DO NOT SUBMIT TO THE IRS - THE CITY OF NEW YORK
SUBMIT FORM TO THE
NEW YORK CITY AGENCY
SUBSTITUTE FORM W-9:
10/14 REVISION REQUEST FOR TAXPAYER IDENTIFICATION NUMBER & CERTIFICATION
TYPE OR PRINT INFORMATION NEATLY. PLEASE REFER TO INSTRUCTIONS FOR MORE INFORMATION.
Part I: Vendor Information
1. Legal Business Name: (As it appears on IRS EIN records, IRS Letter CP575, 2. If you use DBA, please list below:
IRS Letter 147C -or- Social Security Administration Records, Social Security Card)
3. Entity Type (Check one only): Church or Church-Controlled Organization Personal Service Corporation
Non-Profit Corporation/ City of New York Individual/
Government Trust
Corporation LLC Employee Sole Proprietor
Partnership/ Single Member LLC Resident/Non- Non-United States
Joint Venture Estate
LLC (Individual) Resident Alien Business Entity
Part II: Taxpayer Identification Number & Taxpayer Identification Type
1. Enter your TIN here: (DO NOT USE DASHES)
2. Taxpayer Identification Type (check appropriate box):
Employer ID Number (EIN) Social Security Number (SSN) Individual Taxpayer ID Number (ITIN) N/A (Non-United States Business Entity)
Part III: Vendor Addresses
Number, Street, and Apartment or Suite Number City, State,and Nine Digit Zip Code or Country
1. 1099 Address:
Number, Street, and Apartment or Suite Number City, State,and Nine Digit Zip Code or Country
2. Account Administrator Address:
Number, Street, and Apartment or Suite Number City, State,and Nine Digit Zip Code or Country
3. Billing, Ordering & Payment Address:
Part IV: Exemption from Backup Withholding and FATCA Reporting (See Instructions)
Exemption Code for Backup Withholding Exemption Code for FATCA Reporting
Part V: Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct Taxpayer Identification Number, 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 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 US citizen or other US person, and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
Sign
Here:
Signature Phone Number Date
Print Preparer's Name Phone Number Contact's E-Mail Address:
FOR SUBMITTING AGENCY USE ONLY
Submitting Contact
Agency Code: Person:
Contact's E- Telephone ( )
Mail Address: Number:
Payee/Vendor Code:
DO NOT FORWARD W-9 TO COMPTROLLER'S OFFICE. AGENCIES MUST ATTACH COMPLETED W-9 FORMS TO THEIR FMS DOCUMENTS.
The City of New York
Substitute Form W-9 Instructions
The City of New York, like all organizations that file an information return with the IRS, must obtain your correct Taxpayer
Identification Number (TIN) to report income paid to you or your organization. The City uses Substitute Form W-9 to
obtain certification of your TIN in order to ensure accuracy of information contained in its payee/vendor database and to
avoid Backup Withholding as mandated by the IRS.* We ask for the information on the Substitute Form W-9 to carry out
the Internal Revenue laws of the United States (Rev. Proc. 84-65 §11.01). You are required to give us the information.
Any vendor or other payee who wishes to do business with the City of New York must complete the Substitute Form W-9.
Part I: Vendor Information
1.Legal Business Name: An organization should enter the name in IRS records, IRS Letter CP575 or IRS Letter 147C.
For individuals, enter the name of the person who will do business with the City of New York as it appears on the Social
Security card, or other required Federal tax documents. Do not abbreviate names.
2.DBA (Doing Business As): Enter your DBA in designated line, if applicable.
3.Entity Type: Mark the Entity Type of the individual or organization that will do business with the City of New York.
Part II: Taxpayer Identification Number and Taxpayer Identification Type
1.Taxpayer Identification Number: Enter your nine-digit TIN. See the table and Special Note below for instructions on
the type of taxpayer number you should report.
2.Taxpayer Identification Type: Mark the appropriate option.
The following table gives the Taxpayer Identification Type that is appropriate for each Entity Type.
Entity Type Taxpayer Identification Type
Church or Church-Controlled Organization
Personal Service Corporation
Non-Profit Corporation
Corporation / LLC
Government
Individual/Sole Proprietor who has employees other than him or herself Employer Identification Number
Trust
Joint Venture
Partnership / LLC
Single Member LLC who has employees other than him or herself
Estate
City of New York Employee
Individual/Sole Proprietor who does not have employees other than him or herself Social Security Number
Single Member LLC who does not have employees other than him or herself
Resident Alien/Non-Resident Individual Tax Identification Number
Non-United States Business Entity N/A
Custodian account of a minor The minor's Social Security Number
Part III: Vendor Addresses
1. List the locations for tax reporting purposes, administrative and where payments should be delivered.
Part IV: Backup Withholding and FATCA Exemptions
If you are exempt from Backup Withholding and/or FATCA reporting, enter in the Exemptions box, any code(s) that may
apply to you.
Backup Withholding Exemption Codes: Generally, Individuals (including Sole Proprietors) are not exempt from
Backup Withholding. Additionally, Corporations are not exempt from Backup Withholding when supplying legal or
medical services. If you do not fall under the categories below, leave this field blank.
The following codes identify payees that are exempt from Backup Withholding:
1: An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the
account satisfies the requirements of section 401(f)(2)
2: The United States or any of its agencies or instrumentalities
* Backup Withholding - According to IRS Regulations, ACS must withhold 28% of all payments if a vendor or payee fails to provide ACS its certified TIN.
The Substitute Form W-9 certifies a vendor/payee's TIN.
Page 1 of 2 10/14 Revision
The City of New York
Substitute Form W-9 Instructions
3: A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or
Instrumentalities
4: A foreign government or any of its political subdivisions, agencies, or instrumentalities
5: A corporation
6: A dealer in securities or commodities required to register in the United States, the District of Columbia, or a
possession of the United States
7: A futures commission merchant registered with the Commodity Futures Trading Commission
8: A real estate investment trust
9: An entity registered at all times during the tax year under the Investment Company Act of 1940
10: A common trust fund operated by a bank under section 584(a)
11: A financial institution
12: A middleman known in the investment community as a nominee or custodian
13: A trust exempt from tax under section 664 or described in section 4947
FATCA Exemption Codes: The following codes identify payees that are exempt from reporting under FATCA. These
codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign
financial institutions. If you are only submitting this form for an account you hold in the United States, leave this
field blank.
The following codes identify payees that are exempt from FATCA Reporting:
A: An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section
7701(a)(37)
B: The United States or any of its agencies or instrumentalities
C: A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or
instrumentalities
D: A corporation the stock of which is regularly traded on one or more established securities markets, as described in
Reg. section 1.1472-1(c)(1)(i)
E: A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section
1.1472-1(c)(1)(i)
F: A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures,
forwards, and options) that is registered as such under the laws of the United States or any state
G: A real estate investment trust
H: A regulated investment company as defined in section 851 or an entity registered at all times during the tax year
under the Investment Company Act of 1940
I: A common trust fund as defined in section 584(a)
J: A bank as defined in section 581
K: A broker
L: A trust exempt from tax under section 664 or described in section 4947(a)(1)
M: A tax exempt trust under a section 403(b) plan or section 457(g) plan
Part V: Certification
Please sign and date form in appropriate space. Provide preparer's name, telephone number, and e-mail address.
Preparer should be employed by organization.
* Backup Withholding - According to IRS Regulations, ACS must withhold 28% of all payments if a vendor or payee fails to provide ACS its certified TIN.
The Substitute Form W-9 certifies a vendor/payee's TIN.
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