please type another option here" placeholder="Please type another option here"></span></span>
</div>
</div>
</li>
<li class="form-line" data-type="control_dropdown" id="id_142" data-css-selector="id_142"><label class="form-label form-label-top form-label-auto" id="label_142" for="input_142" aria-hidden="false"> If LLC, then choose the Tax classification
code </label>
<div id="cid_142" class="form-input-wide" data-layout="half"> <select class="form-dropdown" id="input_142" name="q142_ifLlc" style="width:310px" data-component="dropdown" aria-label="If LLC, then choose the Tax classification code">
<option value="">Please Select</option>
<option value="C = C Corporation">C = C Corporation</option>
<option value="S = S Corporation">S = S Corporation</option>
<option value="P = Partnership">P = Partnership</option>
</select> </div>
</li>
<li class="form-line" data-type="control_checkbox" id="id_14" data-css-selector="id_14"><label class="form-label form-label-top form-label-auto" id="label_14" for="input_14_0" aria-hidden="false"> If on line 3a you checked “Partnership” or
“Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners,
or beneficiaries. See instructions . . . . . . . . . </label>
<div id="cid_14" class="form-input-wide" data-layout="full">
<div class="form-single-column" role="group" aria-labelledby="label_14" data-component="checkbox"><span class="form-checkbox-item" style="clear:left"><span class="dragger-item"></span><input aria-describedby="label_14" type="checkbox"
class="form-checkbox" id="input_14_0" name="q14_ifOn[]" value=""><label id="label_input_14_0" for="input_14_0"></label></span></div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_9" data-css-selector="id_9"><label class="form-label form-label-top form-label-auto" id="label_9" for="input_9" aria-hidden="false"> 4. Exempt payee code (if any) </label>
<div id="cid_9" class="form-input-wide" data-layout="half"> <input type="text" id="input_9" name="q9_4Exempt" data-type="input-textbox" class="form-textbox" data-defaultvalue="" autocomplete="nope" style="width:20px" size="20"
data-component="textbox" aria-labelledby="label_9" value=""> </div>
</li>
<li class="form-line" data-type="control_textbox" id="id_12" data-css-selector="id_12"><label class="form-label form-label-top form-label-auto" id="label_12" for="input_12" aria-hidden="false"> Exemption from Foreign Account Tax Compliance Act
(FATCA) reporting code (if any) </label>
<div id="cid_12" class="form-input-wide" data-layout="half"> <input type="text" id="input_12" name="q12_exemptionFrom" data-type="input-textbox" class="form-textbox" data-defaultvalue="" autocomplete="nope" style="width:20px" size="20"
data-component="textbox" aria-labelledby="label_12" value=""> </div>
</li>
<li class="form-line jf-required" data-type="control_address" id="id_84" data-compound-hint=",,,,Please Select,,Please Select," data-css-selector="id_84"><label class="form-label form-label-top form-label-auto" id="label_84"
for="input_84_addr_line1" aria-hidden="false"> Address<span class="form-required">*</span> </label>
<div id="cid_84" class="form-input-wide jf-required" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_84_addr_line1" name="q84_address84[addr_line1]" class="form-textbox validate[required] form-address-line" data-defaultvalue="" autocomplete="nope" data-component="address_line_1"
aria-labelledby="label_84 sublabel_84_addr_line1" required="" value="" maxlength="100"><label class="form-sub-label" for="input_84_addr_line1" id="sublabel_84_addr_line1" style="min-height:13px">Street
Address</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_84_addr_line2" name="q84_address84[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="nope" data-component="address_line_2"
aria-labelledby="label_84 sublabel_84_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_84_addr_line2" id="sublabel_84_addr_line2" style="min-height:13px">Street Address Line 2</label></span></span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_84_city" name="q84_address84[city]" class="form-textbox validate[required] form-address-city" data-defaultvalue="" autocomplete="nope" data-component="city" aria-labelledby="label_84 sublabel_84_city" required=""
value="" maxlength="60"><label class="form-sub-label" for="input_84_city" id="sublabel_84_city" style="min-height:13px">City</label></span></span><span
class="form-address-line form-address-state-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_84_state" name="q84_address84[state]"
class="form-textbox validate[required] form-address-state" data-defaultvalue="" autocomplete="nope" data-component="state" aria-labelledby="label_84 sublabel_84_state" required="" value="" maxlength="60"><label
class="form-sub-label" for="input_84_state" id="sublabel_84_state" style="min-height:13px">State / Province</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-zip-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_84_postal" name="q84_address84[postal]" class="form-textbox validate[required] form-address-postal" data-defaultvalue="" autocomplete="nope" data-component="zip" aria-labelledby="label_84 sublabel_84_postal" required=""
value="" maxlength="20"><label class="form-sub-label" for="input_84_postal" id="sublabel_84_postal" style="min-height:13px">Postal / Zip Code</label></span></span></div>
</div>
</div>
</li>
<li class="form-line" data-type="control_address" id="id_18" data-compound-hint=",,,,Please Select,,Please Select," data-css-selector="id_18"><label class="form-label form-label-top form-label-auto" id="label_18" for="input_18_addr_line1"
aria-hidden="false"> Requestor's Address </label>
<div id="cid_18" class="form-input-wide" data-layout="full">
<div summary="" class="form-address-table jsTest-addressField">
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_18_addr_line1" name="q18_requestorsAddress[addr_line1]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="nope" data-component="address_line_1" aria-labelledby="label_18 sublabel_18_addr_line1"
value="" maxlength="100"><label class="form-sub-label" for="input_18_addr_line1" id="sublabel_18_addr_line1" style="min-height:13px">Requester’s name and address (optional)</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-street-line jsTest-address-lineField"><span class="form-sub-label-container"
style="vertical-align:top"><input type="text" id="input_18_addr_line2" name="q18_requestorsAddress[addr_line2]" class="form-textbox form-address-line" data-defaultvalue="" autocomplete="nope" data-component="address_line_2"
aria-labelledby="label_18 sublabel_18_addr_line2" value="" maxlength="100"><label class="form-sub-label" for="input_18_addr_line2" id="sublabel_18_addr_line2" style="min-height:13px">Street Address Line 2</label></span></span>
</div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField"><span class="form-address-line form-address-city-line jsTest-address-lineField "><span class="form-sub-label-container" style="vertical-align:top"><input type="text"
id="input_18_city" name="q18_requestorsAddress[city]" class="form-textbox form-address-city" data-defaultvalue="" autocomplete="nope" data-component="city" aria-labelledby="label_18 sublabel_18_city" value="" maxlength="60"><label
class="form-sub-label" for="input_18_city" id="sublabel_18_city" style="min-height:13px">City, state, and ZIP code</label></span></span><span
class="form-address-line form-address-state-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_18_state"
name="q18_requestorsAddress[state]" class="form-textbox form-address-state" data-defaultvalue="" autocomplete="nope" data-component="state" aria-labelledby="label_18 sublabel_18_state" value="" maxlength="60"><label
class="form-sub-label" for="input_18_state" id="sublabel_18_state" style="min-height:13px">State / Province</label></span></span></div>
<div class="form-address-line-wrapper jsTest-address-line-wrapperField" style="display:none"><span class="form-address-line form-address-zip-line jsTest-address-lineField form-address-hiddenLine" style="display:none"><span
class="form-sub-label-container" style="vertical-align:top"><input type="text" id="input_18_postal" name="q18_requestorsAddress[postal]" class="form-textbox form-address-postal" data-defaultvalue="" autocomplete="nope"
data-component="zip" aria-labelledby="label_18 sublabel_18_postal" value="" maxlength="20"><label class="form-sub-label" for="input_18_postal" id="sublabel_18_postal" style="min-height:13px">Postal / Zip Code</label></span></span>
</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_textbox" id="id_19" data-css-selector="id_19"><label class="form-label form-label-top form-label-auto" id="label_19" for="input_19" aria-hidden="false"> List account number(s) here (optional) </label>
<div id="cid_19" class="form-input-wide" data-layout="half"> <input type="text" id="input_19" name="q19_listAccount" data-type="input-textbox" class="form-textbox" data-defaultvalue="" autocomplete="nope" style="width:20px" size="20"
data-component="textbox" aria-labelledby="label_19" value=""> </div>
</li>
<li id="cid_20" class="form-input-wide" data-type="control_head" data-css-selector="id_20">
<div class="form-header-group header-small">
<div class="header-text httal htvam">
<h3 id="header_20" class="form-header" data-component="header">Part I</h3>
<div id="subHeader_20" class="form-subHeader">Taxpayer Identification Number (TIN)</div>
</div>
</div>
</li>
<li class="form-line" data-type="control_text" id="id_22" data-css-selector="id_22">
<div id="cid_22" class="form-input-wide" data-layout="full">
<div id="text_22" class="form-html" data-component="text" tabindex="0">
<p><span style="color: #000000;">Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid </span> <span style="color: #000000;">backup withholding. For individuals, this is generally your social
security number (SSN</span><span style="color: #000000;"> However, for a </span> <span style="color: #000000;">resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other </span> <span
style="color: #000000;">entities, it is your employer identification number (EIN</span><span style="color: #000000;"> If you do not have a number, see </span><span style="color: #000000;">How to get a </span> <span
style="color: #000000;">TIN</span><span style="color: #000000;">, later.</span></p>
</div>
</div>
</li>
<li id="cid_119" class="form-input-wide" data-type="control_head" data-css-selector="id_119">
<div class="form-header-group header-small">
<div class="header-text httal htvam">
<h3 id="header_119" class="form-header" data-component="header">Social Security Number</h3>
</div>
</div>
</li>
<li class="form-line fixed-width form-line-column form-col-1" data-type="control_number" id="id_89" data-css-selector="id_89"><label class="form-label form-label-top" id="label_89" for="input_89" aria-hidden="true"> </label>
<div id="cid_89" class="form-input-wide" data-layout="half"> <input type="number" id="input_89" name="q89_number" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope" style="width:32px"
size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_89" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-2" data-type="control_number" id="id_90" data-css-selector="id_90"><label class="form-label form-label-top" id="label_90" for="input_90" aria-hidden="true"> </label>
<div id="cid_90" class="form-input-wide" data-layout="half"> <input type="number" id="input_90" name="q90_input90" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope" style="width:32px"
size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_90" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-3" data-type="control_number" id="id_98" data-css-selector="id_98"><label class="form-label form-label-top" id="label_98" for="input_98" aria-hidden="true"> </label>
<div id="cid_98" class="form-input-wide" data-layout="half"> <input type="number" id="input_98" name="q98_input98" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope" style="width:32px"
size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_98" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-4" data-type="control_number" id="id_99" data-css-selector="id_99"><label class="form-label form-label-top" id="label_99" for="input_99" aria-hidden="true"> </label>
<div id="cid_99" class="form-input-wide" data-layout="half"> <input type="number" id="input_99" name="q99_input99" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope" style="width:32px"
size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_99" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-5" data-type="control_number" id="id_100" data-css-selector="id_100"><label class="form-label form-label-top" id="label_100" for="input_100" aria-hidden="true"> </label>
<div id="cid_100" class="form-input-wide" data-layout="half"> <input type="number" id="input_100" name="q100_input100" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope"
style="width:32px" size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_100" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-6" data-type="control_number" id="id_101" data-css-selector="id_101"><label class="form-label form-label-top" id="label_101" for="input_101" aria-hidden="true"> </label>
<div id="cid_101" class="form-input-wide" data-layout="half"> <input type="number" id="input_101" name="q101_input101" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope"
style="width:32px" size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_101" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-7" data-type="control_number" id="id_102" data-css-selector="id_102"><label class="form-label form-label-top" id="label_102" for="input_102" aria-hidden="true"> </label>
<div id="cid_102" class="form-input-wide" data-layout="half"> <input type="number" id="input_102" name="q102_input102" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope"
style="width:32px" size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_102" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-8" data-type="control_number" id="id_103" data-css-selector="id_103"><label class="form-label form-label-top" id="label_103" for="input_103" aria-hidden="true"> </label>
<div id="cid_103" class="form-input-wide" data-layout="half"> <input type="number" id="input_103" name="q103_input103" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope"
style="width:32px" size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_103" step="any" value=""> </div>
</li>
<li class="form-line fixed-width form-line-column form-col-9" data-type="control_number" id="id_104" data-css-selector="id_104"><label class="form-label form-label-top" id="label_104" for="input_104" aria-hidden="true"> </label>
<div id="cid_104" class="form-input-wide" data-layout="half"> <input type="number" id="input_104" name="q104_input104" data-type="input-number" class=" form-number-input form-textbox" data-defaultvalue="" autocomplete="nope"
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<li id="cid_120" class="form-input-wide" data-type="control_head" data-css-selector="id_120">
<div class="form-header-group header-small">
<div class="header-text httal htvam">
<h3 id="header_120" class="form-header" data-component="header">Employer identification number</h3>
</div>
</div>
</li>
<li class="form-line fixed-width form-line-column form-col-10" data-type="control_number" id="id_130" data-css-selector="id_130"><label class="form-label form-label-top" id="label_130" for="input_130" aria-hidden="true"> </label>
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style="width:32px" size="32" data-numbermin="0" data-numbermax="9" data-component="number" aria-labelledby="label_130" step="any" value=""> </div>
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<li class="form-line fixed-width form-line-column form-col-11" data-type="control_number" id="id_131" data-css-selector="id_131"><label class="form-label form-label-top" id="label_131" for="input_131" aria-hidden="true"> </label>
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<h3 id="header_29" class="form-header" data-component="header">Part II</h3>
<div id="subHeader_29" class="form-subHeader">Certification</div>
</div>
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<p><span style="color: #000000;">Under penalties of perjury, I certify that:</span> <span style="color: #000000;">1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to
me); and</span> <span style="color: #000000;">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 </span> <span
style="color: #000000;">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 </span> <span style="color: #000000;">no longer
subject to backup withholding; and</span> <span style="color: #000000;">3. I am a U.S. citizen or other U.S. person (defined below); and</span> <span style="color: #000000;">4. The FATCA code(s) entered on this form (if any)
indicating that I am exempt from FATCA reporting is correct.</span> <span style="font-weight: bold;color: #000000;">Certification instructions. </span><span style="color: #000000;">You must cross out item 2 above if you have been
notified by the IRS that you are currently subject to backup</span><span style="font-weight: bold;color: #000000;"> </span><span style="color: #000000;">withholding </span> <span style="color: #000000;">because you have failed to
report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.</span><span style="font-weight: bold;color: #000000;"> </span><span style="color: #000000;">For mortgage interest paid, </span>
<span style="color: #000000;">acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement</span><span style="font-weight: bold;color: #000000;"> </span><span
style="color: #000000;">arrangement (IRA), and, generally, payments </span> <span style="color: #000000;">other than interest and dividends, you are not required to sign the certification, but you must</span><span
style="font-weight: bold;color: #000000;"> </span><span style="color: #000000;">provide your correct TIN. See the instructions for Part II, later.</span></p>
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</form>Text Content
* REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION * 1. Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded entity's name on line 2.* * 2. Business name/disregarded entity name, if different from above. * 3a. Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Checkonly one of the following seven boxes.* Individual/sole proprietorC corporationS corporationPartnershipTrust/estateLLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership)Other * If LLC, then choose the Tax classification code Please Select C = C Corporation S = S Corporation P = Partnership * If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries. See instructions . . . . . . . . . * 4. Exempt payee code (if any) * Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any) * Address* Street Address Street Address Line 2 CityState / Province Postal / Zip Code * Requestor's Address Requester’s name and address (optional) Street Address Line 2 City, state, and ZIP codeState / Province Postal / Zip Code * List account number(s) here (optional) * PART I Taxpayer Identification Number (TIN) * Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN If you do not have a number, see How to get a TIN, later. * SOCIAL SECURITY NUMBER * * * * * * * * * * EMPLOYER IDENTIFICATION NUMBER * * * * * * * * * * PART II Certification * Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); 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 (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and, generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. * Signature* Clear * * Date* -Month -DayYear Date * * Please verify that you are human* * UPON SUBMITTING THE FORM, YOU WILL BE ABLE TO DOWNLOAD THE COMPLETED FORM. * Preview PDF Submit * Should be Empty: November‹› 2024«» November 2024TodaySMTWTFS27282930311234567891011121314151617181920212223242526272829301234567891011121314 Zurück zum Formular W-9 Request for Taxpayer Identification Number and Certification W-9 Request for Taxpayer Identification Number and Certification Start Filling