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Substitute Form W-9 - Request For Taxpayer Identification Number & Certification - City Of New York

CITY OF NEW YORK

DO NOT SUBMIT FORM TO IRS - SUMBIT

SUBSTITUTE FORM W-9:

FORM TO REQUESTING AGENCY

REQUEST FOR TAXPAYER IDENTIFICATION NUMBER & CERTIFICATION

9/07 Revision

TYPE OR PRINT INFORMATION NEATLY. PLEASE REFER TO INSTRUCTIONS FOR MORE INFORMATION.

Part I: Vendor Information

1. Legal Business Name:

2. If you use DBA, please list below:

(As it appears on IRS EIN records, CP575, 147C - or -

Social Security Admin records, Social Security Card, certified Form SSA7028)

3. Entity Type (Check one only):

Church or Church-Controlled Organization

Personal Service Corporation

Corporation/

Non-Profit

City of New York

Individual / Sole

Trust

Government

Corporation

LLC

Employee

Proprietor

Partnership/

Single Member LLC

Resident/Non-

Non-United States

Joint Venture

Estate

LLC

(Individual)

Resident Alien

Business Entity

Part II: Taxpayer Identification Number (TIN) & Taxpayer Identification Type

1. Enter your TIN here: (DO NOT USE DASHES)

2. Taxpayer Identification Type (check appropriate box):

Employer ID No.

Social Security No.

Individual Taxpayer

N/A (Non-United United

(EIN)

(SSN)

ID No. (ITIN)

States Business Entity)

Part III: Primary 1099 Vendor & Remittance Address

1. Primary 1099 Vendor Address:

2. Remittance Address:

Number, Street, and Apartment or Suite Number

City, State,and Nine Digit Zip Code or Country

Part IV: Exemption from Backup Withholding

For payees exempt from Backup Withholding, check the box below. Valid explanation required for exemption. See instructions.

Exempt from Backup Withholding

Part V: Certification

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup

withholding.

Under penalties of perjury, I certify that the number shown on this form is my correct Taxpayer Identification Number (TIN).

Sign

Here:

Signature

Phone Number

Date

Print Preparer's Name

Phone Number

Contact's E-Mail Address:

FOR SUBMIITTING AGENCY USE ONLY

Submitting

Contact

Agency Code:

Person:

Contact's E-

Telephone

(

)

Mail Address:

Number:

Payee/Vendor Code:

DO NOT FORWARD W-9 TO COMPTROLLER'S OFFICE. FAX COMPLETED W-9 FORMS TO THE SCHOOL/REQUESTOR.

Substitute Form W-9 - Request For Taxpayer Identification Number & Certification - City Of New York

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