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| For this type of account: | Give the name and social security number of: |
For this type of account: | Give the name and taxpayer identification number of: |
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1.
Individual |
The
individual |
6. Disregarded
entity not owned by an individual |
The
owner |
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2. Two or
more individuals (joint account) |
The actual owner
of the account or, if combined funds, the first individual on the account1 |
7. A valid trust,
estate, or pension trust |
The legal
entity4 |
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3. Custodian
account of a minor (Uniform Gift to Minors Act) |
The minor2 |
8.
Corporate |
The
corporation |
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4(a) The
usual revocable savings trust (grantor is also trustee) |
The
grantor-trustee1 |
9. Association,
club, religious, charitable, educational, or other tax-exempt organization |
The
organization |
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4(b)
So-called trust account that is not a legal or valid trust under state law |
The actual
owner1 |
10.
Partnership 11. A broker or registered nominee |
The
partnership The broker or nominee |
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5.
Sole proprietorship or disregarded entity not owned by an individual |
The
owner3 |
12.
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 |
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(1) |
List first and circle the name of the person whose number you furnish. If only one person on a joint account has a social security number, that persons number must be furnished. |
(2) |
Circle the minors name and furnish the minors social security number. |
(3) |
You must show your individual name, but you may also enter your business or doing business as name. You may use either your social security number or your taxpayer identification number (if you have one). |
(4) |
List first and circle the name of the legal trust, estate, or pension trust. (Do not furnish the taxpayer identification number of the personal representative or trustee unless the legal entity itself is not designated in the account title.) |
NOTE: |
If more than one name listed and no name is circled, the number will be considered to be that of the first name listed. |
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An organization exempt from tax under Section 501(a), any individual retirement account (IRA), or a custodial account under Section 403(b)(7) if the account satisfies the requirements of Section 401(f)(2). |
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The United States or any of its agencies or instrumentalities. |
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A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities. |
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A foreign government or any of its political subdivisions, agencies, or instrumentalities. |
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An international organization or any of its agencies or instrumentalities. |
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A corporation. |
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A foreign central bank of issue. |
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A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States. |
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A futures commission merchant registered with the Commodity Futures Trading Commission. |
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A real estate investment trust (REIT). |
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An entity registered at all times during the tax year under the Investment Company Act of 1940. |
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A common trust fund operated by a bank under Section 584(a). |
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A financial institution. |
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A middleman known in the investment community as a nominee or custodian. |
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A trust exempt from tax under Section 664 or described in Section 4947. |
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Payments to nonresident aliens subject to withholding under Section 1441. |
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Payments to partnerships not engaged in a trade or business in the United States and that have at least one nonresident alien partner. |
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Payments of patronage dividends not paid in money. |
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Payments made by certain foreign organizations. |
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Section 404(k) distributions made by an employee stock ownership plan (ESOP). |
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Payments of interest on obligations issued by individuals. However, if you pay $600 or more of interest in the course of your trade or business to a payee, you must report the payment. Backup withholding applies to the reportable payment if the payee has not provided a taxpayer identification number or has provided an incorrect taxpayer identification number. |
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Payments of tax-exempt interest (including exempt-interest dividends under Section 852). |
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Payments described in Section 6049(b)(5) to nonresident aliens. |
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Payments on tax-free covenant bonds under Section 1451. |
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Payments made by certain foreign organizations. |
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Mortgage or student loan interest paid to you. |
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Wages. |
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Distributions from a pension, annuity, profit-sharing or stock bonus plan, any IRA, an owner-employee plan or other deferred compensation plan. |
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Distributions from a medical or health savings account and long-term care benefits. |
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Certain surrenders of life insurance contracts. |
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Gambling winnings if withholding is required under Section 3402(q). However, if withholding is not required under Section 3402(q), backup withholding applies if the payee fails to furnish a taxpayer identification number. |
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Real estate transactions reportable under Section 6045(e). |
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Cancelled debts reportable under Section 6050P. |
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Fish purchases for cash reportable under Section 6050R. |
(1) |
Penalty for Failure to Furnish Taxpayer Identification NumberIf you fail to furnish your correct taxpayer identification number 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. |
(2) |
Civil Penalty for False Information With Respect to WithholdingIf you make a false statement with no reasonable basis that results in no imposition of backup withholding, you are subject to a penalty of $500. |
(3) |
Civil and Criminal Penalties for False InformationWillfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. |
(4) |
Misuse of Taxpayer Identification NumbersIf the requester discloses or uses taxpayer identification numbers in violation of federal law, the requester may be subject to civil and criminal penalties. |