HomeMy WebLinkAbout2012-03-29 Planning Board Supplemental Materials l
Form W 9 Request for Taxpayer Give form to#n.
(Rev,November 2006) identification Number and Certification requester. Do not
or the erAc euy send to the IRS.
latemai itevemre service
ni Name(as shown on your income tax return)
e
Business name,II different from above
p ,
Individual/
y Check appropriate box: ❑ Sole proprietor ❑ Corporation [] Partnership Other ❑ I�empt from backup
wdhhllding
Address(number,street,and apt.or suite no.) Requester's name and address{optional)
City,state,and ZIP code
List account number(s)here(optional)
Taxpayer Identification Number IN
Enter your TIN in the appropriate box.The TIN provided must match the name given on Line 1 to avoidurnlf nwnbsr
backup withholding.For Individuals,this is your soclal security number(SSN).However,for a resident
alien,sale 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 Now to get a TIN on page 3. or
Note.If the account is In more than one name,see the chart an page 4 for guidelines on whose Employer Identitication number
number to enter.
Certification
Under penalties of perjury,1 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. 1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Intemal ,
Revenue Service(IRS)that d 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. 1 am a U.S.person(including a U.S.resident alien).
Certification Instructions.You must cross out item 2 above it 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 Tatum.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 4.)
Sign signature of
Here U.S,person► t7etr►
Purpose of Form •An individual who is a citizen or resident of the United
A person who is required to file an information return with the States,
IRS,must obtain your correct taxpayer Identification number •A partnership,corporation,company,or association
(TIN)to report, for example, income paid to you,real estate created or organized in the United States or under the laws
transactions, mortgage interest you paid,acquisition or of the United States,or
abandonment of secured property,cancellation of debt, or
Any you made to an IRA. Y estate(other than a foreign estate)or trust.See
Regulations sections 301.7701-6(a)and 7(a)for additional
UA person.Use Form W-9 only if you are a U.S.person information.
(Including a resident alien),to provide your correct TIN to the Special rules for partnerships.Partnerships that conduct a
person requesting it(the requester)and,when applicable, to: trade or business In the United States are generally required
1.Certify that the TIN you are giving Is correct(or you are to pay a withholding tax on any foreign partners' share of
waiting for a number to be issued), income from such business. Further, in certain cases where a
2.Certify that you are not subject to backup withholding,or Form W-9 has not been received,a partnership is required to
3. Claim exemption from backup withholding if you are a presume that a partner is a foreign person,and pay the
U.S. exempt payee, withholding tax.Therefore, if you are a U.S. person that is a
In 3 above,if applicable,you are also certifying that as a partner in a partnership conducting a trade or business in the
U.S. person,your allocable share of any partnership income United States, provide Form W-9 to the partnership to
from a U.S.trade or business is not subject to the establish your U.S, status and avoid withholding on your
withholding tax on foreign partners'share of effectively share of partnership income,
connected income. The person who gives Form W-9 to the partnership for
Note.If a requester gives you a form other than Form W-9 to Purposes of establishing its U.S.status and avoiding
request your TIN,you must use the requester's form if It is withholding on its allocable share of net income from the
substantially similar to this Form W-9. partnership conducting a trade or business In the United
For federal tax purposes,you are considered a person if you States is in the following cases:
are: • The U.S.owner of a disregarded entity and not the entity,
Cat.No.10231X Form (Rev.11-2005)
Rise 2
Form W-9(Rev.11-2005)
•The U.S.grantor or other owner of a grantor trust and not 3.The IRS tells the requester that you furnished an
the trust,and incorrect TIN,
•The U.S.trust(other than a grantor_ trust)and not the 4.The IRS tells you that you are subject to backup
beneficiaries of the trust. withholding because you did not report all your interest and
dividends on your tax return(for reportable interest and
Foreign person.If you are a foreign person,do not use dividends only), or
Form W-9. Instead, use the appropriate Form W-8(see 5.You do not certify t4 the requester that you are not
Publication 515,Withholding of Tax an Nonresident Aliens subject to backup withholding under 4 above(for reportable
and Foreign Entities). interest and dividend accounts opened after 1983 only).
Nonresident alien who becomes a resident alien. Certain payees and payments are exempt from backup
Generally,only a nonresident alien individual may use the g y p y
terms of a tax treaty to reduce or eliminate U.S.tax on withholding,See the instructions below and the separate
a instructions for the Requester of Farm W-9.
certain types of income.However,most tax treaties contain
provision known as a"saving clause."Exceptions specified Also see Special rules regarding partnerships on page 1.
In the saving clause may permit an exemption from tax to penalties
continue for certain types of income even after the recipient
has otherwise become a U.S.resident alien for tax purposes. Failure to furnish TIN. If you fall to furnish your correct TIN
If you are a U.S. resident alien who is relying on an to a requester, you are subject to a penalty of$50 for each
exception contained in the saving clause of a tax treaty to such failure unless your failure Is due to reasonable cause
claim an exemption from U.S.tax on certain types of income, and not to willful neglect.
you must attach a statement to Form W-9 that specifies the Civil penalty for false information with respect to
following five items: withholding.if you make a false statement with no
1.The treaty country.Generally,this must be the same reasonable basis that results In no backup withholding,you
treaty under which you claimed exemption from tax as a are subject to a$500 penalty.
nonresident alien. Criminal panalty for falsifying information.Willfully
2.The treaty article addressing the income. falsifying certifications or affirmations may subject you to
3.The article number(or location)In the tax treaty that criminal penalties including fines and/or imprisonment.
contains the saving clause and its exceptions. Misuse of TINS.if the requester discloses or uses TINS In
4.The type and amount of income that qualifies for the violation of federal law,the requester may be subject to civil
exemption from tax. and criminal penalties.
5.Sufficient facts to justify the exemption from tax under Specific Instructions '
the terms of the treaty article.
Example.Article 20 of the U.S.-China income tax treaty Name
allows an exemption from tax for scholarship Income if you are an Individual,you must generally enter the name
received by a Chinese student temporarily present In the shown on your income tax return. However, if you have
United States.Under U.S.law,this student will become a changed your last name,for instance,due to marriage
resident alien for tax purposes if his or her stay in the United without informing the Social Security Administration of the
States exceeds 5 calendar years.However, paragraph'2 of name change,enter your first name,the last name shown on,
the first Protocol to the U.S.-China treaty(dated April 30, your social security card,and your new last name.
1984)allows the provisions of Article a to continue alien apply if the account is in joint names, list first,and then circle,
even after the Chinese student becomes a resident siren of the name of the person or entity whose number you entered
the United States.A Chinese student who qualifies for this in Part I of the form.
ry
exception(under paragraph 2 of the first protocol)and is
relying on this exception to claim an exemption from tax on Sole proprietor.Enter your individual name as shown on
his or her scholarship or fellowship income would attach to your Income tax return on the"Name"line.You may enter
Form W-9 a statement that includes the information your business,trade,or"doing business as(DBA)" name on
described above to support that exemption. the"Business name"line.
If you are a nonresident alien or a foreign entity not subject Limited liabillty company(Li.C).If you are a single-member
to backup withholding,give the requester the appropriate LLC(including a foreign LLC with a domestic owner)that is
completed Form W-8. disregarded as an entity separate from its owner under
What Is backup withholding?Persons making certain Treasury regulations section 301.7701-3, enter the owner's
payments to you must under certain conditions withhold and name on the"Name"line.Enter the LLC's name on the
pay to the IRS 28%of such payments(after December 31, "Business name"line.Check the appropriate box for your
2002).This is called"backup withholding."Payments that filing status(sole proprietor, corporation, etc.),then check
may be subject to backup withholding include interest, the box for"Other"and enter"LLC"in the space provided.
dividends, broker and barter exchange transactions, rents, Other entities.Enter your business name as shown on
royalties,nonemployee pay, and certain payments from required federal tax documents on the"Name"line.This
fishing boat operators.Real estate transactions are not name should match the name shown on the charter or other
subject to backup withholding. legal document creating the entity.You may enter any
You will not be subject to backup withholding on payments business,trade,or DBA name on the"Business name" line.
you receive if you give the requester your correct TIN, make Note.You are requested to check the appropriate box for
the proper certifications, and report all your taxable interest your status (individual/sole proprietor,corporation, etc.).
and dividends on your tax return. Exempt From Backup Withholding
Payments you receive will be subject to backup
withholding it. If you are exempt, enter your name as described above and
1.You do not furnish your TIN to the requester, check the appropriate box for your status,then check the
2.You do not certify your TIN when required (see the Part "Exempt from backup withholding"box in the line following
11 instructions on page 4 for details), the business name, sign and date the form.
.
Form W-9(Rev,11-2005)
Generally, individuals(including sofa proprietors)are not page 3
exempt from backup withholding. Corporations are exempt Part 1. Taxpayer Identification
from backup withholding for certain payments, such as Number (TIN)
interest and dividends.
Note.If you are exempt from backup withholding, End your TIN in the aPPPriate box.lf you are a resident
P g,You alien and you do not have and are.not eft €fife to et an SSN,
should still complete this form to avoid possible erroneous
your is your IRS individual tax g
backup withholding. (ITIN.Enter it in the social security numl e�ba i If you Bober
Exempt payees.Backup withholding Is not required on any not have an ITIN, see How to get a`TlN;below,
payments made to the following payees: If you are a sole proprietor and you have an EIN,you may
1.An organization exempt from tax under section 501(a), enter either your SSN or EIN.However,the IRS prefers that
any IRA,or a custodial account under section 403(b)(7) if the you use your SSN.
account satisfies the requirements of section 401(f)(2), entity yosu are a single-owner LLC#hat is disregarded as an
2.The United States or any of its agencies or operate from its owner(see Limited liablifty company
instrumentalities, (LLC)on page 2),enter your SSN(or EIN,1f you have:one). If
3.A state, the District of Columbia, a the LLC is a corporation,partnership,etc., enter the'entity's
Possession of the EIN.
United States,or any of their political subdivisions or
instrumentalities, Note.See the chart on page 4 for further clarification:of
4.A foreign government or any of its political subdivisions, name and TIN combfnat€Ons,
agencies,or Instrumentalities, or How to get a TIN.If you do not have a TIN,'apply far one
5. An international organization or any of Its agencies or Immediately.To apply for an SSN, et FormgS 5,
instrumentalities. Application for a Social Security C; ,from your local Social
Other payees that may be exempt from backup Security Administration Office or get this form online at
withholding include: www socialsecurity.gov.You may also get this form Ely
6.A corporation, calling 1-800-772-1213.Use Form W-7,Application for IRS
7.A foreign central bank of Issue, Individual Taxpayer Identification Nurnber,to:apply for.an.
8.A dealer in securities or commodities required to register 1TEN, or to ply foApplication an IN You.can apply for anPEiN Pontine
Number,
in the United States,the District of Columbia,or a by accessing the IRS website at wwtN rrs govlbusinesses and „
Possession of the United States, clicking on Employer 1D Numbers:under Related Topics.You
9.A futures commission merchant registered with-the can get Forms W-7 and 88-4 from the IRS by visiting;.
Commodity Futures Trading Commission, www-irs.gov or by calling 1-8o0-TAX=FORW1
10.A real estate investment trust, (1-800-829-3676).
11.An entity registered at all times during the tax year If you are asked to complete Form W-6.butido Trot have a
under the Investment Company Act of 1940, TEN,write `Applied For In the space for the TIN,sign and '
date the form, and give it to the requester For Interest:and
12.A common trust fund operated by a bank under dividend payments, and certain payments made w€th'raspect
section 584(a), to readily tradable instruments,generally you wilt have.60
13.A financial institution, days to get a TIN and give it to the requester before you are
a subject to backup withholding on payments.Th e 60-dayrule
14.A middleman known in the investment community Yo
nominee or custodian, or does not apply to Other types of payments, u wilt he
subject to backup withholding on all Stich payments Until you
15.A trust exempt from tax under section 664 or provide your TIN to the requester.
described in section 4947. Note.Writing"Applied For"means that you have already
The chart below shows types of payments that may be applied for a TIN or that ou intend to a
exempt from backup withholding.The chart applies to the Y ppPY fax one soon.
exempt recipients listed above, 1 through 15. Caution:A disregarded domestic entity that has a foreign
owner must use the appropriate Forin W78.:
IF the payment is for... THEN the paym=ent is exempt
for... 1.
Interest and dividend payments All exempt recipients except
for 9
Broker transactlons Exempt recipients 1 through 13.
Also,a person registered under
the Investment Advisers Act of
1940 who regularly acts as a
broker
Harter exchange transactions Exempt recipients 1.through 5
and patronage dividends
Payments over$600 required Generally,asempt recipients
to be reported and direct I through 7
sales over$5,000 3
See Form 1099-Mist,Miscellaneous Income,and its Instructions.
'However,the following payments made to a corporation(Including gross
Proceeds paid to an attorney under section 6045(f),even if the attorney is a
corporation)and reportable on Form logs-MISC are not exempt front'...
backup with h olding,medical and health care payments aRomeys'fees,and
payments for services paid by a federal executive agency.
s
Page 4
Form W-9(Rev.11-2006)
Part 11, Certification What Name and Number To Give the
To establish to the withholding agent that you are a U.S. Requester
person,or resident alien, sign Form W-9.You may be For thte typo of account Give name and SSN at
requested to sign by the withholding agent even if items 1, 4, The individual
and 5 below Indicate otherwise. 1. Individual
For a joint account, only the person whose TIN is shown in 2.Two or more individuals(Joint The actual owner of the account
Part I should sign(when required).Exempt recipients, see account) or,if combined funds,the first
Exempt From Backup Withholding on page 2. 1 individual on the account'
Signature requirements.Complete the certification as 3.Custodian account of a minor The minor'
(Uniform Gift to Minors Act)
indicated in 1 through 5 below. 4,a.The usual revocable The grantor-trustee'
1.Interest,dividend,and barter exchange accounts savings trust(grantor is
opened before 1984 and broker accounts considered also trustee)
active during 1983.You must give your correct TIN,but you b.So-called trust account The actual owner''
do not have to sign the certification. that is not a legal or valid
trust under state law
2.Interest,dividend,broker,and barter exchange 5.Sole proprietorship la The owner'
accounts opened after 1983 and broker accounts Sale single-owner LLC
considered inactive during 1983.You must sign the
certification or backup withholding will apply. if you are For this"m at account: Give name and EIN of:
subject to backup withholding and you are merely providing a.Sole proprietorship or The owner 9
your correct TIN to the requester,you must cross out item 2 single-owner LLC
in the certification before signing the form. 7.A valid trust,estate,or Legal entity"
3.Real estate transactions.Your must sign the pension trust
certification.You may cross out item 2 of the certification. e.Corporate or LLC electing The corporation
4.Other payments.You must give your correct TIN,but corporate status on Form
you do not have to sign the certification unless you have 3832
been notified that you have previously given an incorrect TIN. 9.Association,club,religious, The organization
"Other payments" include payments made in the course of charitable,educational,or
other
the requester's trade or business for rents, royalties, goods Partn tax-exempt organization
(other than bills for merchandise),medical and health care 10.Partnership or multi-member The partnership
services(including payments to corporations), payments to a LLC
nonemployee for services, payments to certain fishing boat 11.A broker or registered The broker or nominee
crew members and fishermen,and gross proceeds paid to nominee
attorneys(including payments to corporations). 12.Account with the Department The public entity
of Agriculture in the name of
G.Mortgage interest paid by you„acquisition or a public entity(such as a
abandonment of secured property,cancellation of deb% state or local government,
qualified tuition program payments(under section 529), school district,or prison)that
IRA,Coverdell ESA,Archer MSA or HSA contributions or receives agricultural program
distributions,and pension distributions.You must give payments
your correct TIN, but you do not have to sign the
certification. '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 fumished.
gCircle the minor's name and furnish the minor's SSN.
'You must show your individual name and you may also enter your business
or MBA"name on the second name line.You may use either your SSN or
EIN(if you have one).If you are a sole proprietor,iRs encourages you to
use your SSN.
'List first and circle the name of the legal trust,estate,or pension trust.(Do
not furnish the TIN of the personal representative or trustee unless the fegai
entity itself is not designated in the account title.)Also see SPecial rules
regarding partnerships on pegs 1.
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.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns
with the IRS to report interest, dividends, and certain other income paid to you,mortgage interest you paid,the acquisition or
abandonment of secured property, cancellation of debt, or contributions you made to an IRA, or Archer MSA or HSA.The IRS
uses the numbers for identification purposes and to help verify the accuracy of your tax return.The IRS may also provide this
information to the Department of Justice for civil and criminal litigation, and to cities,states, the District of Columbia,and U.S.
possessions to carry out their tax laws, We may also disclose this information to other countries under a tax treaty, to federal
and state agencies to enforce federal nontax 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. Payers must generally withhold 28% of taxable
interest,dividend, and certain other payments to a payee who does not give a TIN to a payer.Certain penaltles.may also apply.