Form W-9 (Rev. 11-2005)Page
Enter your individual name as shown onyour income tax return on the “Name” line. You may enteryour business, trade, or “doing business as (DBA)” name onthe “Business name” line.
Enter your business name as shown onrequired federal tax documents on the “Name” line. Thisname should match the name shown on the charter or otherlegal document creating the entity. You may enter anybusiness, trade, or DBA name on the “Business name” line.If the account is in joint names, list first, and then circle,the name of the person or entity whose number you enteredin Part I of the form.
Limited liability company (LLC).
If you are a single-memberLLC (including a foreign LLC with a domestic owner) that isdisregarded as an entity separate from its owner underTreasury regulations section 301.7701-3, enter the owner’sname on the “Name” line. Enter the LLC’s name on the“Business name” line. Check the appropriate box for yourfiling status (sole proprietor, corporation, etc.), then checkthe box for “Other” and enter “LLC” in the space provided.
NameExempt From Backup Withholding
5. You do not certify to the requester that you are notsubject to backup withholding under 4 above (for reportableinterest and dividend accounts opened after 1983 only).Certain payees and payments are exempt from backupwithholding. See the instructions below and the separateInstructions for the Requester of Form W-9.
Civil penalty for false information with respect towithholding.
If you make a false statement with noreasonable basis that results in no backup withholding, youare subject to a $500 penalty.
Criminal penalty for falsifying information.
Willfullyfalsifying certifications or affirmations may subject you tocriminal penalties including fines and/or imprisonment.
Failure to furnish TIN.
If you fail to furnish your correct TINto a requester, you are subject to a penalty of $50 for eachsuch failure unless your failure is due to reasonable causeand not to willful neglect.
Misuse of TINs.
If the requester discloses or uses TINs inviolation of federal law, the requester may be subject to civiland criminal penalties.If you are an individual, you must generally enter the nameshown on your income tax return. However, if you havechanged your last name, for instance, due to marriagewithout informing the Social Security Administration of thename change, enter your first name, the last name shown onyour social security card, and your new last name.If you are exempt, enter your name as described above andcheck the appropriate box for your status, then check the“Exemptfrom backup withholding”boxin the line followingthe business name, sign and date the form.4. The IRS tells you that you are subject to backupwithholding because you did not report all your interest anddividends on your tax return (for reportable interest anddividends only), or3. The IRS tells the requester that you furnished anincorrect TIN,2. You do not certify your TIN when required (see the PartII instructions on page 4 for details),You will not be subject to backup withholding on paymentsyou receive if you give the requester your correct TIN, makethe proper certifications, and report all your taxable interestand dividends on your tax return.1. You do not furnish your TIN to the requester,
What is backup withholding?
Persons making certainpayments to you must under certain conditions withhold andpay to the IRS 28% of such payments (after December 31,2002). This is called “backup withholding.” Payments thatmay be subject to backup withholding include interest,dividends, broker and barter exchange transactions, rents,royalties, nonemployee pay, and certain payments fromfishing boat operators. Real estate transactions are notsubject to backup withholding.
Payments you receive will be subject to backupwithholding if:
If you are a nonresident alien or a foreign entity not subjectto backup withholding, give the requester the appropriatecompleted Form W-8.
Article 20 of the U.S.-China income tax treatyallows an exemption from tax for scholarship incomereceived by a Chinese student temporarily present in theUnited States. Under U.S. law, this student will become aresident alien for tax purposes if his or her stay in the UnitedStates exceeds 5 calendar years. However, paragraph 2 ofthe first Protocol to the U.S.-China treaty (dated April 30,1984) allows the provisions of Article 20 to continue to applyeven after the Chinese student becomes a resident alien ofthe United States. A Chinese student who qualifies for thisexception (under paragraph 2 of the first protocol) and isrelying on this exception to claim an exemption from tax onhis or her scholarship or fellowship income would attach toForm W-9 a statement that includes the informationdescribed above to support that exemption.
You are requested to check the appropriate box foryour status (individual/sole proprietor, corporation, etc.).4. The type and amount of income that qualifies for theexemption from tax.5. Sufficient facts to justify the exemption from tax underthe terms of the treaty article.
Nonresident alien who becomes a resident alien.
Generally, only a nonresident alien individual may use theterms of a tax treaty to reduce or eliminate U.S. tax oncertain types of income. However, most tax treaties contain aprovision known as a“savingclause.”Exceptionsspecifiedin the saving clause may permit an exemption from tax tocontinue for certain types of income even after the recipienthas otherwise become a U.S. resident alien for tax purposes.If you are a U.S. resident alien who is relying on anexception contained in the saving clause of a tax treaty toclaim an exemption from U.S. tax on certain types of income,you must attach a statement to Form W-9 that specifies thefollowing five items:1. The treaty country. Generally, this must be the sametreaty under which you claimed exemption from tax as anonresident alien.2. The treaty article addressing the income.3. The article number (or location) in the tax treaty thatcontains the saving clause and its exceptions. Also see
Special rules regarding partnerships
on page 1.
If you are a foreign person, do not useForm W-9. Instead, use the appropriate Form W-8 (seePublication 515, Withholding of Tax on Nonresident Aliensand Foreign Entities).
The U.S. grantor or other owner of a grantor trust and notthe trust, and
The U.S. trust (other than a grantor trust) and not thebeneficiaries of the trust.