W9 - Formstack

W9 - Substitute for IRS form W9
Request for Taxpayer - Identification Number and Certification
(For W9 instructions click here)

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

First Name

Last Name

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 Other (see instructions) ▶

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

Please explain:

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)

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

Address Line 1

Address Line 2

6. Business Address cont'd*

City

State

ZIP Code

7. Tenant/Renter's Name (for internal Housing Authority records) Name is required on this line; do not leave this line blank.*

First Name

Last Name

8. Address of assisted unit submitted for tenancy approval (number, street, and apt. no.) *

Address Line 1

Address Line 2

9. Address of Assisted unit cont'd*

City

State

ZIP Code

10. List account number(s) here (optional)

Requester's name and address (optional)

Part I - Taxpayer Identification Number

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.

Tax Identification Number *

Social Security Number Employer Identification Number

Social Security Number*

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.

Landlord Signature

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