IRS Form W-9 | Broadway Play Publishing Inc

Request for Taxpayer Identification and Certification

1. Name (as shown on your income tax return)*

2. Business name (only if different from above)

3. Check appropriate box for federal tax classification of the name entered in field 1.*

Individual/sole proprietor or single-member LLC
C Corporation
S Corporation
Partnership
Trust/estate
Limited liability company

Enter the LLC 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 W-9 instructions on page 3.

Yes
No

Exempt payee code (if any)

Exemption from FATCA reporting code (if any)

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

6. City, state, and ZIP code*

7. Email*

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

Select taxpayer identification to submit*

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 in Instructions); and

4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Date*

Signature

Please sign below

Phone

This field is for validation purposes and should be left unchanged.