Certification instructions. You must cross out item (2) above if the IRS has notified you that you are subject to backup withholding because you have failed to report all interest and dividends on your tax return. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS that you were no longer subject to backup withholding, do not cross out item (2). Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: ______________________________ Date: _________________________ , 200 NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 30% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCK. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number to Give the Payer. The taxpayer identification number for an individual is the individual’s Social Security number. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to give the payer.
Appears in 2 contracts
Sources: Subscription Agreement (Ebank Financial Services Inc), Subscription Agreement (Ebank Financial Services Inc)
Certification instructions. You must cross out item (2) above if you have been notified by the IRS has notified you that you are subject to backup withholding because you have failed to report all of under-reporting interest and or dividends on your tax return. However, if after being notified by the IRS that you were are subject to backup withholding withholding, you received another notification from the IRS that you were are no longer subject to backup withholding, do not cross out item (2). Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: ----------------------------------------------------------------------------------------------------------------------------- SIGNATURE__________________________________________________ Date: DATE_________________________ , 200 1998 ----------------------------------------------------------------------------------------------------------------------------- NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE THIS FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 3031% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCKYOU. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number 8 GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 WHAT IS BACKUP WITHHOLDING? -- Persons making certain payments to Give the Payeryou are required to withhold and pay to IRS 31% of such payments under certain conditions. The taxpayer identification number for an individual This is the individual’s Social Security numbercalled "backup withholding." Payments that could be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include real estate transactions. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to If you give the payerrequester your correct TIN, make the appropriate certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: (1) You do not furnish your TIN to the requester, or (2) IRS notifies the requester that you furnished an incorrect TIN, or (3) You are notified by IRS that you are subject to backup withholding because you failed to report all your interest and dividends on your tax return (for interest and dividend accounts only), or (4) You fail to certify to the requester that you are not subject to backup withholding under (3) above (for interest and dividend accounts opened after 1983 only), or (5) You fail to certify your TIN. This applies only to interest, dividend, broker or barter exchange accounts opened after 1983, or broker accounts considered inactive in 1983. For other payments, you are subject to backup withholding only if (1) or (2) above applies. Certain Payees and payments are exempt from backup withholding and information reporting. See payees and Payments Exempt From Backup Withholding, below, and Exempt Payees and Payments under Specific Instructions below if you are an exempt payee. PAYEES AND PAYMENTS EXEMPT FROM BACKUP WITHHOLDING. -- The following is a list of payees exempt from backup withholding and for which no information reporting is required. For interest and dividends, all listed payees are exempt except item (9). For broker transactions, payees listed in (1) through (13), and a person registered under the Investment Advisers Act of 1940 who regularly acts as a broker are exempt. Payments subject to reporting under sections 6041 and 6041A are generally exempt from backup withholding only if made to payees described in items (1) through (7), except that a corporation that provides medical and health care services or bills and collects payments for such services is not exempt from backup withholding or information reporting. Only payees described in items (2) through (6) are exempt from backup withholding for barter exchange transactions, patronage dividends, and payments by certain fishing boat operators.
Appears in 1 contract
Sources: Letter of Transmittal (Hudson Respiratory Care Inc)
Certification instructions. You must cross out item (2) above if you have been notified by the IRS has notified you that you are subject to backup withholding because you have failed to report all interest and dividends on your tax returnwithholding. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS that you were are no longer subject to backup withholding, do not cross out item (2). SignatureSignature Date ----------------------------------------- --------------------- IF YOU CHECKED THE BOX IN PART III OF THIS SUBSTITUTE FORM W-9, YOU MUST SIGN AND DATE THE FOLLOWING CERTIFICATION: Date: CERTIFICATION OF PAYEE AWAITING TAXPAYER IDENTIFICATION NUMBER I certify certify, under penalties of perjury perjury, that a taxpayer identification number Taxpayer Identification Number has not been issued to me, and either (a) that I have mailed or delivered an application to receive a taxpayer identification number Taxpayer Identification Number to the appropriate Internal Revenue Service IRS Center or Social Security Administration Office (or (b) I intend to mail or deliver an application in the near future). I understand that if I do not provide a Taxpayer Identification Number to the payer, 31% of all payments shall be withheld until I provide a Taxpayer Identification Number to the payer and that, notwithstanding the information if I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting do not provide my Taxpayer Identification Number)Number within sixty (60) days, such retained amounts shall be remitted to the IRS as backup withholding and 31% of all reportable payments made to me thereafter will be subject withheld and remitted to a 30% backup withholding tax the IRS until I provide a properly certified taxpayer identification numberTaxpayer Identification Number. SignatureSignature Date ----------------------------------------- --------------------- ------------------------------------------------------------------------------- ------------------------------------------------ ----------------------------------------------------------------------- SUBSTITUTE Under penalties of perjury, I certify that: ______________________________ Date: _________________________ FORM W-8 DEPARTMENT OF THE TREASURY, 200 [ ] For INTEREST PAYMENTS, I am not a U.S. citizen or resident INTERNAL REVENUE SERVICE (or I am filing for a foreign corporation, partnership, estate or trust); CERTIFICATE OF FOREIGN HOLDERS WHO ARE INDIVIDUALS [ ] For DIVIDENDS, I am not a U.S. citizen or resident (or I am filing for a foreign corporation, partnership, estate or trust); AND [ ] For BROKER TRANSACTIONS or BARTER EXCHANGES, I am an exempt foreign person. ----------------------------------------------------------------------- Signature Date ----------------------------------------------------- ------------------------------------------------ Print Name ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE FORM W-9 W-9, OR, IF A FOREIGN PERSON, THE SUBSTITUTE FORM W-8, MAY RESULT IN BACKUP WITHHOLDING TAX OF 3031% OF ANY CASH PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCKTHE REORGANIZATION AGREEMENT. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS, PLEASE REVIEW SUPPLEMENTAL INSTRUCTIONS 11, 12 AND 13. Guidelines ================================================================================ TAX BASIS INFORMATION Please provide the total tax basis you have in all ▇▇▇▇▇▇ Shares delivered pursuant to this Form of Election or, if such information is maintained for Determining the Proper Identification Number you by ▇▇▇▇▇▇▇▇▇ & ▇▇▇▇▇▇▇▇, Ltd., please indicate below your authorization for ▇▇▇▇▇▇▇▇▇ & ▇▇▇▇▇▇▇▇, Ltd. to Give the Payerprovide tax basis information to McClatchy Newspapers, Inc. (Tax basis information provided herein will have no effect upon your election to receive stock and/or cash). The taxpayer identification number for an individual is the individual’s Social Security number. Social Security numbers have nine digits separated by two hyphensTotal tax basis in all ▇▇▇▇▇▇ Shares delivered pursuant to this Form of Election: e.g.---------------------------------------------------------------------- I hereby authorize ▇▇▇▇▇▇▇▇▇ & ▇▇▇▇▇▇▇▇, 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g.Ltd. to provide tax basis information respecting my ▇▇▇▇▇▇ Shares to McClatchy Newspapers, 00-0000000. The table below will help determine the number to give the payer.Inc. ----------------------------------------- Signature ================================================================================ SUPPLEMENTAL INSTRUCTIONS TO FORM OF ELECTION
Appears in 1 contract
Sources: Form of Election (Mni Newco Inc)
Certification instructions. You must cross out item (2) 2 above if you have been notified by the IRS has notified you that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. HoweverSignature of Subscriber/Representative Subscriber Authorized Signatory X Date Signature of Co-Subscriber #1 (if necessary) X Date Name (Print) of Subscriber/Representative Subscriber Authorized Signatory Name (Print) of Subscriber/Representative Subscriber Authorized Signatory Capacity (Print) of Subscriber/Representative Subscriber Authorized Signatory (if necessary) Capacity (Print) of Subscriber/Representative Subscriber Authorized Signatory (if necessary) Signature of Co-Subscriber #2 (if necessary) X Date Name (Print) of Subscriber/Representative Subscriber Authorized Signatory Capacity (Print) of Subscriber/Representative Subscriber Authorized Signatory (if necessary) Signature of Financial Advisor X Date Name (Print) of Signatory Title (Print) of Signatory Please provide the following supporting documentation based on your account type. Individual If a non-US person, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS that you were no longer subject to backup withholdingForm W-8BEN and Passport or National ID Joint (including JTWROS, do not cross out item Tenants in Common, Community Property) For each non-US Person account holder, Form W-8BEN and Passport or National ID IRA (2). Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to meincluding ▇▇▇▇, and either SEP, Rollover, Inherited) None Pension Plan (aNon-ERISA) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Plan documents Trust Certificate of Awaiting Taxpayer Identification NumberTrust or Declaration of Trust Appropriate Form W-8 (see ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇▇/forms-pubs/about-form-w-8) Estate Letters of testamentary or letters of administration dated within 60 days unless accompanies by a medallion signature guarantee Corporation (including C Corporation, S Corporation, LLC) Formation documents Articles of incorporation or operating agreement Authorized signatory list Appropriate Form W-8 (see ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇▇/forms-pubs/about-form-w-8) If the entity is a fund (mutual fund, private equity fund, hedge fund), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: ______________________________ Date: _________________________ , 200 NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 30% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCK. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number to Give prospectus or offering memorandum Partnership Formation documents Partnership agreement Authorized signatory list Appropriate Form W-8 (see ▇▇▇▇▇://▇▇▇.▇▇▇.▇▇▇/forms-pubs/about-form-w-8) If the Payer. The taxpayer identification number for an individual is the individual’s Social Security number. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is a fund (mutual fund, private equity fund, hedge fund), provide the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to give the payer.prospectus or offering memorandum
Appears in 1 contract
Sources: Subscription Agreement (Goldman Sachs Private Credit Fund LLC)
Certification instructions. You must cross out item (part 2) above if you have been notified by the IRS has notified you that you are currently subject to backup withholding because you have failed to report all of under-reporting or lack of reporting of interest and or dividends on your tax return. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS that you were are no longer subject to backup withholding, do not cross out item (such part 2). Signature: Date: The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding. Signature(s) Date - Day Month Year --------------------------------------- --------- --------- ---------------- --------------------------------------- --------- --------- ---------------- YOU MUST COMPLETE THE FOLLOWING CERTIFICATE IF YOU CHECKED THE "AWAITING TIN" BOX ABOVE. CERTIFICATE OF AWAITING TAXPAYER IDENIFICATION NUMBER I certify under penalties of perjury that (i) a taxpayer identification number TIN has not been issued to me, and (ii) either (a) I have mailed or delivered an application to receive a taxpayer identification number TIN to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. , and (iii) I understand thatthat if I do not provide a TIN by the time of payment, notwithstanding the information I provided in Part III will be subject to backup withholding at a rate of the Substitute Form W-9 (and the fact that I have completed this Certificate 28% of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification numberme. Signature: ______________________________ Date: _________________________ , 200 Signature(s) Date - Day Month Year --------------------------------------- --------- --------- ---------------- --------------------------------------- --------- --------- ---------------- NOTE: FAILURE TO COMPLETE AND RETURN THE THIS SUBSTITUTE FORM W-9 W-9, MAY RESULT IN BACKUP WITHHOLDING TAX BEING WITHHELD AT A RATE OF 3028% OF ON ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCKYOU. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 OBTAINING A NUMBER Payments of interest not generally subject to backup withholding include the following: If you do not have a taxpayer identification number ("TIN") or you don't know your number, o Payments of tax-exempt interest (including obtain Form SS-5, Application for a Social exempt-interest dividends under Section 852) of Security Number Card or Form SS-4, Application the Internal Revenue Code. for Employer Identification Number, at the local office of the Social Security Administration or o Payments described in Section 6049(b)(5) of the Internal Revenue Service and apply for a the Internal Revenue Code to non-resident number. aliens. PAYEES EXEMPT FROM BACKUP WITHHOLDING o Payments made by certain foreign organizations. Payees that may be exempted from backup withholding on all dividend and interest o Payments made to a nominee. payments and on broker transactions include the following: EXEMPT PAYEES DESCRIBED ABOVE SHOULD FILE THE SUBSTITUTE FORM W-9 TO AVOID POSSIBLE ERRONEOUS o A corporation. BACKUP WITHHOLDING. COMPLETE THE SUBSTITUTE FORM W-9 AS FOLLOWS: o A financial institution. ENTER YOUR TAXPAYER IDENTIFICATION NUMBER, WRITE o An organization exempt from tax under Section "EXEMPT" ACROSS THE FACE OF THE FORM, AND RETURN 501(a) of the Internal Revenue Code, or an THE FORM TO THE PAYER. individual retirement plan, or a custodial account under Section 403(b)(7) of the Internal Certain payments, other than payments of Revenue Code. interest, dividends, and patronage dividends, that are subject to information reporting are o The United States or any agency or also not subject to backup withholding. For instrumentality thereof. details, see Sections 6041, 6041A(a), 6042, 6044, 6045, 6049, 6050A and 6050N of the o A state, the District of Columbia, a Internal Revenue Code and the regulations possession of the United States, or any thereunder. subdivision or instrumentality thereof. PRIVACY ACT NOTICE o An international organization or any agency or Section 6109 of the Internal Revenue Code instrumentality thereof. requires you to provide your correct taxpayer identification number to payers, who must report o A foreign government, a political subdivision the payments to the IRS. The IRS uses the number of a foreign government, or any agency or for identification purposes and may also provide instrumentality thereof. this information to various government agencies for tax enforcement or litigation purposes. o A registered dealer in securities or Payers must be given the numbers whether or not commodities registered in the United States or a recipients are required to file tax returns. possession of the United States. Payers must generally withhold 30% of taxable interest, dividend, and certain other payments o A real estate investment trust. to a payee who does not furnish a taxpayer identification number to a payer. Certain o A common trust fund operated by a bank under penalties may also apply. Section 584(a) of the Internal Revenue Code. PENALTIES o An entity registered at all times during the (1) PENALTY FOR FAILURE TO FURNISH TAXPAYER tax year under the Investment Company Act of IDENTIFICATION NUMBER -- If you fail to furnish 1940. your correct taxpayer identification number to a payer, you are subject to a penalty of $50 for o A foreign central bank of issue. each such failure unless your failure is due to reasonable cause and not to willful neglect. o An exempt charitable remainder trust, or a (2) CIVIL PENALTY FOR FALSE INFORMATION WITH non-exempt trust described in Section 4947 of RESPECT TO WITHHOLDING -- If you make a false the Internal Revenue Code. statement with no reasonable basis which results in no imposition of backup withholding, you are Payments of dividends and patronage dividends subject to a penalty of $500. not generally subject to backup withholding (3) CRIMINAL PENALTY FOR FALSIFYING INFORMATION include the following: -- Willfully falsifying certifications or affirmations may subject you to criminal o Payments to nonresident aliens subject to penalties including fines and/or imprisonment. withholding under Section 1441 of the Internal (4) MISUSE OF TAXPAYER IDENTIFICATION NUMBERS -- Revenue Code. If the payer discloses or uses taxpayer identification numbers in violation of Federal o Payments to partnerships not engaged in a law, the payer may be subject to civil and trade or business in the United States and which criminal penalties. have at least one nonresident partner. FOR ADDITIONAL DETAILSINFORMATION CONTACT YOUR TAX o Payments of patronage dividends where the CONSULTANT OR THE INTERNAL REVENUE SERVICE amounts received are not paid in money. o Payments made by certain foreign organizations. o Payments made to a nominee. ------------------------------------------------------------------------------------------------------------------ GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 Guidelines for Determining the Proper Identification Number for the Payee (You) to Give the Payer. The taxpayer identification number for an individual is the individual’s Social Security number. Payer -- Social Security numbers have nine digits separated by two hyphens: e.g., i.e. 000-00-0000. The taxpayer , employer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., i.e. 00-0000000. The , the table below will help determine the number to give the payer.. -------------------------------------------------------
Appears in 1 contract
Certification instructions. You must cross out item (2) 2 above if you have been notified by the IRS has notified you that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax returnreturn The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required to avoid back-up withholding. HoweverSign Here Signature of U.S. person u Date u I certify, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS that you were no longer subject to backup withholding, do not cross out item (2). Signature: Date: I certify under penalties of perjury perjury, that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office Office, or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding that I must provide a taxpayer identification number to the information I provided in Part III Exchange Agent within 60 days of the submitting this Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax at the applicable rate on all reportable payments until I provide a properly certified my taxpayer identification numbernumber to the Exchange Agent. Signature: ______________________________ Date: _________________________ I also understand that if I provide my taxpayer identification number to the Exchange Agent within 60 days, 200 NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 30% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCKthe Exchange Agent will refund any amounts backup withheld from reportable payments made during the 60-day period, and if I do not provide the Exchange Agent with my taxpayer identification number within the 60-day period, the Exchange Agent will remit such previously retained amounts to the IRS as backup withholding. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Signature Date Guidelines for For Determining the Proper Identification Number to Give the Payer. The taxpayer identification number for an individual is the individual’s Payer – Social Security number. Social Security numbers Numbers (“SSNs”) have nine digits separated by two hyphens: e.g.i.e., 000▇▇▇-00▇▇-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number▇▇▇. Employer Identification numbers Numbers (“EINs”) have nine digits separated by only one hyphen: e.g.i.e., 00-0000000. The table below will help determine the number to give the payer.
Appears in 1 contract
Sources: Merger Agreement (Ixia)
Certification instructions. You must cross Cross out item (2) 2 above if you have been notified by the IRS has notified you that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. However, Cross out item 3 and complete a W-8 BEN if after being notified by you are not a U.S. person. Credit Report Authorization: By signing below you authorize the IRS credit For Credit Requests: By signing below you acknowledge that you were have union to check your employment and credit history and to obtain credit received and agree to the terms and conditions contained in the reports in connection with any request for membership or credit, including LOANLINER Credit and Security Agreement including the Addendum, any update, increase, renewal, extension or collection of credit you disclosures and information related to voluntary payment protection and receive. If you request, the credit union will tell you the name and address to any amendments that may be made to any of these documents from of any credit bureau from which it received a credit report on you. The time to time; and you grant the credit union a security interest in all share credit union will rely on information you have provided. By signing below and/or deposit accounts that you own now and in the future to secure you affirm that all information on this document or that has been provided what you owe under the LOANLINER Credit and Security Agreement. elsewhere is correct. When you are in default, you authorize the credit union to apply the For Account and/or Account Service Requests: By signing below you balance in these accounts to any amounts due. Shares and deposits in an acknowledge that you have received and agree to the terms and Individual Retirement Account, and any other account that would lose conditions contained in the Membership and Account Agreement, Truth in special tax treatment under state or federal law if given as security, are Savings Disclosure, Funds Availability Policy Disclosure, Electronic Funds not subject to backup withholding the security interest you received another notification have given in your shares and Transfer Agreement and Disclosure and Privacy Notice and to any deposits. amendments to these documents that the credit union may make from the IRS that you were no longer subject time to backup withholding, do not cross out item (2)time. Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate The Internal Revenue Service Center or Social Security Administration Office or (b) I intend does not require your consent to mail or deliver an application in any provision of this document other than the near futurecertifications required to avoid backup withholding. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: ______________________________ Date: _________________________ , 200 NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 30% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCK. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number to Give the Payer. The taxpayer identification number for an individual is the individual’s Social Security number. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to give the payer.X X SIGNATURE DATE SIGNATURE DATE X X SIGNATURE DATE SIGNATURE DATE
Appears in 1 contract
Sources: Membership Agreement
Certification instructions. You must cross out item (2) above if you have been notified by the IRS has notified you that you are subject to backup withholding because you have failed to report all of under-reporting interest and or dividends on your tax return. However, if after being notified by the IRS that you were are subject to backup withholding withholding, you received another notification from the IRS that you were are no longer subject to backup withholding, do not cross out item (2). Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: __------------------------------------------------------------------------------- SIGNATURE ____________________________ Date: _____________DATE ____________ , 200 1998 ------------------------------------------------------------------------------- NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE THIS FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 3031% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCKYOU. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 WHAT IS BACKUP WITHHOLDING? -- Persons making certain payments to Give the Payeryou are required to withhold and pay to IRS 31% of such payments under certain conditions. The taxpayer identification number for an individual This is the individual’s Social Security numbercalled "backup withholding." Payments that could be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include real estate transactions. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to If you give the payerrequester your correct TIN, make the appropriate certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: (1) You do not furnish your TIN to the requester, or (2) IRS notifies the requester that you furnished an incorrect TIN, or (3) You are notified by IRS that you are subject to backup withholding because you failed to report all your interest and dividends on your tax return (for interest and dividend accounts only), or (4) You fail to certify to the requester that you are not subject to backup withholding under (3) above (for interest and dividend accounts opened after 1983 only), or (5) You fail to certify your TIN. This applies only to interest, dividend, broker or barter exchange accounts opened after 1983, or broker accounts considered inactive in 1983. For other payments, you are subject to backup withholding only if (1) or (2) above applies. Certain Payees and payments are exempt from backup withholding and information reporting. See payees and Payments Exempt From Backup Withholding, below, and Exempt Payees and Payments under Specific Instructions below if you are an exempt payee. PAYEES AND PAYMENTS EXEMPT FROM BACKUP WITHHOLDING. -- The following is a list of payees exempt from backup withholding and for which no information reporting is required. For interest and dividends, all listed payees are exempt except item (9). For broker transactions, payees listed in (1) through (13), and a person registered under the Investment Advisers Act of 1940 who regularly acts as a broker are exempt. Payments subject to reporting under sections 6041 and 6041A are generally exempt from backup withholding only if made to payees described in items (1) through (7), except that a corporation that provides medical and health care services or bills and collects payments for such services is not exempt from backup withholding or information reporting. Only payees described in items (2) through (6) are exempt from backup withholding for barter exchange transactions, patronage dividends, and payments by certain fishing boat operators.
Appears in 1 contract
Certification instructions. You must cross out item (2) above if the IRS has notified you that you are subject to backup withholding because you have failed to wit report all interest and dividends on your tax return. However, if after being notified r by the IRS that you were subject to backup withholding you received another with notification from the IRS that you were no longer subject to backup withholding, do long not cross out item (2). hholding because you have failed to eturn. However, if after being notified holding you received another er subject to backup withholding, do Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: ______________________________ Date: _________________________ , 200 NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 30% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCK. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number to Give the Payer. The taxpayer identification number for an individual is the individual’s Social Security number. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to give the payer.
Appears in 1 contract
Sources: Subscription Agreement (Ebank Financial Services Inc)
Certification instructions. You must cross out item (2) 2 above if you have been notified by the IRS has notified you that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. However, if after being notified by the IRS that you were subject to backup withholding you received another notification from the IRS that you were no longer subject to backup withholding, do not cross out item (2). Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: ________________________________ Date: ______________________ Ž ¨ All Cash Election Only ¨ All Stock Election Only ¨ Cash and Stock Election ¨¨¨¨¨¨¨¨ l ¨¨¨¨ ‘ ¨ No Election If you cannot produce some or all of your First Mutual Bancshares, Inc. stock certificates, you must obtain a lost instrument open penalty surety bond. Please see the reverse side of this form for instructions. ’ AFFIDAVIT OF LOST, MISSING OR DESTROYED CERTIFICATE(S) AND AGREEMENT OF INDEMNITY Investor ID Number TOTAL SHARES LOST Please Fill In Certificate No(s). if Known Number of Shares Attach separate schedule if needed By signing this Election and Transmittal Form, I/we or myself/ourselves swear, depose and state that: I/we or myself/ourselves am/are the lawful owner(s) of the certificate(s) representing shares of First Mutual common stock owned by the undersigned (the “Securities”). The Securities have not been endorsed, pledged, cashed, negotiated, transferred, assigned, or otherwise disposed of. I/We or myself/ourselves have made a diligent search for the securities and have been unable to find it or them and make this Affidavit for the purpose of inducing the sale, exchange, redemption, or cancellation of the securities, as outlined in this Election and Transmittal Form, without the surrender of the original(s), and also to request and induce Federal Insurance Company to provide suretyship for me/us to cover the missing securities under its Blanket Bond # 8302-00-67. I/We or myself/ourselves hereby agree to surrender the Securities for cancellation should I/we or myself/ourselves, at any time, find the Securities. I/We or myself/ ourselves hereby agree for myself/ourselves, my/our heirs, successors, assigns and personal representatives, in consideration of the proceeds of the sale, exchange, redemption or cancellation of the Securities, and the aforementioned suretyship, to indemnify, protect and hold harmless Federal Insurance Company (the Surety), Mellon Investor Services LLC, Washington Federal, First Mutual, and each of their subsidiaries, successors and assigns from and against any and all loss, costs, and damages including court costs and attorney’s fees, which they may be subject to or liable for in respect to the sale, exchange, redemption, or cancellation of the Securities without requiring surrender of the original Securities. The rights accruing to the parties under the preceding sentence shall not be limited or abridged by their negligence, inadvertence, accident, oversight, breach or failure to inquire into, contest, or litigate any claim, whenever such negligence, inadvertence, accident, oversight, breach or failure may occur or may have occurred. I/We or myself/ourselves agree that this Affidavit and Indemnity Agreement is to become part of Blanket Bond # 8302-00-67 underwritten by Federal Insurance Company. Any person who, knowingly and with intent to defraud any insurance company or other person, files an application or statement of claim, containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to civil penalties as prescribed by law. X Signed by Affiant (stockholder) ______________________________________on this (date)_______________________________________________ , 200 NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 30% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCK. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number to Give the Payer. The taxpayer identification number for an individual is the individual’s (Deponent) (Indemnitor) (Heirs Individually) Month Day Year Social Security number. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to give the payer.#___________________________ Date____________________ Notary Public_____________________________________
Appears in 1 contract
Certification instructions. You must cross out item (2) 2 above if you have been notified by the IRS has notified you that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. HoweverFor real estate transactions, if after being notified by item 2 does not apply. For mortgage interest paid, acquisi- tion or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRS) and generally, payments other than interest and dividends, you are not required to sign the IRS that Certification, but you were subject to backup withholding you received another notification from must provide your correct TIN. (See the IRS that you were no longer subject to backup withholding, do not cross out item (2). Signature: Date: instructions.) ce y ha am o ega age he age o ma o y o he s a e n wh ch es de have ca e u y ead he e ms and cond ons on he back o h s App ca on and Ag eemen he 4L e Po c es and P ocedu es and he I certify under penalties that I am of perjury that a taxpayer identification number has not been issued to me, and either legal age (athe age of majority) for the state in which I reside. I have mailed or delivered an application to receive a taxpayer identification number to carefully read the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in terms and conditions on the near future. I understand thatback of this Application and Agreement, notwithstanding the information I provided in Part III of the Substitute Form W-9 (4Life Policies and Procedures and the fact Compensa on P an and ag ee o ab de by a e ms se o h n hese documen s Add ona y ag ee ha have comp e ed he W 9 Reques o Taxpaye den ca on Numbe and Ce ca on hones y and o 4Life Compensation Plan and agree to abide by all terms set forth in these documents. Additionally, I agree that I have completed this Certificate of Awaiting the W-9 Request for Taxpayer Identification Number)Number and Certification honestly and to the best of my knowledge. I hereby confirm that my signing of this application does not violate any other agreements or contracts to which I am a party. A PARTICIPANT IN THIS MULTILEVEL MARKETING PLAN HAS A RIGHT TO CANCEL AT ANY TIME, all reportable payments made REGARDLESS OF REASON. CANCELLATION MUST BE SUBMITTED IN WRITING TO THE COMPANY AT ITS PRINCIPAL PLACE OF BUSINESS WITHIN 3 BUSINESS DAYS AFTER THE DATE OF THIS TRANSACTION. Applicant’s Signature Date Co-Applicant’s Signature Date Please mail or fax your completed Application and Agreement to me thereafter will 4Life to finalize the distributor enrollment process. If your Application and Agreement is not received within 30 days of enrollment, your Distributorship shall automatically be subject converted to a 30% backup withholding tax until I provide a properly certified taxpayer identification numberCustomer status and you will no longer be eligible for bonuses or commissions. Signature: ______________________________ Date: _________________________ , 200 NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 30% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCK*This information can only be changed within 10 days of enrollment without receiving upline approval. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number to Give the Payer. The taxpayer identification number for an individual is the individual’s Social Security number. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to give the payer.050305 Item#8052 Terms & Conditions on reverse side White - 4Life Yellow - Applicant Pink - Sponsor
Appears in 1 contract
Sources: Distributor Agreement
Certification instructions. You must cross out item (2) above if you have been notified by the IRS has notified you that you are subject to backup withholding because you have failed to report all of under-reporting interest and or dividends on your tax return. However, if after being notified by the IRS that you were are subject to backup withholding withholding, you received another notification from the IRS that you were are no longer subject to backup withholding, do not cross out item (2). Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to me----------------------------------------------------------------------------------------------------------------------------- SIGNATURE DATE , and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: ______________________________ Date: _________________________ , 200 1998 --------------------------------------------------------------------- ------------------------------- NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE THIS FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 3031% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCKYOU. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 WHAT IS BACKUP WITHHOLDING? -- Persons making certain payments to Give the Payeryou are required to withhold and pay to IRS 31% of such payments under certain conditions. The taxpayer identification number for an individual This is the individual’s Social Security numbercalled "backup withholding." Payments that could be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include real estate transactions. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to If you give the payerrequester your correct TIN, make the appropriate certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: (1) You do not furnish your TIN to the requester, or (2) IRS notifies the requester that you furnished an incorrect TIN, or (3) You are notified by IRS that you are subject to backup withholding because you failed to report all your interest and dividends on your tax return (for interest and dividend accounts only), or (4) You fail to certify to the requester that you are not subject to backup withholding under (3) above (for interest and dividend accounts opened after 1983 only), or (5) You fail to certify your TIN. This applies only to interest, dividend, broker or barter exchange accounts opened after 1983, or broker accounts considered inactive in 1983. For other payments, you are subject to backup withholding only if (1) or (2) above applies. Certain Payees and payments are exempt from backup withholding and information reporting. See payees and Payments Exempt From Backup Withholding, below, and Exempt Payees and Payments under Specific Instructions below if you are an exempt payee.
Appears in 1 contract
Sources: Letter of Transmittal (Century Maintenance Supply Inc)
Certification instructions. You must cross out item (2) above if you have been notified by the IRS has notified you that you are subject to backup withholding because you have failed to report all of under-reporting interest and or dividends on your tax return. However, if after being notified by the IRS that you were are subject to backup withholding withholding, you received another notification from the IRS that you were are no longer subject to backup withholding, do not cross out item (2). Signature: Date: I certify under penalties of perjury that a taxpayer identification number has not been issued to me------------------------------------------------------------------------------------------------------------------------- SIGNATURE DATE , and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that, notwithstanding the information I provided in Part III of the Substitute Form W-9 (and the fact that I have completed this Certificate of Awaiting Taxpayer Identification Number), all reportable payments made to me thereafter will be subject to a 30% backup withholding tax until I provide a properly certified taxpayer identification number. Signature: ______________________________ Date: _________________________ , 200 1998 -------------------------------------------------------------------- ---------------------- ------------------------------------------------------------------------------------------------------------------------- NOTE: FAILURE TO COMPLETE AND RETURN THE SUBSTITUTE THIS FORM W-9 MAY RESULT IN BACKUP WITHHOLDING TAX OF 3031% OF ANY PAYMENTS MADE TO YOU PURSUANT TO YOUR SUBSCRIPTION FOR COMMON STOCKYOU. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS. Guidelines for Determining the Proper Identification Number 8 GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 WHAT IS BACKUP WITHHOLDING? -- Persons making certain payments to Give the Payeryou are required to withhold and pay to IRS 31% of such payments under certain conditions. The taxpayer identification number for an individual This is the individual’s Social Security numbercalled "backup withholding." Payments that could be subject to backup withholding include interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include real estate transactions. Social Security numbers have nine digits separated by two hyphens: e.g., 000-00-0000. The taxpayer identification number for an entity is the entity’s Employer Identification number. Employer Identification numbers have nine digits separated by only one hyphen: e.g., 00-0000000. The table below will help determine the number to If you give the payerrequester your correct TIN, make the appropriate certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: (1) You do not furnish your TIN to the requester, or (2) IRS notifies the requester that you furnished an incorrect TIN, or (3) You are notified by IRS that you are subject to backup withholding because you failed to report all your interest and dividends on your tax return (for interest and dividend accounts only), or (4) You fail to certify to the requester that you are not subject to backup withholding under (3) above (for interest and dividend accounts opened after 1983 only), or (5) You fail to certify your TIN. This applies only to interest, dividend, broker or barter exchange accounts opened after 1983, or broker accounts considered inactive in 1983. For other payments, you are subject to backup withholding only if (1) or (2) above applies. Certain Payees and payments are exempt from backup withholding and information reporting. See payees and Payments Exempt From Backup Withholding, below, and Exempt Payees and Payments under Specific Instructions below if you are an exempt payee. PAYEES AND PAYMENTS EXEMPT FROM BACKUP WITHHOLDING. -- The following is a list of payees exempt from backup withholding and for which no information reporting is required. For interest and dividends, all listed payees are exempt except item (9). For broker transactions, payees listed in (1) through (13), and a person registered under the Investment Advisers Act of 1940 who regularly acts as a broker are exempt. Payments subject to reporting under sections 6041 and 6041A are generally exempt from backup withholding only if made to payees described in items (1) through (7), except that a corporation that provides medical and health care services or bills and collects payments for such services is not exempt from backup withholding or information reporting. Only payees described in items (2) through (6) are exempt from backup withholding for barter exchange transactions, patronage dividends, and payments by certain fishing boat operators.
Appears in 1 contract
Sources: Letter of Transmittal (Hudson Respiratory Care Inc)