W9


Request for Taxpayer ID Number and Certification
(if you need instructions for this document, these are on the IRS website.)

Most individuals only need to complete lines 1, 3, 5 and 6, enter your social security number and sign.

 

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.
 


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

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

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. For other
entities, it is your employer identification number (EIN).  

If you do not have a number, see How to get a TIN.
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.

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.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

 

 

Leave this empty:

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Signature Certificate
Document name: W9
lock iconUnique Document ID: eb525e179daf2fd278131c29fe11a879e4ccb1cc
Timestamp Audit
December 7, 2022 4:07 pm PSTW9 Uploaded by Jennifer Blair - [email protected] IP 73.252.165.197
December 7, 2022 5:00 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
December 7, 2022 5:04 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
December 8, 2022 11:15 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
December 8, 2022 11:16 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
December 8, 2022 11:17 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
December 16, 2022 10:01 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
December 16, 2022 10:01 am PSTBob Richards - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
January 25, 2023 9:30 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
January 25, 2023 9:30 am PSTBob Richards - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
March 10, 2023 1:51 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
March 10, 2023 1:51 pm PSTBob Richards - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
March 11, 2023 3:43 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
March 11, 2023 3:43 pm PSTBob Richards - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
April 17, 2023 1:40 pm PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
April 17, 2023 1:40 pm PSTBob Richards - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.71.69.111
July 15, 2024 11:44 am PSTLisa Johnson - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.252.165.197
July 15, 2024 11:44 am PSTBob Richards - [email protected] added by Jennifer Blair - [email protected] as a CC'd Recipient Ip: 73.252.165.197
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