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GOLDE WELLNESS, INC.
ONLINE
W-9 REQUEST
POWERED BY
THANK YOU - W-9 COMPLETE
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if you have a newer email. If not, ask your Company to send the W-9 request
again. Their information is in your email.
Best,
The Track1099 Team
WELCOME BACK, FIRST INSURANCE
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WELCOME, FIRST INSURANCE
1. 1 Please complete your W-9 for Golde Wellness, Inc.
2. 2 We will send your W-9 to Golde Wellness, Inc. and download a PDF to your
computer.
3. 3 Please contact bryan@fullstackfinance.com or peruse Track1099 by Avalara
for more information.
4. 4 Scroll down for detailed W-9 instructions.
SECURITY CENTER
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to manage their W-9s.
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We are committed to being best in class.
IRS FORM W-9
Name (as shown on your income tax return) (required field)
Business name/disregarded entity name, if different from above
Select one appropriate box for federal tax classification of the person whose
name is entered on line 1.
Choose...Individual/sole proprietor or single member LLCC CorporationS
CorporationPartnershipTrust/estateLimited liability company (C
Corporation)Limited liability company (S Corporation)Limited liability company
(Partnership)Other...
Note: Select 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
single-member LLC that is disregarded from the owner unless the owner of the LLC
is another LLC that is not disregarded from the owner for U.S. 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.
Exemptions (codes apply only to certain entities, not individuals. See instr.):
Exempt payee code (if any)
Exemption from FATCA reporting code (if any)
(Applies to accounts maintained outside US)
Check for foreign address
Address
City
State
Choose...AA - Armed Forces AmericasAE - Armed Forces EuropeAK - AlaskaAL -
AlabamaAP - Armed Forces PacificAR - ArkansasAS - American SamoaAZ - ArizonaCA -
CaliforniaCO - ColoradoCT - ConnecticutDC - District of ColumbiaDE - DelawareFL
- FloridaFM - Federated MicronesiaGA - GeorgiaGU - GuamHI - HawaiiIA - IowaID -
IdahoIL - IllinoisIN - IndianaKS - KansasKY - KentuckyLA - LouisianaMA -
MassachusettsMD - MarylandME - MaineMH - Marshall IslandsMI - MichiganMN -
MinnesotaMO - MissouriMP - N. Mariana IslandsMS - MississippiMT - MontanaNC -
North CarolinaND - North DakotaNE - NebraskaNH - New HampshireNJ - New JerseyNM
- New MexicoNV - NevadaNY - New YorkOH - OhioOK - OklahomaOR - OregonPA -
PennsylvaniaPR - Puerto RicoPW - PalauRI - Rhode IslandSC - South CarolinaSD -
South DakotaTN - TennesseeTX - TexasUT - UtahVA - VirginiaVI - US Virgin
IslandsVT - VermontWA - WashingtonWI - WisconsinWV - West VirginiaWY - Wyoming
Zip code
Email
List Account number(s) here (optional)
PART I. TAXPAYER IDENTIFICATION NUMBER (TIN)
Fill in either the SSN or the EIN
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.
Note. If the account is in more than one name, see the instructions for line 1.
Also see What Name and Number To Give the Requester for guidelines on whose
number to enter.
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.
I am not subject to backup withholding.
Signature of US Person (use mouse or fingertip)
Clear
Continue
--------------------------------------------------------------------------------
W-9 INSTRUCTIONS
GENERAL INSTRUCTIONS
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. For the latest information about developments related to
Form W-9 and its instructions, such as legislation enacted after they were
published, go to www.irs.gov/FormW9.
PURPOSE OF FORM
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer identification
number (TIN) which may be your social security number (SSN), individual taxpayer
identification number (ITIN), adoption taxpayer identification number (ATIN), or
employer identification number (EIN), to report on an information return the
amount paid to you, or other amount reportable on an information return.
Examples of information returns include, but are not limited to, the following:
* Form 1099-INT (interest earned or paid)
* Form 1099-DIV (dividends, including those from stocks or mutual funds)
* Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
* Form 1099-B (stock or mutual fund sales and certain other transactions by
brokers)
* Form 1099-S (proceeds from real estate transactions)
* Form 1099-K (merchant card and third party network transactions)
* Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T
(tuition)
* Form 1099-S (proceeds from real estate transactions)
* Form 1099-C (canceled debt)
* Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person (including a resident alien), to
provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might be subject
to backup withholding. See What is backup withholding, later.
By signing the filled-out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
applicable, you are also certifying that as a U.S. person, your allocable
share of any partnership income from a U.S. trade or business is not subject
to the withholding tax on foreign partners' share of effectively connected
income, and
4. Certify that FATCA code(s) entered on this form (if any) indicating that you
are exempt from the FATCA reporting, is correct. See What is FATCA
reporting? later for further information.
Note. If you are a U.S. person and a requester gives you a form other than Form
W-9 to request your TIN, you must use the requester’s form if it is
substantially similar to this Form W-9.
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 under section
1446 on any foreign partners’ share of effectively connected taxable income from
such business. Further, in certain cases where a Form W-9 has not been received,
the rules under section 1446 require a partnership to presume that a partner is
a foreign person, and pay the section 1446 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 section 1446 withholding on your share of partnership
income.
In the cases below, the following person must give Form W-9 to the partnership
for purposes of establishing its U.S. status and avoiding withholding on its
allocable share of net income from the partnership conducting a trade or
business in the United States.
* In the case of a disregarded entity with a U.S. owner, the U.S. owner of the
disregarded entity and not the entity,
* In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and not
the trust, and
* In the case of a U.S. trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
Foreign person. If you are a foreign person or the U.S. branch of a foreign bank
that has elected to be treated as a U.S. person, do not use Form W-9. Instead,
use the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of
Tax on Nonresident Aliens and Foreign Entities).
Nonresident alien who becomes a resident alien. Generally, only a nonresident
alien individual may use the terms of a tax treaty to reduce or eliminate U.S.
tax on certain types of income. However, most tax treaties contain a provision
known as a “saving clause.” Exceptions specified in the saving clause may permit
an exemption from tax to continue for certain types of income even after the
payee has otherwise become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception contained in the
saving clause of a tax treaty to claim an exemption from U.S. tax on certain
types of income, you must attach a statement to Form W-9 that specifies the
following five items:
1. The treaty country. Generally, this must be the same treaty under which you
claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the saving
clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
5. Sufficient facts to justify the exemption from tax under the terms of the
treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an exemption from
tax for scholarship income received by a Chinese student temporarily present in
the United States. Under U.S. law, this student will become a resident alien for
tax purposes if his or her stay in the United States exceeds 5 calendar years.
However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April
30, 1984) allows the provisions of Article 20 to continue to apply even after
the Chinese student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
protocol) and is relying on this exception to claim an exemption from tax on his
or her scholarship or fellowship income would attach to Form W-9 a statement
that includes the information described above to support that exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
BACKUP WITHHOLDING
What is backup withholding? Persons making certain payments to you must under
certain conditions withhold and pay to the IRS 24% of such payments. This is
called “backup withholding.” Payments that may be subject to backup withholding
include interest, tax-exempt interest, dividends, broker and barter exchange
transactions, rents, royalties, nonemployee pay, payments made in settlement of
payment card and third party network transactions, and certain payments from
fishing boat operators. Real estate transactions are not subject to backup
withholding.
You will not be subject to backup withholding on payments you receive if you
give the requester your correct TIN, make the proper certifications, and report
all your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester,
2. You do not certify your TIN when required (see the instructions for Part II
for details),
3. The IRS tells the requester that you furnished an incorrect TIN,
4. The IRS tells you that you are subject to backup withholding because you did
not report all your interest and dividends on your tax return (for
reportable interest and dividends only), or
5. You do not certify to the requester that you are not subject to backup
withholding under 4 above (for reportable interest and dividend accounts
opened after 1983 only).
Certain payees and payments are exempt from backup withholding. See Exempt payee
code, later and the separate Instructions for the Requester of Form W-9 for more
information.
Also see Special rules for partnerships, earlier.
WHAT IS FATCA REPORTING?
The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign
financial institution to report all United States account holders that are
specified United States persons. Certain payees are exempt from FATCA reporting.
See Exemption from FATCA reporting code, later, and the Instructions for the
Requester of Form W-9 for more information.
UPDATING YOUR INFORMATION
You must provide updated information to any person to whom you claimed to be an
exempt payee if you are no longer an exempt payee and anticipate receiving
reportable payments in the future from this person. For example, you may need to
provide updated information if you are a C corporation that elects to be an S
corporation, or if you no longer are tax exempt. In addition, you must furnish a
new Form W-9 if the name or TIN changes for the account, for example, if the
grantor of a grantor trust dies.
PENALTIES
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester,
you are subject to a penalty of $50 for each such failure unless your failure is
due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you make a
false statement with no reasonable basis that results in no backup withholding,
you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying certifications
or affirmations may subject you to criminal penalties including fines and/or
imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of federal
law, the requester may be subject to civil and criminal penalties.
SPECIFIC INSTRUCTIONS
LINE 1
You must enter one of the following on this line; do not leave this line blank.
The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account maintained by a
foreign financial institution (FFI)), list first, and then circle, the name of
the person or entity whose number you entered in Part I of Form W-9. If you are
providing Form W-9 to an FFI to document a joint account, each holder of the
account that is a U.S. person must provide a Form W-9.
Individual. Generally, enter the name shown on your tax return. If you have
changed your last name without informing the Social Security Administration
(SSA) of the name change, enter your first name, the last name as shown on your
social security card, and your new last name.
Note. ITIN applicant: Enter your individual name as it was entered on your Form
W-7 application, line 1a. This should also be the same as the name you entered
on the Form 1040/1040A/1040EZ you filed with your application.
Sole proprietor or single member LLC. Enter your individual name as shown on
your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or “doing
business as” (DBA) name on line 2.
Partnership, LLC that is not a single-member LLC, C Corporation, or S
Corporation. Enter the entity's name as shown on the entity's tax return on line
1 and any business, trade, or DBA name on line 2.
Other entities. Enter your name as shown on required U.S. federal tax documents
on line 1. This name should match the name shown on the charter or other legal
document creating the entity. You may enter any business, trade, or DBA name on
line 2.
Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded
as an entity separate from its owner is treated as a “disregarded entity.” See
Regulations section 301.7701-2(c)(2)(iii). Enter the owner's name on line 1. The
name of the entity entered on line 1 should never be a disregarded entity. The
name on line 1 should be the name shown on the income tax return on which the
income should be reported. For example, if a foreign LLC that is treated as a
disregarded entity for U.S. federal tax purposes has a single owner that is a
U.S. person, the U.S. owner's name is required to be provided on line 1. If the
direct owner of the entity is also a disregarded entity, enter the first owner
that is not disregarded for federal tax purposes. Enter the disregarded entity's
name on line 2, “Business name/disregarded entity name.” If the owner of the
disregarded entity is a foreign person, the owner must complete an appropriate
Form W-8 instead of a Form W-9. This is the case even if the foreign person has
a U.S. TIN.
LINE 2
If you have a business name, trade name, DBA name, or disregarded entity name,
you may enter it on line 2.
LINE 3
Check the appropriate box on line 3 for the U.S. federal tax classification of
the person whose name is entered on line 1. Check only one box in line 3.
IF the entity/person on line 1 is a(n) . . .THEN check the box for . . .
* Corporation
Corporation
* Individual
* Sole proprietorship, or
* Single-member limited liability company (LLC) owned by an individual and
disregarded for U.S. federal tax purposes.
Individual/sole proprietor or single member LLC
* LLC treated as a partnership for U.S. federal tax purposes,
* LLC that has filed Form 8832 or 2553 to be taxed as a corporation, or
* LLC that is disregarded as an entity separate from its owner but the owner is
another LLC that is not disregarded for U.S. federal tax purposes
Limited liability company and enter the appropriate tax classification. (P=
Partnership; C= C corporation; or S= S corporation)
* Partnership
Partnership
* Trust/estate
Trust/estate
LINE 4, EXEMPTIONS
If you are exempt from backup withholding and/or FATCA reporting, enter in the
appropriate space in line 4 any code(s) that may apply to you.
Exempt Payee Code
* Generally, individuals (including sole proprietors) are not exempt from
backup withholding.
* Except as provided below, corporations are exempt from backup withholding for
certain payments, including interest and dividends.
* Corporations are not exempt from backup withholding for payments made in
settlement of payment card or third party network transactions.
* Corporations are not exempt from backup withholding with respect to
attorneys' fees or gross proceeds paid to attorneys, and corporations that
provide medical or health care services are not exempt with respect to
payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup withholding.
Enter the appropriate code in the space in line 4.
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
The following chart shows types of payments that may be exempt from backup
withholding. The chart applies to the exempt payees listed above, 1 through 13.
IF the payment is for... THEN the payment is exempt for... Interest and dividend
payments All exempt payees except for 7 Broker transactions Exempt payees 1
through 4 and 6 through 11 and all C corporations. S corporations must not enter
an exempt payee code because they are exempt only for sales of noncovered
securities acquired prior to 2012. Barter exchange transactions and patronage
dividends Exempt payees 1 through 4 Payments over $600 required to be reported
and direct sales over $5,000 (Note 1) Generally, exempt payees 1 through 5 (Note
2) Payments made in settlement of payment card or third party network
transactions Exempt payees 1 through 4
(Note 1) See Form 1099-MISC, Miscellaneous Income, and its instructions.
(Note 2) However, the following payments made to a corporation and reportable on
Form 1099-MISC are not exempt from backup withholding: medical and health care
payments, attorneys' fees, gross proceeds paid to an attorney reportable under
section 6045(f), and payments for services paid by a federal executive agency.
Exemption from FATCA Reporting Code
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.
Therefore, if you are only submitting this form for an account you hold in the
United States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is not
required by providing you with a Form W-9 with “Not Applicable” (or any similar
indication) written or printed on the line for a FATCA exemption code.
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 Regulations 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 Regulations 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
Note. You may wish to consult with the financial institution requesting this
form to determine whether the FATCA code and/or exempt payee code should be
completed.
LINE 5
Enter your address (number, street, and apartment or suite number). This is
where the requester of this Form W-9 will mail your information returns. If this
address differs from the one the requester already has on file, write NEW at the
top. If a new address is provided, there is still a chance the old address will
be used until the payor changes your address in their records.
LINE 6
Enter your city, state, and ZIP code.
PART I. TAXPAYER IDENTIFICATION NUMBER (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and you do
not have and are not eligible to get an SSN, your TIN is your IRS individual
taxpayer identification number (ITIN). Enter it in the social security number
box. If you do not have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either your SSN
or EIN.
If you are a single-member LLC that is disregarded as an entity separate from
its owner, enter the owner’s SSN (or EIN, if the owner has one). Do not enter
the disregarded entity’s EIN. If the LLC is classified as a corporation or
partnership, enter the entity’s EIN.
Note. See What Name and Number To Give the Requester, later, for further
clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
for an SSN, get Form SS-5, Application for a Social Security Card, from your
local SSA office or get this form online at www.ssa.gov. You may also get this
form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual
Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application
for Employer Identification Number, to apply for an EIN. You can apply for an
EIN online by accessing the IRS website at www.irs.gov/businesses and clicking
on Employer Identification Number (EIN) under Starting a Business. Go to
www.irs.gov/Forms to view, download, or print Form W-7 and/or Form SS-4. Or, you
can go to www.irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4
mailed to you within 10 business days.
If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and
write “Applied For” in the space for the TIN, sign and date the form, and give
it to the requester. For interest and dividend payments, and certain payments
made with respect to readily tradable instruments, generally you will have 60
days to get a TIN and give it to the requester before you are subject to backup
withholding on payments. The 60-day rule does not apply to other types of
payments. You will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note. Entering “Applied For” means that you have already applied for a TIN or
that you intend to apply for one soon.
Caution: A disregarded U.S. entity that has a foreign owner must use the
appropriate Form W-8.
PART II. CERTIFICATION
To establish to the withholding agent that you are a U.S. person, or resident
alien, sign Form W-9. You may be requested to sign by the withholding agent even
if items 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I should sign
(when required). In the case of a disregarded entity, the person identified on
the “Name” line must sign. Exempt payees, see Exempt payee code, earlier.
Signature requirements. Complete the certification as indicated in items 1
through 5 below.
1. Interest, dividend, and barter exchange accounts opened before 1984 and
broker accounts considered active during 1983. You must give your correct
TIN, but you do not have to sign the certification.
2. Interest, dividend, broker, and barter exchange accounts opened after 1983
and broker accounts considered inactive during 1983. You must sign the
certification or backup withholding will apply. If you are subject to backup
withholding and you are merely providing your correct TIN to the requester,
you must cross out item 2 in the certification before signing the form.
3. Real estate transactions. You must sign the certification. You may cross out
item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not have to sign
the certification unless you have been notified that you have previously
given an incorrect TIN. “Other payments” include payments made in the course
of the requester’s trade or business for rents, royalties, goods (other than
bills for merchandise), medical and health care services (including payments
to corporations), payments to a nonemployee for services, payments made in
settlement of payment card and third party network transactions, payments to
certain fishing boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of secured
property, cancellation of debt, qualified tuition program payments (under
section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct TIN,
but you do not have to sign the certification.
WHAT NAME AND NUMBER TO GIVE THE REQUESTER
For this type of account: Give name and SSN of: 1. Individual The individual 2.
Two or more individuals (joint account) other than an account maintained by an
FFI The actual owner of the account or, if combined funds, the first individual
on the account (Note 1) 3. Two or more U.S. persons (joint account maintained by
an FFI) Each holder of the account 4. Custodial account of a minor (Uniform Gift
to Minors Act) The Minor (Note 2) 5a. The usual revocable savings trust (grantor
is also trustee) The grantor-trustee (Note 1) 5b. So-called trust account that
is not a legal or valid trust under state law The actual owner (Note 1) 6. Sole
proprietorship or disregarded entity owned by an individual The owner (Note 3)
7. Grantor trust filing under Optional Form 1099 Filing Method 1 (see
Regulations section 1.671-4(b)(2)(i)(A)) The grantor (Note *)
For this type of account: Give name and EIN of: 8. Disregarded entity not owned
by an individual The owner 9. A valid trust, estate, or pension trust Legal
entity (Note 4) 10. Corporation or LLC electing corporate status on Form 8832 or
Form 2553 The corporation 11. Association, club, religious, charitable,
educational, or other tax-exempt organization The organization 12. Partnership
or multi-member LLC The partnership 13. A broker or registered nominee The
broker or nominee 14. Account with the Department of Agriculture in the name of
a public entity (such as a state or local government, school district, or
prison) that receives agricultural program payments The public entity 15.
Grantor trust filing under the Form 1041 Filing Method or the Optional Form 1099
Filing Method 2 (see Regulations section 1.671-4(b)(2)(i)(B)) The trust
Note 1 List first and circle the name of the person whose number you furnish. If
only one person on a joint account has an SSN, that person’s number must be
furnished.
Note 2 Circle the minor’s name and furnish the minor’s SSN.
Note 3 You must show your individual name and you may also enter your business
or DBA name on the “Business name/disregarded entity” name line. You may use
either your SSN or EIN (if you have one), but the IRS encourages you to use your
SSN.
Note 4 List first and circle the name of the trust, estate, or pension trust.
(Do not furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.) Also see Special
rules for partnerships, earlier.
*Note The grantor also must provide a Form W-9 to trustee of trust.
Note If no name is circled when more than one name is listed, the number will be
considered to be that of the first name listed.
SECURE YOUR TAX RECORDS FROM IDENTITY THEFT
Identity theft occurs when someone uses your personal information such as your
name, social security number (SSN), or other identifying information, without
your permission, to commit fraud or other crimes. An identity thief may use your
SSN to get a job or may file a tax return using your SSN to receive a refund.
To reduce your risk:
* Protect your SSN,
* Ensure your employer is protecting your SSN, and
* Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a notice from
the IRS, respond right away to the name and phone number printed on the IRS
notice or letter.
If your tax records are not currently affected by identity theft but you think
you are at risk due to a lost or stolen purse or wallet, questionable credit
card activity or credit report, contact the IRS Identity Theft Hotline at
1-800-908-4490 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for Taxpayers.
Victims of identity theft who are experiencing economic harm or a system
problem, or are seeking help in resolving tax problems that have not been
resolved through normal channels, may be eligible for Taxpayer Advocate Service
(TAS) assistance. You can reach TAS by calling the TAS toll-free case intake
line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
Protect yourself from suspicious emails or phishing schemes. Phishing is the
creation and use of email and websites designed to mimic legitimate business
emails and websites. The most common act is sending an email to a user falsely
claiming to be an established legitimate enterprise in an attempt to scam the
user into surrendering private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does
not request personal detailed information through email or ask taxpayers for the
PIN numbers, passwords, or similar secret access information for their credit
card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS, forward this
message to phishing@irs.gov. You may also report misuse of the IRS name, logo,
or other IRS property to the Treasury Inspector General for Tax Administration
(TIGTA) at 1-800-366-4484. You can forward suspicious emails to the Federal
Trade Commission at: spam@uce.gov or report them at www.ftc.gov/complaint. You
can contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). If you
have been the victim of identity theft, see www.IdentityTheft.gov and Pub. 5027.
Visit IRS.gov to learn more about identity theft and how to reduce your risk.
PRIVACY ACT NOTICE
Section 6109 of the Internal Revenue Code requires you to provide your correct
TIN to persons (including federal agencies) who are required to file information
returns with the IRS to report interest, dividends, or certain other income paid
to you; mortgage interest you paid; the acquisition or abandonment of secured
property; the cancellation of debt; or contributions you made to an IRA, Archer
MSA, or HSA. The person collecting this form uses the information on the form to
file information returns with the IRS, reporting the above information. Routine
uses of this information include giving it to the Department of Justice for
civil and criminal litigation and to cities, states, the District of Columbia,
and U.S. commonwealths and possessions for use in administering their laws. The
information also may be disclosed to other countries under a treaty, to federal
and state agencies to enforce civil and criminal laws, or to federal law
enforcement and intelligence agencies to combat terrorism. You must provide your
TIN whether or not you are required to file a tax return. Under section 3406,
payers must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer. Certain
penalties may also apply for providing false or fraudulent information.
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