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Form UU-S Requestfor Taxpayer (Rev. January 2011) Department of theTreasury Intemal Revenue Service Name (as shown on your incone tax refum) H*ft E?E-f 's Ha.csi*€B: K*r*s, ?rc*. Business name/disregarded entity name, if different from above I rxempt payee Requestefs name ard address (optionaD Ust account number(s) here (optional) ldentification Number fflN] Enter your TIN in the appropriate box- The TIN provided must match the name given on the "Name" line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see tFe Part I instruetions on page 3. furother entities, it is your employer identification number (ElN). lf you do not have a number, see How to get a I/N on page 3. Under penalties of p€rjury, I certifythat 1. Thonumb€.stptfln on thls fom ls nV corEt ia)eEEr identificatonnumb€r (or I am waitingio( a number to be issu€d to rne), and 2. I am not subl€ct to bacl(Jp withholdirq because: (a)| am €r<emd fiom baclqp withhobing,or (b) I ha,e not b€€nmfified by tho Intemal R€wnue Servic€ (lRS) that I am subj€ct to bachrp wlthholding as a r€suh of a failur€ to r€portall int€{est or dividends, or (c)tho IFS has notili€dme that | 8m no long€r sutiect to bacl(lp withholding, and 3. I am a U.S.c$zen or otherU.S. pqson (d€fined belou4. Corlificalion lEtnrclioB. You must cro6s out ii8m 2 aboveif you hsvebeen nottfied by tle IRS hd ),ou ale cun€rtly subi€ot to bqd(up wittfiolding b€causo )/ou haw tailedto r€portall interEt and divid$tds on yeur tax retum,For real6tato transactions, itern2 dos not apply,For mortgag6 int€t6t paid,acqulsitlon or abandonm€ri of s€c{rcd prop€rty, canodlatbn of d€bt, coflkihnbns to an individual rgtir€rnsf arang€rEnt (liv[), and 96fi€rally, paymqts otherthan int€r€st ard dMdonds, you arc mt rcquir€d to sign ltle cstificatlon, ht you must prq,ide your conect lH. Sebttre instructions on page 4. ldentification Number and Gertifieation Give Form to the requester. Do not send to tfre lRS, c\l o o, {E o. C o ^9, t9c 3c} Efl : o oi ? -o' o'o !E () o o. CI' o o U' [nm Sign Here Generallnstructions Section references are to the Internal RevenueCode unless otherwise noted.. Purpose of Form A person who is required to file an information retum with the IRS must obtain your correct taxpayer identificatiOn number [tlN) to report, for example, income paid to you, realestate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or oontribtrtions you made to an lRA. Use Form W-9 only if you are a U.S" peron (includirg a resident alien),to provide yourconect TIN to tte person requesting it (the requester) and, when applirxble, to: 1. Certiry that the TIN you are giving is conect (or you are waiting for a numberto be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption ftom backup withhofding if you are a U.S. exernpt payee. lf applieble, you are also certifying that as a U.S. person, your allocable $hare of any partnership income from a U.S. trade or tnrsiness is not subject to the withholding tax on foreign partners'share of effectively connected income. Dare> 7*ll -l( Note. lf a requester gives you a form other than Form W-g to request your TlN, you must use the reguester's form if it is substantially similar to this Form W.9. Definition of a U.S. penson. For federal tax puryoses, you are considered a U.S. per$on if you are: o An individualwho is a U.S. citizen or U.S. resident alien, o A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, e An estate (other than a foreign etate), or o A domestic trust (ds defined in Regrulations section 901.7701-Z). Specid rulesfor partnerships, Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on anyforeQn partners'share of income from such business. Furfter, in certain cases where a FomrW-g has not been received, a patnaship b reqlired to presume that a parher is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership cor,ductirg a trade or brsiness in the United States, provide Form W-9 to the parfership to establish your U.S. status ard avoid withholdirE oill lour share of prtnership income. Check appropnate box forfederal tax classification (required): fl ndiviOuaysote proprietor fl C Corporation ff S Gorporatton tr Partnership I Trusyestate f] UmiteO liability company. Enter the tax classification {C=C corporation, S=S corporation, P=partnership) } fl Otner (see instructions) ) Address (number, street, and apt. or suite no) S€S* AErg;=*r: Fr**""*;*3r, 5a*5E* G City, state, and ZP code $*eEE**tr ***9, Fli ?S€ €? Note- lf the account is in more than one name, see the chart on page 4 for guidelines on whose numberto enter.
1

Form UU-S Request for Taxpayer requester. Do notcbspress.net/kennyskustomkards/wp-includes/images/linkedfiles/New... · Form UU-S Request for Taxpayer (Rev. January 2011) ... entities,

Mar 10, 2018

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Page 1: Form UU-S Request for Taxpayer requester. Do notcbspress.net/kennyskustomkards/wp-includes/images/linkedfiles/New... · Form UU-S Request for Taxpayer (Rev. January 2011) ... entities,

Form UU-S Request for Taxpayer(Rev. January 2011)Department of the TreasuryIntemal Revenue Service

Name (as shown on your incone tax refum)

H*ft E?E-f 's Ha.csi*€B: K*r*s, ?rc*.Business name/disregarded entity name, if different from above

I rxempt payee

Requestefs name ard address (optionaD

Ust account number(s) here (optional)

ldentification Number fflN]Enter your TIN in the appropriate box- The TIN provided must match the name given on the "Name" lineto avoid backup withholding. For individuals, this is your social security number (SSN). However, for aresident alien, sole proprietor, or disregarded entity, see tFe Part I instruetions on page 3. furotherentities, it is your employer identification number (ElN). lf you do not have a number, see How to get aI/N on page 3.

Under penalties of p€rjury, I certify that1. Tho numb€.stptfln on thls fom ls nV corEt ia)eEEr identificaton numb€r (or I am waiting io( a number to be issu€d to rne), and2. I am not subl€ct to bacl(Jp withholdirq because: (a) | am €r<emd fiom baclqp withhobing, or (b) I ha,e not b€€n mfified by tho Intemal R€wnue

Servic€ (lRS) that I am subj€ct to bachrp wlthholding as a r€suh of a failur€ to r€port all int€{est or dividends, or (c) tho IFS has notili€d me that | 8mno long€r sutiect to bacl(lp withholding, and

3. I am a U.S. c$zen or other U.S. pqson (d€fined belou4.Corlificalion lEtnrclioB. You must cro6s out ii8m 2 above if you hsve been nottfied by tle IRS hd ),ou ale cun€rtly subi€ot to bqd(up wittfioldingb€causo )/ou haw tailed to r€port all interEt and divid$tds on yeur tax retum, For real 6tato transactions, itern 2 dos not apply, For mortgag6int€t6t paid, acqulsitlon or abandonm€ri of s€c{rcd prop€rty, canodlatbn of d€bt, coflkihnbns to an individual rgtir€rnsf arang€rEnt (liv[), and96fi€rally, paymqts other than int€r€st ard dMdonds, you arc mt rcquir€d to sign ltle cstificatlon, ht you must prq,ide your conect lH. Seb ttreinstructions on page 4.

ldentification Number and GertifieationGive Form to therequester. Do notsend to tfre lRS,

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General lnstructionsSection references are to the Internal Revenue Code unless otherwisenoted..

Purpose of FormA person who is required to file an information retum with the IRS mustobtain your correct taxpayer identificatiOn number [tlN) to report, forexample, income paid to you, realestate transactions, mortgage interestyou paid, acquisition or abandonment of secured property, cancellationof debt, or oontribtrtions you made to an lRA.

Use Form W-9 only if you are a U.S" peron (includirg a residentalien), to provide yourconect TIN to tte person requesting it (therequester) and, when applirxble, to:

1. Certiry that the TIN you are giving is conect (or you are waiting for anumberto be issued),

2. Certify that you are not subject to backup withholding, or3. Claim exemption ftom backup withhofding if you are a U.S. exernpt

payee. lf applieble, you are also certifying that as a U.S. person, yourallocable $hare of any partnership income from a U.S. trade or tnrsinessis not subject to the withholding tax on foreign partners'share ofeffectively connected income.

Dare> 7*l l - l (

Note. lf a requester gives you a form other than Form W-g to requestyour TlN, you must use the reguester's form if it is substantially similarto this Form W.9.Definition of a U.S. penson. For federal tax puryoses, you areconsidered a U.S. per$on if you are:o An individualwho is a U.S. citizen or U.S. resident alien,o A partnership, corporation, company, or association created ororganized in the United States or under the laws of the United States,e An estate (other than a foreign etate), oro A domestic trust (ds defined in Regrulations section 901.7701-Z).Specid rulesfor partnerships, Partnerships that conduct a trade orbusiness in the United States are generally required to pay a withholdingtax on anyforeQn partners'share of income from such business.Furfter, in certain cases where a FomrW-g has not been received, apatnaship b reqlired to presume that a parher is a foreign person,and pay the withholding tax. Therefore, if you are a U.S. person that is apartner in a partnership cor,ductirg a trade or brsiness in the UnitedStates, provide Form W-9 to the parfership to establish your U.S.status ard avoid withholdirE oill lour share of prtnership income.

Check appropnate box forfederal tax

classification (required): fl ndiviOuaysote proprietor fl C Corporation ff S Gorporatton tr Partnership I Trusyestate

f] UmiteO liability company. Enter the tax classification {C=C corporation, S=S corporation, P=partnership) }

fl Otner (see instructions) )Address (number, street, and apt. or suite no)

S€S* AErg;=*r: Fr**""*;*3r, 5a*5E* GCity, state, and ZP code

$*eEE**tr ***9, Fli ?S€ € ?

Note- lf the account is in more than one name, see the chart on page 4 for guidelines on whosenumberto enter.