W-9 Form

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Do you already have a completed W-9 that you would like to upload? *

Name of Business or Individual *

Which City Employee Hired you? *

Click Below to Upload W-9 *

Browse Files

Are you doing work for our Public Works Department (ex. Electric, Sewer, Water, Streets, Engineering) *

Yes No

An image of Form W-9 is displayed below. This image is meant to be used for informational purposes only. You are required to enter your taxpayer information in the section below the image.

Full Name (as shown on your income tax return) *

First Name Last Name

Business name/disregarded entity name, if different from above

Check appropriate box for federal tax classification: *

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

(Note: for a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner.)

If you selected "Limited Liability Company" above, enter the tax classification below *

C Corportation S Corportation Partnership

Are you exempt from backup withholding and/or FATCA reporting? *

Yes No

Exemptions (codes apply only to certain entitites, not individuals; see instructions on page 3):

	Code
Exempt payee code (if any)
Exemption from FATCA reporting code (if any)

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

List account number(s) here (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 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 instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.

Which of the following do you operate your business under?

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 below); and

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

Certification instructions. You must 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 interest 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 required to sign the certification, but you must provide your correct TIN. See the instructions on page 3.

Signature of U.S. person *

Clear

Date *

Date

Click here to see the General Instructions for the W-9 form.

Form W-9

W-9 Request for Taxpayer Identification Number and Certification