Form W-9 - Request For Taxpayer Identification Number And Certification printable pdf download

W-9

Request for Taxpayer

Give Form to the

Form

requester. Do not

(Rev. December 2014)

Identification Number and Certification

send to the IRS.

Department of the Treasury

Internal Revenue Service

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

Fort Ross Conservancy (FRC)

2 Business name/disregarded entity name, if different from above

4 Exemptions (codes apply only to

3 Check appropriate box for federal tax classification; check only one of the following seven boxes:

certain entities, not individuals; see

✔

Individual/sole proprietor or

C Corporation

S Corporation

Partnership

Trust/estate

instructions on page 3):

single-member LLC

Exempt payee code (if any)

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)

Exemption from FATCA reporting

Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for

the tax classification of the single-member owner.

code (if any)

(Applies to accounts maintained outside the U.S.)

Other (see instructions)

5 Address (number, street, and apt. or suite no.)

Requester’s name and address (optional)

19005 Coast Highway One

6 City, state, and ZIP code

Jenner, CA 95450

7 List account number(s) here (optional)

Part I

Taxpayer Identification Number (TIN)

Social security number

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 Part I instructions on page 3. For other

–

entities, it is your employer identification number (EIN). If you do not have a number, see How to get a

TIN on page 3.

Employer identification number

Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for

guidelines on whose number to enter.

9 4

2 3 7 0

7 5

–

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 on page 3.

Sign

Signature of

Here

U.S. person

Date

General Instructions

• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T

(tuition)

Section references are to the Internal Revenue Code unless otherwise noted.

• Form 1099-C (canceled debt)

Future developments. Information about developments affecting Form W-9 (such

• Form 1099-A (acquisition or abandonment of secured property)

as legislation enacted after we release it) is at

Use Form W-9 only if you are a U.S. person (including a resident alien), to

Purpose of Form

provide your correct TIN.

If you do not return Form W-9 to the requester with a TIN, you might be subject

An individual or entity (Form W-9 requester) who is required to file an information

to backup withholding. See What is backup withholding? on page 2.

return with the IRS must obtain your correct taxpayer identification number (TIN)

which may be your social security number (SSN), individual taxpayer identification

By signing the filled-out form, you:

number (ITIN), adoption taxpayer identification number (ATIN), or employer

1. Certify that the TIN you are giving is correct (or you are waiting for a number

identification number (EIN), to report on an information return the amount paid to

to be issued),

you, or other amount reportable on an information return. Examples of information

2. Certify that you are not subject to backup withholding, or

returns include, but are not limited to, the following:

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If

• Form 1099-INT (interest earned or paid)

applicable, you are also certifying that as a U.S. person, your allocable share of

• Form 1099-DIV (dividends, including those from stocks or mutual funds)

any partnership income from a U.S. trade or business is not subject to the

• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)

withholding tax on foreign partners' share of effectively connected income, and

• Form 1099-B (stock or mutual fund sales and certain other transactions by

4. Certify that FATCA code(s) entered on this form (if any) indicating that you are

brokers)

exempt from the FATCA reporting, is correct. See What is FATCA reporting? on

page 2 for further information.

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-K (merchant card and third party network transactions)

W-9

Form

(Rev. 12-2014)

Cat. No. 10231X

Form W-9 - Request For Taxpayer Identification Number And Certification

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