IRS Form W-9Michael Q Fellmeth, Executive Director2025-11-10T12:11:32-05:00 IRS W-9 Form "*" indicates required fields FacebookThis field is for validation purposes and should be left unchanged.Request for Taxpayer Identification and Certification View IRS Form W-9 Complete Instructions1. 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*Please enter city, state and zip code. Example: New York, NY 100247. 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: CertificationUnder 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 MM slash DD slash YYYY SignaturePlease sign below
