Form W-9

(Rev. October 2018)

Department of the Treasury 

Internal Revenue Service 

Request for Taxpayer 

Identification Number and Certification

a Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the 

requester. Do not 

send to the IRS.

Print or type. 

See Specific Instructions on page 3.

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

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

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 

following seven boxes. 

Individual/sole proprietor or 

single-member LLC

 C Corporation S Corporation Partnership Trust/estate

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

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check 

LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is 

another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that 

is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions) a

4 Exemptions (codes apply only to 

certain entities, not individuals; see 

instructions on page 3):

Exempt payee code (if any)

Exemption from FATCA reporting

 code (if any)

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

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

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)

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 instructions for Part I, later. For other 

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

TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and 

Number To Give the Requester for guidelines on whose number to enter.

Social security number

– –

or

Employer identification number

–

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 for Part II, later.

Sign 

Here Signature of 

U.S. person a Date a

General Instructions

Section references are to the Internal Revenue Code unless otherwise 

noted.

Future developments. For the latest information about developments 

related to Form W-9 and its instructions, such as legislation enacted 

after they were published, go to www.irs.gov/FormW9.

Purpose of Form

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

information return with the IRS must obtain your correct taxpayer 

identification number (TIN) which may be your social security number 

(SSN), individual taxpayer identification number (ITIN), adoption 

taxpayer identification number (ATIN), or employer identification number 

(EIN), to report on an information return the amount paid to you, or other 

amount reportable on an information return. Examples of information 

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

• Form 1099-INT (interest earned or paid)

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

funds)

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

proceeds)

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

transactions by brokers)

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

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

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

1098-T (tuition)

• Form 1099-C (canceled debt)

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

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

alien), to provide your correct TIN. 

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

be subject to backup withholding. See What is backup withholding, 

later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)

US Government Publishing Office

✔ US Federal Government

N. Capitol & H Streets, NW

Washington, DC 20401

5 3 6002509

2

B

Michelle M. Gibbs Digitally signed by Michelle M. Gibbs 

Date: 2020.06.23 16:29:03 -04'00'