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Home My WebLink AboutW-9 form~orm W'9 Request for Taxpayer G;ve form to the Identification Number and Certification requester. Do not send to the IRS. {Rev. October 2007) Name (as shown on your income tax return) Business name, if different from above Check appropriate box: [] Individual/Sole proprietor [] Co~poration [] Partnership Exempt [] Limited liabilY~y company. Enter the tax classd=ication (D=disreg~rded entity, C=corporation, P=partnership) I~ ....... [] payee Address (number, street, and apt. or suite no.) City, state, and ZIP code R~uester's name and ~dress (opliona~ Town of Southold PO Box 1179 Southold, NY 11971 List account number(s) here (optional) a! 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 your social security number (SSN). However, for a resident alien, sole 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 How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guide(ines on whose number to enter. I~a~a Certification [S~clal security number or Employer identlficafion number 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 subiect to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not peen 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. ~ am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have peen 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 retum, For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contribut~ns 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 · Date · General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, me,gage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Note. (f a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, yuu are considered a U.S. person if you are: · An individual who is a U.S, citizen or U.S. resident alien, · A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, · An estate (other than a foreign estate), or · A domestic trust (as defined in Regulations section 301.7701 -7). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such businass. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide. Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. 'The person who gives Form W-9 to the partnership for purposes of establishing its U.S, status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: · The U.S. owner of a disregarded entity and not the entity, Cat. No. 10231x Perm W-9 (Rev. 10-2007)