Signature of U.S. Person Date Type of Ownership (Check Appropriate Box(es)) * Business Classification (Check Appropriate Box(es)) *
Signature of U.S. Person: Date: NOT PART OF W-9. REQUIRED FOR REPORTING PURPOSES ONLY. PLEASE COMPLETE Is your organization (association, club, religious, charitable, educational, Or other group) tax exempt under IRS Code Section 501(a)? YES or NO Are you a Real Estate Agent? YES or NO Is your business a *DMBE Certified Women Owned Business (WB)? YES or NO Is your business a *DMBE Certified Small Business (SB)? YES or NO Is your business a *DMBE Certified Minority Business (MB)? YES or NO African American Native American Subcontinent-Asian American Hispanic American Asian-Pacific American Other *DMBE = The Commonwealth of Virginia Department of Minority Business Enterprise @xxx.xxxx.xxxxxxxx.xxx PLEASE PRINT: Contact Person: Title: Contact Phone: Contact Fax: Purpose of Form A person who is required to file an information return with the IRS Exempt from backup withholding. If you are exempt, enter your name as described above, then check the AExempt from backup withholding@ box in the line following the business name6, . distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. must get your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an XXX. sign and date the form. Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup
Signature of U.S person a Xxxx Xxxxx, CEO Date a 1/6/2021 tructions General Ins Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to xxx.xxx.xxx/XxxxX0.
