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Full title: Certificate of service (re:1572 Order confirming chapter 11 plan) filed by Donlin Recano & Company, Inc.. (Donlin, Recano & Company Inc) (Entered: 05/25/2021)
Document posted on May 24, 2021 in the bankruptcy, 15 pages and 0 tables.
Bankrupt11 Summary (Automatically Generated)
We write to request that you complete the enclosed IRS Form W-9 (or, if applicable, complete an IRS Form W-8 for non-U.S. creditors) supplying your TIN and other information, and send or upload the completed form to the Trust at either the mailing address or secure website set forth on the reverse side of this letter.urpose of Form •Form 1099-K (merchant card and third party network transactions)n individual or entity (Form W-9 requester) who is required to file an •Form 1098 (home mortgage interest), 1098-E (student loan interest),formation return with the IRS must obtain your correct taxpayer 1098-T (tuition)entification number (TIN) which may be your social security number •Form 1099-C (canceled debt)SN), individual taxpayer identification number (ITIN), adoption •Form 1099-A (acquisition or abandonment of secured property)xpayer identification number (ATIN), or employer identification number IN), to report on an information return the amount paid to you, or other If you are a nonresident alien or a foreign entity, give the requester than Form W-9 to request your TIN, you must use the requester’s form if appropriate completed Form W-8 or Form 8233. In the case of a grantor trust with a U.S. grantor or other U.S. owner, enerally, the U.S. grantor or other U.S. owner of the grantor trust and Certain payees and payments are exempt from backup withholding.For example, if a foreign LLC that is treated as a disregarded 1—An organization exempt from tax under section 501(a), any IRA, or ntity for U.S. federal tax purposes has a single owner that is a U.S. a custodial account under section 403(b)(7) if the account satisfies the erson, the U.S. owner's name is required to be provided on line 1.
List of Tables
Document ContentsFOR THE DISTRICT OF MINNESOTA Jointly Administered Under In re: Case No. 17-30673 (MER) Gander Mountain Company, Case No. 17-30673 Overton’s, Inc., Case No. 17-30675 Debtors. Chapter 11 Cases AFFIDAVIT OF SERVICE STATE OF NEW YORK ) ) ss: COUNTY OF KINGS ) I, John Burlacu, declare: 1. I am over the age of 18 years and not a party to this case. 2. I am employed by Donlin, Recano & Company, Inc., (“DRC”), 6201 15th Avenue, Brooklyn, NY 11219. 3. On the 13th day of May, 2021, DRC, at my direction and under my supervision, employees of DRC caused to be served the following materials via electronic mail upon the parties set forth on Exhibit 3, attached hereto: a) W8-W9 Request Cover Letter (the “Cover Letter”), attached hereto as Exhibit 1; b) W9 Form (the “W9 Form”), attached hereto as Exhibit 2; and
1knowledge. Executed this 24th day of May, 2021, Brooklyn, New York. By ________________________ John Burlacu Sworn before me this 24th day of May, 2021 _____________________ Notary Public
3April 23, 2021 *** Time-Sensitive – R esponse Required *** Re: In re Gander Mountain Company and In re Overton’s, Inc. Case No. 17-30673 (MER) – Request for IRS Form W-9 (or, if applicable, IRS Form W-8) Dear Creditor: META Advisors LLC serves as trustee (the “Liquidating Trustee”) appointed by the United States Bankruptcy Court for the District of Minnesota (the “Bankruptcy Court”) under the Debtors’ and Official Committee of Unsecured Creditors’ Joint Chapter 11 Plan of Liquidation Dated October 31, 2017 (as confirmed, the “Plan”) in the chapter 11 cases of Gander Mountain Company and Overton’s, Inc. (the “Bankruptcy Cases”). The Plan was confirmed by order of the Bankruptcy Court on January 26, 2018 and became effective on February 8, 2018. On the effective date of the Plan, the Gander Mountain Liquidating Trust (the “Trust”) was established. To comply with any applicable tax withholding, payment and reporting requirements imposed by any federal, state, provincial, local or foreign taxing authority, the Plan and its ancillary documents provide that the Liquidating Trustee may require the holder of an Allowed general unsecured claim to complete and return to the Trust an appropriate tax form evidencing such holder’s taxpayer identification number (“TIN”). Please be advised that the fact that you are receiving this letter does not mean that your claim has been Allowed or is presently entitled to a distribution. We write to request that you complete the enclosed IRS Form W-9 (or, if applicable, complete an IRS Form W-8 for non-U.S. creditors) supplying your TIN and other information, and send or upload the completed form to the Trust at either the mailing address or secure website set forth on the reverse side of this letter. Please be sure to use the enclosed form or a current IRS form, the latest revision of which (for Form W-9) was October 2018. [Please note: for Form W-9, older versions prior to the October 2018 version will not be accepted]. Additional copies of IRS forms are available at: (i) for Form W-9, https://www.irs.gov/forms-pubs/about-form-w9; and (ii) for Form W-8, https://www.irs.gov/forms-pubs/about-form-w8. Your completed form must be received by the Liquidating Trustee within 90 days, i.e., no later than July 22, 2021. As explained below, if you fail to send the completed form timely, you risk forfeiting your right to all distributions from the Trust. The Trust is a grantor, liquidating trust and, as such, needs your TIN to be able to fulfill its tax reporting obligations under IRS Revenue Procedure 94-45, 1994-2 C.B. 684, and U.S. Treasury Regulations sections 1.671-4(a) and 301.7701-4(d). If you are a business, your TIN is likely your employer tax identification number. If you are an individual, your TIN is likely your social security number. If you are unsure of your TIN or need help completing the Form W-9 (or, if applicable, Form W-8), please consult with your tax advisor. Please understand that the Liquidating Trustee requires your completed Form W-9 (or, if applicable, completed Form W-8), including your TIN, before making any distribution to you. If the taxpayer name that you indicate on Line 1 of your Form W-9 (or, if applicable, W-8) is different from the name to which this mailing is addressed, please write the addressee name at the very top of the form you are returning. Also, please remember to sign and date your form and to use the most current IRS form.
4Your completed Form W-9 (or, if applicable, Form W-8) must be sent by mail to the Trust’s solicitation agent at the address below or uploaded to the Trust’s secure website. If sending by regular mail, you may direct your completed form to this address: Donlin Recano & Company, Inc. Re: Gander Mountain Liquidating Trust Attn: W-9 Processing P.O. Box 199043 Blythebourne Station Brooklyn, New York 11219 Alternatively, you may upload your completed form to this secure website maintained for the Trust by the Liquidating Trustee’s affiliate, Kelley Drye & Warren LLP, in .pdf format: https://kelleydryewarren.sharefile.com/r-r99e559abbf147738 Please do not fax or email the completed tax form, because it is not a secure way to transmit or receive the form. As noted above, the Liquidating Trustee must receive your current executed Form W-9 (or, if applicable, Form W-8) by July 22, 2021. Under the terms and conditions of the trust agreement and the Plan, failure to provide a current executed form by such date will result in a forfeiture of your right to receive any reserved or future distribution from the Trust under the Plan. Any such forfeited distribution will revert to the Trust for distribution to other creditors that are beneficiaries of the Trust, and your general unsecured claim will be waived, discharged and barred without further order of the Bankruptcy Court. Additionally, if your address changes, it is your responsibility to notify us. If a distribution check is returned to us because of an incorrect address and you do not provide a correct address, eventually your right to that distribution and any further distribution will be forfeited under the relevant provisions of the Plan. Finally, if you would like a copy of the Plan or the order confirming the Plan, those documents are available free of charge here: https://www.donlinrecano.com/Clients/gmc/Dockets If you have any questions about which form to use or the legal or tax implications of the information provided on the form, you should contact your attorney or tax advisor. Neither the Liquidating Trustee nor its advisors will provide advice concerning those matters. Sincerely, META Advisors LLC, not individually, but solely as Liquidating Trustee of the Gander Mountain Liquidating Trust Enclosure
6epartment of the Treasury send to the IRS. ternal Revenue Service (cid:97) Go to www.irs.gov/FormW9 for instructions and the latest information. 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 abovee 3. 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to g following seven boxes. certain entities, not individuals; see pa instructions on page 3): on Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estates single-member LLC Exempt payee code (if any) n o cti Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) (cid:97) ru Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reportingc Inst LaisnL doCits hirfe etrgh LaeLr LdCLe Cdth fairsto cimsla ntshoseitf idoewids rnaeesgr a asr hdsoienudgl dlfer -ocmmhee ctmhkeb t ehorew L naLpeCrp frtoohrpa tUr iia.sSt ed. ifbseordexeg rfaaorlrd tteahdxe pftrauoxrmp co tlashesess oi.f wiOcnathetiero rnuw noilsefe si,ts sa t ohswein ngoelwer.-nmere omf btheer LLLLCC tihsa t code (if any)ecifi Other (see instructions) (cid:97) (Applies to accounts maintained outside the U.S.)Sp 5 Address (number, street, and apt. or suite no.) See instructions. Requester’s name and address (optional)e e S 6 City, state, and ZIP code 7 List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) nter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security numberackup withholding. For individuals, this is generally your social security number (SSN). However, for a sident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other – –ntities, it is your employer identification number (EIN). If you do not have a number, see How to get a IN, later. or ote: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number umber To Give the Requester for guidelines on whose number to enter. – art II Certification nder penalties of perjury, I certify that: .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.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 RevenueService (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 ano longer subject to backup withholding; and .I am a U.S. citizen or other U.S. person (defined below); and.The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. ertification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding becausu 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, cquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments ther than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later. ign Signature of ere U.S. person (cid:97) Date (cid:97) eneral Instructions •Form 1099-DIV (dividends, including those from stocks or mutualfunds) ection references are to the Internal Revenue Code unless otherwise •Form 1099-MISC (various types of income, prizes, awards, or grossoted. proceeds) uture developments. For the latest information about developments •Form 1099-B (stock or mutual fund sales and certain otherlated to Form W-9 and its instructions, such as legislation enacted transactions by brokers)fter they were published, go to www.irs.gov/FormW9. •Form 1099-S (proceeds from real estate transactions) urpose of Form •Form 1099-K (merchant card and third party network transactions)n individual or entity (Form W-9 requester) who is required to file an •Form 1098 (home mortgage interest), 1098-E (student loan interest),formation return with the IRS must obtain your correct taxpayer 1098-T (tuition)entification number (TIN) which may be your social security number •Form 1099-C (canceled debt)SN), individual taxpayer identification number (ITIN), adoption •Form 1099-A (acquisition or abandonment of secured property)xpayer identification number (ATIN), or employer identification number IN), to report on an information return the amount paid to you, or other Use Form W-9 only if you are a U.S. person (including a residentmount reportable on an information return. Examples of information alien), to provide your correct TIN. turns include, but are not limited to, the following.
71. Certify that the TIN you are giving is correct (or you are waiting for a exemption from tax for scholarship income received by a Chinese umber to be issued), student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay i2. Certify that you are not subject to backup withholding, or the United States exceeds 5 calendar years. However, paragraph 2 of 3. Claim exemption from backup withholding if you are a U.S. exempt the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows ayee. If applicable, you are also certifying that as a U.S. person, your the provisions of Article 20 to continue to apply even after the Chinese llocable share of any partnership income from a U.S. trade or business student becomes a resident alien of the United States. A Chinese not subject to the withholding tax on foreign partners' share of student who qualifies for this exception (under paragraph 2 of the first ffectively connected income, and protocol) and is relying on this exception to claim an exemption from ta4. Certify that FATCA code(s) entered on this form (if any) indicating on his or her scholarship or fellowship income would attach to Form at you are exempt from the FATCA reporting, is correct. See What is W-9 a statement that includes the information described above to ATCA reporting, later, for further information. support that exemption. ote: If you are a U.S. person and a requester gives you a form other If you are a nonresident alien or a foreign entity, give the requester than Form W-9 to request your TIN, you must use the requester’s form if appropriate completed Form W-8 or Form 8233. is substantially similar to this Form W-9. Backup Withholdingefinition of a U.S. person. For federal tax purposes, you are onsidered a U.S. person if you are: What is backup withholding? Persons making certain payments to yomust under certain conditions withhold and pay to the IRS 24% of suc An individual who is a U.S. citizen or U.S. resident alien;payments. This is called “backup withholding.” Payments that may be A partnership, corporation, company, or association created or subject to backup withholding include interest, tax-exempt interest, rganized in the United States or under the laws of the United States; dividends, broker and barter exchange transactions, rents, royalties, An estate (other than a foreign estate); or nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing bo A domestic trust (as defined in Regulations section 301.7701-7). operators. Real estate transactions are not subject to backup pecial rules for partnerships. Partnerships that conduct a trade or withholding. usiness in the United States are generally required to pay a withholding You will not be subject to backup withholding on payments you x under section 1446 on any foreign partners’ share of effectively receive if you give the requester your correct TIN, make the proper onnected taxable income from such business. Further, in certain cases certifications, and report all your taxable interest and dividends on yourhere a Form W-9 has not been received, the rules under section 1446 tax return. quire a partnership to presume that a partner is a foreign person, and ay the section 1446 withholding tax. Therefore, if you are a U.S. person Payments you receive will be subject to backup withholding if: at is a partner in a partnership conducting a trade or business in the 1. You do not furnish your TIN to the requester,nited States, provide Form W-9 to the partnership to establish your 2. You do not certify your TIN when required (see the instructions for .S. status and avoid section 1446 withholding on your share of Part II for details), artnership income. 3. The IRS tells the requester that you furnished an incorrect TIN,In the cases below, the following person must give Form W-9 to the artnership for purposes of establishing its U.S. status and avoiding 4. The IRS tells you that you are subject to backup withholding ithholding on its allocable share of net income from the partnership because you did not report all your interest and dividends on your tax onducting a trade or business in the United States. return (for reportable interest and dividends only), or In the case of a disregarded entity with a U.S. owner, the U.S. owner 5. You do not certify to the requester that you are not subject to f the disregarded entity and not the entity; backup withholding under 4 above (for reportable interest and dividendaccounts opened after 1983 only). In the case of a grantor trust with a U.S. grantor or other U.S. owner, enerally, the U.S. grantor or other U.S. owner of the grantor trust and Certain payees and payments are exempt from backup withholding. ot the trust; and See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information. In the case of a U.S. trust (other than a grantor trust), the U.S. trust ther than a grantor trust) and not the beneficiaries of the trust. Also see Special rules for partnerships, earlier. oreign person. If you are a foreign person or the U.S. branch of a What is FATCA Reporting? reign bank that has elected to be treated as a U.S. person, do not use orm W-9. Instead, use the appropriate Form W-8 or Form 8233 (see The Foreign Account Tax Compliance Act (FATCA) requires a ub. 515, Withholding of Tax on Nonresident Aliens and Foreign participating foreign financial institution to report all United States ntities). account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCAonresident alien who becomes a resident alien. Generally, only a reporting code, later, and the Instructions for the Requester of Form onresident alien individual may use the terms of a tax treaty to reduce W-9 for more information. r eliminate U.S. tax on certain types of income. However, most tax eaties contain a provision known as a “saving clause.” Exceptions Updating Your Informationpecified in the saving clause may permit an exemption from tax to ontinue for certain types of income even after the payee has otherwise You must provide updated information to any person to whom you ecome a U.S. resident alien for tax purposes. claimed to be an exempt payee if you are no longer an exempt payee If you are a U.S. resident alien who is relying on an exception and anticipate receiving reportable payments in the future from this ontained in the saving clause of a tax treaty to claim an exemption person. For example, you may need to provide updated information if om U.S. tax on certain types of income, you must attach a statement you are a C corporation that elects to be an S corporation, or if you no Form W-9 that specifies the following five items. longer are tax exempt. In addition, you must furnish a new Form W-9 if 1. The treaty country. Generally, this must be the same treaty under the name or TIN changes for the account; for example, if the grantor of hich you claimed exemption from tax as a nonresident alien. grantor trust dies. 2. The treaty article addressing the income. Penalties 3. The article number (or location) in the tax treaty that contains the aving clause and its exceptions. Failure to furnish TIN. If you fail to furnish your correct TIN to a 4. The type and amount of income that qualifies for the exemption requester, you are subject to a penalty of $50 for each such failure om tax. unless your failure is due to reasonable cause and not to willful neglect. 5. Sufficient facts to justify the exemption from tax under the terms of Civil penalty for false information with respect to withholding. If yo
8ertifications or affirmations may subject you to criminal penalties a(n) . . .
• Sole proprietorship, or
• Single-member limited liability
company (LLC) owned by an
individual and disregarded for U.S.
federal tax purposes.
|• LLC treated as a partnership for
U.S. federal tax purposes,
• LLC that has filed Form 8832 or
2553 to be taxed as a corporation,
• LLC that is disregarded as an
entity separate from its owner but
the owner is another LLC that is
not disregarded for U.S. federal tax
9om backup withholding. The chart applies to the exempt payees listed planbove, 1 through 13. Note: You may wish to consult with the financial institution requesting the payment is for . . . THEN the payment is exempt this form to determine whether the FATCA code and/or exempt payee for . . . code should be completed. terest and dividend payments All exempt payees except Line 5for 7 Enter your address (number, street, and apartment or suite number). roker transactions Exempt payees 1 through 4 and 6 This is where the requester of this Form W-9 will mail your information through 11 and all C corporations. returns. If this address differs from the one the requester already has oS corporations must not enter an file, write NEW at the top. If a new address is provided, there is still a exempt payee code because they chance the old address will be used until the payor changes your are exempt only for sales of address in their records. noncovered securities acquired Line 6 prior to 2012. Enter your city, state, and ZIP code. arter exchange transactions and Exempt payees 1 through 4 atronage dividends Part I. Taxpayer Identification Number (TIN)ayments over $600 required to be Generally, exempt payees Enter your TIN in the appropriate box. If you are a resident alien and ported and direct sales over 1 through 52 you do not have and are not eligible to get an SSN, your TIN is your IR5,0001 individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN ayments made in settlement of Exempt payees 1 through 4 below. ayment card or third party network If you are a sole proprietor and you have an EIN, you may enter eitheansactions your SSN or EIN. See Form 1099-MISC, Miscellaneous Income, and its instructions. If you are a single-member LLC that is disregarded as an entity separate from its owner, enter the owner’s SSN (or EIN, if the owner haHowever, the following payments made to a corporation and one). Do not enter the disregarded entity’s EIN. If the LLC is classified aeportable on Form 1099-MISC are not exempt from backup a corporation or partnership, enter the entity’s EIN. withholding: medical and health care payments, attorneys’ fees, gross Note: See What Name and Number To Give the Requester, later, for roceeds paid to an attorney reportable under section 6045(f), and further clarification of name and TIN combinations. ayments for services paid by a federal executive agency. How to get a TIN. If you do not have a TIN, apply for one immediately. xemption from FATCA reporting code. The following codes identify To apply for an SSN, get Form SS-5, Application for a Social Security ayees that are exempt from reporting under FATCA. These codes Card, from your local SSA office or get this form online at pply to persons submitting this form for accounts maintained outside www.SSA.gov. You may also get this form by calling 1-800-772-1213. f the United States by certain foreign financial institutions. Therefore, if Use Form W-7, Application for IRS Individual Taxpayer Identification u are only submitting this form for an account you hold in the United Number, to apply for an ITIN, or Form SS-4, Application for Employer tates, you may leave this field blank. Consult with the person Identification Number, to apply for an EIN. You can apply for an EIN questing this form if you are uncertain if the financial institution is online by accessing the IRS website at www.irs.gov/Businesses and bject to these requirements. A requester may indicate that a code is clicking on Employer Identification Number (EIN) under Starting a ot required by providing you with a Form W-9 with “Not Applicable” (or Business. Go to www.irs.gov/Forms to view, download, or print Form ny similar indication) written or printed on the line for a FATCA W-7 and/or Form SS-4. Or, you can go to www.irs.gov/OrderForms to xemption code. place an order and have Form W-7 and/or SS-4 mailed to you within 10A—An organization exempt from tax under section 501(a) or any business days. dividual retirement plan as defined in section 7701(a)(37) If you are asked to complete Form W-9 but do not have a TIN, apply B—The United States or any of its agencies or instrumentalities for a TIN and write “Applied For” in the space for the TIN, sign and dateC—A state, the District of Columbia, a U.S. commonwealth or the form, and give it to the requester. For interest and dividend ossession, or any of their political subdivisions or instrumentalities payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to D—A corporation the stock of which is regularly traded on one or the requester before you are subject to backup withholding on ore established securities markets, as described in Regulations payments. The 60-day rule does not apply to other types of payments. ction 1.1472-1(c)(1)(i) You will be subject to backup withholding on all such payments until E—A corporation that is a member of the same expanded affiliated you provide your TIN to the requester. roup as a corporation described in Regulations section 1.1472-1(c)(1)(i)Note: Entering “Applied For” means that you have already applied for aF—A dealer in securities, commodities, or derivative financial TIN or that you intend to apply for one soon. struments (including notional principal contracts, futures, forwards, Caution: A disregarded U.S. entity that has a foreign owner must use nd options) that is registered as such under the laws of the United the appropriate Form W-8. tates or any state G—A real estate investment trust Part II. Certification H—A regulated investment company as defined in section 851 or an To establish to the withholding agent that you are a U.S. person, or ntity registered at all times during the tax year under the Investment resident alien, sign Form W-9. You may be requested to sign by the ompany Act of 1940 withholding agent even if item 1, 4, or 5 below indicates otherwise. I—A common trust fund as defined in section 584(a) For a joint account, only the person whose TIN is shown in Part I J—A bank as defined in section 581 should sign (when required). In the case of a disregarded entity, the K—A broker person identified on line 1 must sign. Exempt payees, see Exempt payeecode, earlier. L—A trust exempt from tax under section 664 or described in section 947(a)(1) Signature requirements. Complete the certification as indicated in items 1 through 5 below.
10efore 1984 and broker accounts considered active during 1983. 14. Account with the Department of The public entity ou must give your correct TIN, but you do not have to sign the Agriculture in the name of a public ertification. entity (such as a state or local 2. Interest, dividend, broker, and barter exchange accounts government, school district, or pened after 1983 and broker accounts considered inactive during prison) that receives agricultural 983. You must sign the certification or backup withholding will apply. If program paymentsou are subject to backup withholding and you are merely providing our correct TIN to the requester, you must cross out item 2 in the 15. Grantor trust filing under the Form The trustertification before signing the form. 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see 3. Real estate transactions. You must sign the certification. You may Regulations section 1.671-4(b)(2)(i)(B)) ross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not 1 List first and circle the name of the person whose number you furnish. ave to sign the certification unless you have been notified that you If only one person on a joint account has an SSN, that person’s numbeave previously given an incorrect TIN. “Other payments” include must be furnished. ayments made in the course of the requester’s trade or business for 2 Circle the minor’s name and furnish the minor’s SSN. nts, royalties, goods (other than bills for merchandise), medical and ealth care services (including payments to corporations), payments to 3 You must show your individual name and you may also enter your nonemployee for services, payments made in settlement of payment business or DBA name on the “Business name/disregarded entity” ard and third party network transactions, payments to certain fishing name line. You may use either your SSN or EIN (if you have one), but thoat crew members and fishermen, and gross proceeds paid to IRS encourages you to use your SSN. ttorneys (including payments to corporations). 4 List first and circle the name of the trust, estate, or pension trust. (Do 5. Mortgage interest paid by you, acquisition or abandonment of not furnish the TIN of the personal representative or trustee unless the ecured property, cancellation of debt, qualified tuition program legal entity itself is not designated in the account title.) Also see Specialayments (under section 529), ABLE accounts (under section 529A), rules for partnerships, earlier. A, Coverdell ESA, Archer MSA or HSA contributions or *Note: The grantor also must provide a Form W-9 to trustee of trust. istributions, and pension distributions. You must give your correct Note: If no name is circled when more than one name is listed, the IN, but you do not have to sign the certification. number will be considered to be that of the first name listed. hat Name and Number To Give the Requester Secure Your Tax Records From Identity Theft For this type of account: Give name and SSN of: Identity theft occurs when someone uses your personal information 1. Individual The individual such as your name, SSN, or other identifying information, without your 2. Two or more individuals (joint The actual owner of the account or, if permission, to commit fraud or other crimes. An identity thief may use account) other than an account combined funds, the first individual on your SSN to get a job or may file a tax return using your SSN to receivemaintained by an FFI the account1 a refund. 3. Two or more U.S. persons Each holder of the account To reduce your risk: (joint account maintained by an FFI) • Protect your SSN,4. Custodial account of a minor The minor2 • Ensure your employer is protecting your SSN, and(Uniform Gift to Minors Act) • Be careful when choosing a tax preparer. 5. a. The usual revocable savings trust The grantor-trustee1 If your tax records are affected by identity theft and you receive a (grantor is also trustee) notice from the IRS, respond right away to the name and phone numbeb. So-called trust account that is not The actual owner1 printed on the IRS notice or letter. a legal or valid trust under state law If your tax records are not currently affected by identity theft but you 6. Sole proprietorship or disregarded The owner3 think you are at risk due to a lost or stolen purse or wallet, questionableentity owned by an individual credit card activity or credit report, contact the IRS Identity Theft Hotlinat 1-800-908-4490 or submit Form 14039. 7. Grantor trust filing under Optional The grantor* Form 1099 Filing Method 1 (see For more information, see Pub. 5027, Identity Theft Information for Regulations section 1.671-4(b)(2)(i) Taxpayers. (A)) Victims of identity theft who are experiencing economic harm or a For this type of account: Give name and EIN of: systemic problem, or are seeking help in resolving tax problems that 8. Disregarded entity not owned by an The owner have not been resolved through normal channels, may be eligible for individual Taxpayer Advocate Service (TAS) assistance. You can reach TAS by 9. A valid trust, estate, or pension trust Legal entity4 calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD1-800-829-4059. 0. Corporation or LLC electing The corporation Protect yourself from suspicious emails or phishing schemes. corporate status on Form 8832 or Phishing is the creation and use of email and websites designed to Form 2553 mimic legitimate business emails and websites. The most common act 1. Association, club, religious, The organization is sending an email to a user falsely claiming to be an established charitable, educational, or other tax- legitimate enterprise in an attempt to scam the user into surrendering exempt organization private information that will be used for identity theft. 2. Partnership or multi-member LLC The partnership 3. A broker or registered nominee The broker or nominee
11S does not request personal detailed information through email or ask xpayers for the PIN numbers, passwords, or similar secret access Section 6109 of the Internal Revenue Code requires you to provide youformation for their credit card, bank, or other financial accounts. correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or If you receive an unsolicited email claiming to be from the IRS, certain other income paid to you; mortgage interest you paid; the rward this message to email@example.com. You may also report misuse acquisition or abandonment of secured property; the cancellation of f the IRS name, logo, or other IRS property to the Treasury Inspector debt; or contributions you made to an IRA, Archer MSA, or HSA. The eneral for Tax Administration (TIGTA) at 1-800-366-4484. You can person collecting this form uses the information on the form to file rward suspicious emails to the Federal Trade Commission at information returns with the IRS, reporting the above information. firstname.lastname@example.org or report them at www.ftc.gov/complaint. You can Routine uses of this information include giving it to the Department of ontact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338). Justice for civil and criminal litigation and to cities, states, the District o you have been the victim of identity theft, see www.IdentityTheft.gov Columbia, and U.S. commonwealths and possessions for use in nd Pub. 5027. administering their laws. The information also may be disclosed to otheVisit www.irs.gov/IdentityTheft to learn more about identity theft and countries under a treaty, to federal and state agencies to enforce civil ow to reduce your risk. and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, andcertain other payments to a payee who does not give a TIN to the payeCertain penalties may also apply for providing false or fraudulent information.
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