Common use of FEDERAL INCOME TAX BACKUP WITHHOLDING Clause in Contracts

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 penalty imposed by the IRS. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i) the number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number to be issued to me), and (ii) 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. You must cross out item (ii) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest 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 are not longer subject to backup withholding, do not cross out item (ii). Each subscriber should complete this section. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Social Security or Employer Identification No.

Appears in 3 contracts

Samples: Subscription Agreement (T Bancshares, Inc.), Subscription Agreement (T Bancshares, Inc.), Subscription Agreement (T Bancshares, Inc.)

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FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 penalty imposed by the IRS. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i) the The number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number to be issued to me), and (ii) 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. You must cross out item (ii) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest 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 are not longer subject to backup withholding, do not cross out item (ii). Each subscriber should complete this section. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Social Security or Employer Identification No.

Appears in 2 contracts

Samples: Subscription Agreement (Independence Bancshares, Inc.), Subscription Agreement (Palmetto Bancshares Inc)

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company with a correct Taxpayer Identification Number ("TIN"). An individual’s 's social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 penalty imposed by the Internal Revenue Service ("IRS"). Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, "Applied For" should be written in the space provided for the TIN on the Substitute Form W-9. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i) the number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number to be issued to me), and (ii) 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”) 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. You must cross out item (ii) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest 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 are not no longer subject to backup withholding, do not cross out item (ii). Each subscriber should complete this section. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Social Security or Employer Identification No.Name

Appears in 2 contracts

Samples: Subscription Agreement (Trinity Capital Corp), Trinity Capital Corp

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 penalty imposed by the IRS. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i) the The number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number to be issued to me), and (ii) 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. You must cross out item (ii) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest 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 are not longer subject to backup withholding, do not cross out item (ii). Each subscriber should complete this section. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Social Security or Employer Identification No.. EXHIBIT A Form of Transferee Letter [●], 2016 HCSB Financial Corporation 0000 Xxxxx Xxxxxx Xxxxx, XX 00000 RE: Purchase of ___ shares of Common Stock of HCSB Financial Corporation (the “Purchased Shares”) Ladies and Gentlemen: I acknowledge that the Company has valuable net operating loss carry-forwards the use of which would be limited if the Company were to experience an “ownership change” under Section 382 of the Internal Revenue Code, and accordingly, I hereby certify that, following this purchase of the Purchased Shares, either: _____ I will not be a 5% Shareholder of the Company; _____ I am or pursuant to this transfer will become a 5% Shareholder of the Company, but the Company has delivered a letter to the Company’s transfer agent stating that my attainment of 5% Shareholder status will not jeopardize or endanger the Company’s utilization of the Tax Benefits or is otherwise in the best interests of the Company; or _____ I do not meet either of the foregoing qualifications, and I acknowledge that my acquisition of the Purchased Shares may cause a material and irreparable economic harm to the Company and the value of the Purchase Shares that I am acquiring. For purposes of this letter, the following definitions shall apply:

Appears in 1 contract

Samples: Subscription Agreement (HCSB Financial Corp)

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company us with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirementsrequirement, may be subject to a $50 penalty imposed by the IRS. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i) the number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number number to be issued to me), and (ii) 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. You must cross out item (ii) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest 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 are not no longer subject to backup withholding, do not cross out item (ii). Each subscriber should complete this section. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Number Social Security or Employer Identification No.Number

Appears in 1 contract

Samples: Subscription Agreement (Monarch Financial Holdings, Inc.)

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company us with a correct Taxpayer Identification Number (“TIN”). An individual’s 's social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 penalty imposed by the IRS. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i) the The number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number to be issued to me), and (ii) 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. You must cross out item (ii) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest 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 are not longer subject to backup withholding, do not cross out item (ii). Each subscriber should complete this section. Signature of Subscriber Signature of Co-Subscriber (if applicable) Printed Name Printed Name Social Security or Employer Identification No. Social Security or Employer Identification No.

Appears in 1 contract

Samples: Final Subscription Agreement (Independence Bancshares, Inc.)

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company escrow agent with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 W-9, which is set forth below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 penalty imposed by the Internal Revenue Service (“IRS”). Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify the undersigned certifies that: (i) the The number shown on this form is my the undersigned’s correct Taxpayer Identification Number (or I am the undersigned is waiting for a Taxpayer Identification Number to be issued to meissued), and (ii) I am the undersigned is not subject to backup withholding because: (a) I am the undersigned is exempt from backup withholding; or (b) I have the undersigned has not been notified by the Internal Revenue Service (“IRS”) that I am the undersigned is subject to backup withholding as a result of a failure to report all interest or dividends; or (c) the IRS has notified me the undersigned that I am the undersigned is no longer subject to backup withholding. You must cross out item (ii) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest 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 are not longer subject to backup withholding, do not cross out item (ii). Each subscriber should complete this section. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Social Security or Employer Identification No.: __________________________ Identification No.: __________________________

Appears in 1 contract

Samples: Subscription Agreement (CNB Holdings Inc /Ga/)

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FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 W-9, which is set forth below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 50.00 penalty imposed by the IRS. If backup withholding applies, Centra Financial Holdings, Inc. is required to withhold 31% of payments of dividends or interest made to such subscriber. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. In such case, if Centra Financial Holdings, Inc. is not provided with a TIN within 60 days, the Escrow Agent will withhold 31% of the dividends or interest payments thereafter made to each subscriber until a TIN is provided to Centra Financial Holdings, Inc. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i1) the The number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number to be issued to me), and ; (ii2) 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. person (including a U.S. resident alien). You must cross out item (ii2) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting under reporting interest 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 are not no longer subject to backup withholding, do not cross out item (ii2). Each subscriber should complete Subscriber Should Complete this sectionSection. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Number Social Security or Employer Identification No.Number

Appears in 1 contract

Samples: Subscription Agreement (Centra Financial Holdings Inc)

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company us with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirementsrequirement, may be subject to a $50 penalty imposed by the IRS. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i) the number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number number to be issued to me), and (ii) 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. You must cross out item (ii) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting interest 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 are not no longer subject to backup withholding, do not cross out item (ii). Each subscriber should complete this section. _____________________________ Signature of Subscriber _____________________________ Signature of Subscriber _____________________________ Printed Name _____________________________ Printed Name _____________________________ Social Security or Employer Identification No. Number _____________________________ Social Security or Employer Identification No.Number

Appears in 1 contract

Samples: Subscription Agreement (State Bancorp Inc)

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 W-9, which is set forth below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 50.00 penalty imposed by the IRS. If backup withholding applies, Centra Financial Holdings, Inc. is required to withhold 31% of payments of dividends or interest made to such subscriber. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. In such case, if Centra Financial Holdings, Inc. is not provided with a TIN within 60 days, the Escrow Agent will withhold 31% of the dividends or interest payments thereafter made to each subscriber until a TIN is provided to Centra Financial Holdings, Inc. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i1) the The number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number to be issued to me), and ; (ii2) 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. person (including a U.S. resident alien). You must cross out item (ii2) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting under reporting interest 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 are not no longer subject to backup withholding, do not cross out item (ii2). Each subscriber should complete Subscriber Should Complete this sectionSection. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Social Security or Employer Identification No.Number Identification Number

Appears in 1 contract

Samples: Subscription Agreement (Centra Financial Holdings Inc)

FEDERAL INCOME TAX BACKUP WITHHOLDING. In order to prevent the application of federal income tax backup withholding, each subscriber must provide the Company with a correct Taxpayer Identification Number (“TIN”). An individual’s social security number is his or her TIN. The TIN should be provided in the space provided in the Substitute Form W-9 W-9, which is set forth below. Under federal income tax law, any person who is required to furnish his or her correct TIN to another person, and who fails to comply with such requirements, may be subject to a $50 50.00 penalty imposed by the IRS. If backup withholding applies, Centra Financial Holdings, Inc. is required to withhold 31% of payments of dividends or interest made to such subscriber. Backup withholding is not an additional tax. Rather, the tax liability of persons subject to backup withholding will be reduced by the amount of tax withheld. If backup withholding results in an overpayment of taxes, a refund may be obtained from the IRS. Certain taxpayers, including all corporations, are not subject to these backup withholding and reporting requirements. If the shareholder has not been issued a TIN and has applied for a TIN or intends to apply for a TIN in the near future, “Applied For” should be written in the space provided for the TIN on the Substitute Form W-9. In such case, if Centra Financial Holdings, Inc. is not provided with a TIN within 60 days, the Escrow Agent will withhold 31% of the dividends or interest payments thereafter made to each subscriber until a TIN is provided to Centra Financial Holdings, Inc. SUBSTITUTE FORM W-9 Under penalties of perjury, I certify that: (i1) the The number shown on this form is my correct Taxpayer Identification Number (or I am waiting for a Taxpayer Identification Number to be issued to me), ; and (ii2) 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. You must cross out item (ii2) above if you have been notified by the IRS that you are subject to backup withholding because of underreporting under reporting interest 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 are not no longer subject to backup withholding, do not cross out item (ii2). Each subscriber should complete Subscriber Should Complete this sectionSection. Signature of Subscriber Signature of Subscriber Printed Name Printed Name Social Security or Employer Identification No. Social Security or Employer Identification No.Number Identification Number

Appears in 1 contract

Samples: Subscription Agreement (Centra Financial Holdings Inc)

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