14397 E Geronimo Rd, Scottsdale, AZ 85259
(Rev. Nove.mber 2017)Department of the TreasuryInternal Revenue Service
Go to www.irs.gov/FormW9 for Instructions and the latest information.
Give Form to the requester. Do not send to the IRS.
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.
Enter 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.
Other (see instructions)
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 code
7 List account number(s) here (optional)
Requester’s name and address (optional)
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, 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. A'.is.o see What Name and Number To Give the Requester for guidelines on whose number to enter.
Social security number
- - or Employer identification number
Part II Certification
Under penalties of perjury, I certify that:
Certification instructions. You must 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 requt 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 interesired to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
Section references are to the internal Revenue Code unless otherwise noted.
FL Mire developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/ForrnW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.
Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.
if you do not return Form W-9 to the requester with a TIN you might be subject to backup withholding. See What is backup withholding, later.
Ca:. No. 10231XForm W-9(Rev. 11-2017)
Date September 22, 2023
Leave this empty:
Your legal name
Your email address
If you have questions about the contents of this document, you can email the document owner.
Document Name: W-9 Form
Agree & Sign