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Form W-9 (Rev. 10-2018) Page rJ
<br />1. Interest, dividend, and barter exchange accounts opened
<br />before 1984 and broker accounts considered active during 1983.
<br />You must give your correct TIN, but you do not have to sign the
<br />certification.
<br />2. Interest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considered inactive during
<br />1983. You must sign the certification or backup withholding will apply. If
<br />you are subject to backup withholding and you are merely providing
<br />your correct TIN to the requester, you must cross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the certification. You may
<br />cross out item 2 of the certification.
<br />4. Other payments. You must give your correct TIN, but you do not
<br />have to sign the certification unless you have been notified that you
<br />have previously given an incorrect TIN. "Other payments" include
<br />payments made in the course of the requester's trade or business for
<br />rents, royalties, goods (other than bills for merchandise), medical and
<br />health care services (including payments to corporations), payments to
<br />a nonemployee for services, payments made in settlement of payment
<br />card and third party network transactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualified tuition program
<br />payments (under section 529), ABLE accounts (under section 529A),
<br />IRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your correct
<br />TIN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this type of account: I Give name and SSN of:
<br />1. Individual I The individual
<br />2. Two or more individuals (Joint
<br />The actual owner of the account or, if
<br />account) other than an account
<br />combined funds, the first individual on
<br />maintained by an FFI
<br />the account'
<br />3. Two or more U.S. persons
<br />Each holder of the account
<br />(Joint account maintained by an FFI)
<br />4. Custodial account of a minor
<br />The minor2
<br />(Uniform Gift to Minors Act)
<br />5. a. The usual revocable savings trust
<br />The grantor-trustee1
<br />(grantor is also trustee)
<br />b. So-called trust account that is not
<br />The actual owner'
<br />a legal or valid trust under state law
<br />6. Sole proprietorship or disregarded
<br />The owner3
<br />entity owned by an individual
<br />7. Grantor trust filing under Optional
<br />The grantor*
<br />Form 1099 Filing Method 1 (see
<br />Regulations section 1.671-4(b)(2)(i)
<br />(A))
<br />For this type of account: I
<br />Give name and EIN of:
<br />8. Disregarded entity not owned by an I
<br />The owner
<br />individual
<br />9. A valid trust, estate, or pension trust
<br />10. Corporation or LLC electing
<br />corporate status on Form 8832 or
<br />Form 2553
<br />11. Association, club, religious,
<br />charitable, educational, or other tax-
<br />exempt organization
<br />12. Partnership or multi -member LLC
<br />13. A broker or registered nominee
<br />Legal entity
<br />For this type of account: I Give name and EIN of:
<br />14. Account with the Department of The public entity
<br />Agriculture in the name of a public
<br />entity (such as a state or local
<br />government, school district, or
<br />prison) that receives agricultural
<br />program payments
<br />15. Grantor trust filing under the Form The trust
<br />1041 Filing Method or the Optional
<br />Form 1099 Filing Method 2 (see
<br />Regulations section 1.671-4(b)(2)17(B))
<br />List first and circle the name of the person whose number you furnish.
<br />If only one person on a joint account has an SSN, that person's number
<br />must be furnished.
<br />2 Circle the minor's name and furnish the minor's SSN.
<br />3 You must show your individual name and you may also enter your
<br />business or DBA name on the "Business name/disregarded entity"
<br />name line. You may use either your SSN or EIN (if you have one), but the
<br />IRS encourages you to use your SSN.
<br />4 List first and circle the name of the trust, estate, or pension trust. (Do
<br />not furnish the TIN of the personal representative or trustee unless the
<br />legal entity itself is not designated in the account title.) Also see Special
<br />rules for partnerships, earlier.
<br />*Note: The grantor also must provide a Form W-9 to trustee of trust.
<br />Note: If no name is circled when more than one name is listed, the
<br />number will be considered to be that of the first name listed.
<br />Secure Your Tax Records From Identity Theft
<br />Identity theft occurs when someone uses your personal information
<br />such as your name, SSN, or other identifying information, without your
<br />permission, to commit fraud or other crimes. An identity thief may use
<br />your SSN to get a job or may file a tax return using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />• Protect your SSN,
<br />• Ensure your employer is protecting your SSN, and
<br />• Be careful when choosing a tax preparer.
<br />If your tax records are affected by identity theft and you receive a
<br />notice from the IRS, respond right away to the name and phone number
<br />printed on the IRS notice or letter.
<br />If your tax records are not currently affected by identity theft but you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activity or credit report, contact the IRS Identity Theft Hotline
<br />at 1-800-908-4490 or submit Form 14039.
<br />For more information, see Pub. 5027, Identity Theft Information for
<br />Taxpayers.
<br />Victims of identity theft who are experiencing economic harm or a
<br />systemic problem, or are seeking help in resolving tax problems that
<br />have not been resolved through normal channels, may be eligible for
<br />Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
<br />calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
<br />1-800-829-4059.
<br />The corporation Protect yourself from suspicious emails or phishing schemes.
<br />Phishing is the creation and use of email and websites designed to
<br />mimic legitimate business emails and websites. The most common act
<br />The organization is sending an email to a user falsely claiming to be an established
<br />legitimate enterprise in an attempt to scam the user into surrendering
<br />private information that will be used for identity theft.
<br />The partnership
<br />The broker or nominee
<br />
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