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HomeMy Public PortalAboutParks and Rec Contract for Services Scottie MiltonParks & Recreation CONTRACT FOR SERVICES THIS CONTRACT FOR SERVICES made and entered into this 2 "5" day •IE by and between the City of Crestview, a municipal corporation, hereinafter referred to as "City" and SCOTTIE MILTON , hereafter referred to as "Vendor". WITNESSETH: WHEREAS, the City has chosen to procure services for the recreation of children; and WHEREAS, the City charges the Parks & Recreation Division with the overall responsibility of administering said services; and WHEREAS, the City directs that measures be taken to procure services of qualified providers through a contract for services not to exceed FY 2012-2013 Budget payable in one lump sum of $ NOW, THEREFORE, in consideration of the mutual covenants contained herein the parties agree as follows: 1. VENDOR agrees to perform scheduled work on behalf of the CITY. 2. VENDOR agrees to receive Form 1099 at the end of the City's business year for the tax purposes. 3. VENDOR understands that managerial direction and supervision of assigned duties shall emanate from, the Parks & Recreation Division. 4. CITY agrees to provide facilities essential to carryout services by the VENDOR. 5. Provisions of this contract may be terminated at any time with thirty days notice to either party in written form. 6. This contract constitutes the entire agreement between the parties and any changes or amendments hereto must be reduced to writing and signed by both parties to be legally binding. IN W1TNE...___________7EREOF, the parties hav set their hands this day of �J�� 2013. :'/ eOTTI LTON, VENDOR BETH M. ROY, CITY CLERK Farm W-9 (Rev. December2011) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not Send to the IRS. N m rn m Q- c w C O cii , o 0 R o 0 co ■ - Name (as sh wn n you, come tax r �) ji/f �� /% errcP _ Business name/disregarded entity n e, if different from abov ChecJs appropriate Individual/sole box for federal tax classification: Trust/estate ► proprietor C Corporation . S Corporation NI Partnership . company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ► Limited liability Exempt payee ni Other (see Instructions) Address ustreet, anr suit' noy,// d/ e0Q Requester's name and address (optional) CI s and ZIP tYo ///f q/ -' / S/ cod / y/-5z5/1 q\ i/ List account number(s) here (optional) -- -- payer Identification Number 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 the Part I instructions on page 3. For other entities, it Is your employer identification number (EIN). If you do not have a number, see How to get a T7N on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Part II Social security number 9 S� Employer identification number Certification Under penalties of perjury, I certify that: 1. 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 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 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, citizen or other U.S. person (defined below). Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interes d dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S, person ► General Instru Ions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain 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 IRA Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Date ► CP 29 2_4'`_ Note. If a requester gives you form oth r than Form/ W-9 to request your TIN, you must use the r uester's form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined In Regulations section 301.7701-7). Special rules for partnerships.- Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business In the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No.10231X Form W-9 (Rev.12-2011) Form W-9 (Rev. 12-2011) t Page 2 The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases: • The U.S. owner of a disregarded entity and not the entity, • The U.S. grantor or other owner of a grantor trust and not the trust, and • The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entitles). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese 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 in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the flrst protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax retum. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you fumished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax retum (for reportable Interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable Interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9. Also see Special rules for partnerships on page 1. Updating Your Information You must provide updated Information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Fomi W-9 If the name or TIN changes for the account, for example, If the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name If you are an individual, you must generally enter the name shown on your income tax retum. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is In joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form. Sole proprietor. Enter your individual name as shown on your Income tax retum on the "Name" line. You may enter your business, trade, or "doing business as (DBA)" name on the "Business name/disregarded entity name" line. Partnership, C Corporation, or S Corporation. Enter the entity's name on the "Name" line and any business, trade, or "doing business as (DBA) name" on the "Business name/disregarded entity name" line. Disregarded entity. Enter the owner's name on the "Name" line. The name of the entity entered on the "Name" line should never be a disregarded entity. The name on the "Name" line must be the name shown on the income tax retum on which the Income will be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name is required to be provided on the "Name" line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the "Business name/disregarded entity name" line. If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8. Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the "Name" line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate). Limited Liability Company (LLC). If the person identified on the "Name" line is an LLC, check the "Limited liability company" box only and enter the appropriate code for the tax classification In the space provided. If you are an LLC that Is treated as a partnership for federal tax purposes, enter "P" for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter "C" for C corporation or "S" for S corporation. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the "Name" line) is another LLC that is not disregarded for federal tax purposes. If the LLC is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner Identified on the "Name" line. Form W-9 (Rev.12-2011) Page 3 Other entities. Enter your business name as shown on required federal tax documents on the "Name" line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the "Business name/ disregarded entity name" line. Exempt Payee If you are exempt from backup withholding, enter your name as described above and check the appropriate box for your status, then check the "Exempt payee" box in the line following the "Business name/ disregarded entity name," sign and date the form. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. The following payees 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, 3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities, 4. A foreign govemment or any of its political subdivisions, agencies, or instrumentalities, or 5. An intemational organization or any of its agencies or instrumentalities. Other payees that may be exempt from backup withholding include: 6. A corporation, 7. A foreign central bank of issue, 8. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States, 9. A futures commission merchant registered with the Commodity Futures Trading Commission, 10. A real estate investment trust, 11. An entity registered at all times during the tax year under the Investment Company Act of 1940, 12. A common trust fund operated by a bank under section 584(a), 13. A financial Institution, 14. A middleman known in the investment community as a nominee or custodian, or 15. A trust exempt from tax under section 664 or described in section 4947. The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15. IF the payment is for ... THEN the payment is exempt for... Interest and dividend payments All exempt payees except for 9 Broker transactions Exempt payees 1 through 5 and 7 through 13. Also, C corporations. Barter exchange transactions and patronage dividends Exempt payees 1 through 5 Payments over $600 required to be reported and direct sales over $5,0001 Generally, exempt payees 1 through 72 ' See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attomeys' fees, gross proceeds paid to an attomey, and payments for services paid by a federal executive agency. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS 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 below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single -member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC Is classified as a corporation or partnership, enter the entity's EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676). If you are asked to complete Form W-9 but do not have a TIN, write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend 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 the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering "Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, below, and items 4 and 5 on page 4 indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the "Name" line must sign. Exempt payees, see Exempt Payee on page 3. Signature requirements. Complete the certification as indicated in items 1 through 3, below, and items 4 and 5 on page 4. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out Item 2 of the certification. Form W-9 (Rev. 12-2011) Page 4 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "tither payments" include payments made In the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services Qncluding payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529); IRArCoverdell ESA, Archer- MSA or. — NSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Blame and Number To Give the Requester For this type of account: Give name and SSN of: 1. Individual 2. Two or more Individuals Qoint account) 3. Custodian account of a minor (Uniform Gift to Minors Act) 4. a. The usual revocable savings trust (grantor Is also trustee) b. So-called trust account that Is not a legal or valid trust under state law 5. Sole proprietorship or disregarded entity owned by an individual 6. Grantor trust filing under Optional Form 1099 Fling Method 1 (see Regulation section 1.671-4(b)(2)()(A)) The Individual The actual owner of the account or, If combined funds, the first individual on the account' The minor' The grantor -trustee' The actual owner' The owner' The grantor' For this type of account: Give name and EIN of: 7. Disregarded entity not owned by an individual 8. A valid trust, estate, or pension trust 9. Corporation or LLC electing corporate status on Forrn 8832 or Form 2553 10. Association, club, religious, charitable, educational, or other tax-exempt organization 11. Partnership or multi -member LLC 12. A broker or registered nominee 13. Account with the Department of Agriculture In the name of a public entity (such as a state or local govemment, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form 1041 Fling Method or the Optional Form 1099 Fling Method 2 (see Regulation section 1.671-4(b)(2)0)(B)) The owner Legal entity' The corporation The organization The partnership The broker or nominee The public entity The trust ' List flrst and circle the name of the person whose number you furnish. If only one person on a Joint account has an SSN, that person's number must be furnished. 2 Circle the minor's name and furnish the minor's SSN. 3You must show your Individual name and you may also enter your business or'DBA" name on the 'Business name/disregarded entity" name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. List first and circle the name of the trust, estate, or pension trust. (Do not furnish the "RN of the personal representative or trustee unless the legal entity itself is not designated In the account title.) Also see Special rules for partnerships on page 1. *Note. Grantor also must provide a Form W-g to trustee of trust. Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying Information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax retum using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll -free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phlshing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user Into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: spam@uce.gov or contact them at www.ftc.gov/Idtheft or 1-877-IDTHEFT (1-877-438-4338). Visit IRS.gov to leam more about identity theft and how to reduce your risk. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information retums with the IRS to report Interest, dividends, or certain other Income paid to you; mortgage Interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file Information retums with the IRS, reporting the above Information. Routine uses of this information Include giving It to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. possessions for use In administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil 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, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information. 00'0S17$ 1V101 00'00£$ 00'0£$ INVOO:TT-Wd00:6 8Z-17Z 31%If11' SH M31A1S3210 H3V03 213330S NO1111A1 3111035 (dfl'8 9) 213330S 00'OST$ 1 00'0£$ Wd00:0T-Wd00:6 8Z-la 3Nflf SH M31/11S3213 H3V03 2133305 NO1111N 311103S (S-b) 213330S , 00'017Z$ 111101 00'0VZ$ 00'0£$ Wd00:8-1Ald00:9 8Z-SZ 3Nflf SH M31/115320 2101dpna3 S2100a1f10 N1121dW 311%1213 (u-s) 9NIHS1d 00°SL9$ 1V101 00'SZZ$ 00'0E$ INVOO:T-Wt/OE:6 ZT-8 Alflf SW HAIN 1VOHS H31/0311d813NSd8 M313)13f18 HIlIW (ZT-OT) SA0811d813)ISV8 00'SZZ$ 00'OE$ Wd0E:6-Wd00:8 ZT-8 Alflf SW H3Alkl 1VOHS H31/0311d813)1Sd8 M313)13f18 HaLIW (6-L) SA0811d813NSd8 00'SZZ$ 00'0E$ Wd0E:6-Wd00:8 TZ-LT 3Nflf SW H3A1111VOHS H3V0311V813)1Sd8 M313)13f18 HalIW (ZT-L) S1HID 11d813NSd8 BCD unoH aid 3 W 11/31da tionnuism A11ALDV s3111A113d unywns ETOz CKYSOSIZS 1V101 ONVhD - 00°017S$ 1V1O1 00'OLZ$ 00'0£$ WdSKEI-WdSI:OI Wd00:0I-Wd0£:8 8Z-9Z-VZ 3Nnr SW H3AI211VOHS HDVOD A211N11O0 SSO210 M313N3118 A113)1 (17I-II) (II-6) 11d8A311OA 00'OLZ$ 00'0£$ UVdSVII-UVdSVOI INV00:0I-Wd0£:8 IZ-6I-LI 31\nr SW 213A1211VOHS H3V03 A211N11O0 SSOHD M313)1Or18 A113)1 (VI -II) (II-6) 11d8A311OA 00'009$ 1V101 00'00£$ 0010£$ WdSO:ZI-WdS0:0I ZI-8 Alnr 3931103 N213H110S WdH9NIWHI8 MOM VAOW (ZI-6) SINN31 00'00£$ 001)£$ Wd00:0I-Wd00:8 ZI-8 Alnr 3931103 NH3H1110S INVH9NI1/0118 3HOOIN VAOW (8-9) SINN31 Water fun plavaround picnic Tables Restrooms EELST�'iE�1' CI- ILL LEWS HOURS: Closed Mondays Tues—Suns g a to S p Parties mno be held Inside the playground area. Use picnic tables outside of Me playground. No cooking grills In the playground area. Facilities are on a first come first serve basis. Total TWIN HILLS Cost $30 TENNIS CAMP Ages 6-12 yrs. W,a, k of Jggiy 8 - V 2 Won -Friday 6-8 yr. 8:00-10:00 ant 9-12 yr. 10:05am-12:05 pm Must have your own racquet. Instruction by Moya Moore. Moya Moore is presently the # 1 seed on the Birmingham Southern College Tennis Team. She finished the 2013 Tennis season 74 in Southem Collegiate Athletic Conference play. She was the Southem Athletic Asso- ciation player of the week for March 12. Moya won 3 single matches in- cluding a victory against # 13 ranked Campbellsville, a Div II College. Moya's assistant coach, Bill Moore, has been the Head Tennis Coach the last 15 years at Shoal River and Richbourg Middle School. Mission: All players will have the opportunity to learn skills in ground strokes, serving and volleying along with the rules of the game. • • • • ♦ Digital Child ID kits • • Twin Hills Gym ® June 26 6 28 9am-12 noon ♦ EZ Child ID.corn 8AM BASKETBALL CAMP TWIN HILLS GYM GIRLS CAMP 7-12 YR. JUNE 17-21 TO 9:30 AM BOYS CAMP JULY 8-12 7.9 YR. 8:00AM TO 9:30 AM 10-12 YR. 9:30AM TO 11:00AM CAMP INSTRUCTOR COACH MITCH BUCKELEIL' Coach Buckelew is the Boys Basketball Coach and Athletic Director at Shoal River Middie School. He has coached basketball for the past 27 years, with stops at Crestview High, Laurel Hill, Paxton, and Briarwood in Birmingham, AL He played collegiate ball at Southeastern Bible College in Birmingham. He is a family man. He enjoys the game, and loves teaching the importance of the team concept, hard work and discipline. Mission : All players will have the opportunity to learn ball handling, defensive, shooting, passing and rebounding skills. These skills will allow your youngster to become a better basketball player. Drills will be given where each camper can take them home and improve. TOTAL COST $30.00 "MEET TH E FIREMEN" PRESENTED BY THE CRESTVIEW FIRE DEPT. PROMOTES FIRE SAFETY. COME SEE THE FIRE TRUCKS. JUNE 20 l0a-noon �rf-N (DiA L p Week of June 25- 28 Tues. thru Friday 7:30 - 9:30am each evening. Ages 5 - 12 yrs. Old Under 9 yrs old must have a parent present, BRING YOUR OWN CANE POLE. TOTAL cost $35 The class size will be limited to the first twenty bids who resister. INSTRUCTOR Ernie Martin Ernie has fished with Shaw Grigsby Jr. as a partner. He is the outdoors education instructor at Crestview High School. Avid outdoorsman and has fished many major salt and freshwater tournaments as well as an international fishing rodeo. ADULT COED VOLLEYBALL REGIST R,ATICA June 17 thru July 5 CAUL C82-4111(J YOUTH REGISTRATION SCHEDULE BASEBALL JANUARY FOOTBALL/SOCCER JUNE TO JULY 5TH BASKETBALL OCTOBER arm June 24 CAIVIl" To June 28 Mon, thru Fri 9-10am 485yr. COST $30 9-11am 6 8 up COST $45 Instruction by Scottie Milton Crestview HS Soccer Coach Camp Director Scottie Milton, from Pensacola, has been involved in soccer at all levels for many years. Scottie has coached at the University of West Florida as an as- sistant and a head coach at Andrew College. He is the current coach of Crestview High School. Also coach Scot- tie is a highly respected youth coach in the Pensacola community where he coaches several youth teams for the Gulf Coast Texans. He is also a National License Goalkeeping Coach for the National Soccer Coaches of America. �_ 44 s .f u :s u 1� •r :r I Y 4,44--4,-4.-4.-4+-4.-4n=4,4,=,rw-=w.---ir=a,=-14=-A�'-e',F-�iY,A.- St CCM 1 CC,It-ALI CVEEEI TAILING !REGISTRATION THE MONTH OF JUNE THRU JULY 11 $65 T1-115 IS A RECREATION LEAGUE. ALL GAMES PLAYED LOCALLY NO TRAVEL REQUIRED. AUGUST THRU OCTOBER. SOCCER U6-U8-U10-U12-U15 FOOTBALL 6-8, 9-11 CHEERLEADING 4- 12 ♦•••••••o•s•••••♦ ♦ ***FREE*** • ♦ BICYCLE SAFETY COW?SE PRESENTED BY THE CRESTVIEW POLICE DEPARTMENT JUNE 18 a 20 9:00am-12:00pm BRING YOUR OWN BIKE AND HELMET TWIN HILLS GYM VOLLEYBALL CAMP JUNE 17-19-21 M-W-F AGES 9-11 yr. 8:30am-10:00am COST $30 AGES 12-14 yr 10:15am—11:45am COST 35 JUNE 24-26-28 M-W-F AGES 9-11 yr. 8:30am-10:00am COST $30 AGES 12-14 yr. 10::15am — 11:45 am COST $35 Coach Kelly Buckelew was a setter in high school and was a back row specialist in college at UAB. She coached the 2005 CHS JV volley- ball team to a one loss season. Coach Buckelew is currently coaching the Cross Country Team at Shoal River Middle School. She is married to Mitch Buckelew and the mother of 3. Malt our Twin Hills Park Walk Path/Fitness Park Area CHILD SAFETY SEAT INSPECTIONS WEDNESDAY 9:00 am to 12:00 pm JUNE 19TH MUST SIGN UP WITH PARK OFFICE IN ORDER TO TAKE PART IN THIS FRI L- SERVICE. PROVIDED BY THE CRESTVIEW POLICE DEPT. 2013 5zl11111/EtMME E%.(E:ttr,S TWIN HILLS PALE ScSO-682-4715 Parks & Recreation Mon. 3pm-7:p, Tue—Fri. gam -7pm Sat 9am-5pm CON r ACT This Ls aw agreewtewt betweew Mr. Towel LarleLws to ?Lad for "ri. L% "N' ci aat^TL,�i n Qai )) Located ate ��PSts\kt,tufNt ni--11>f�+Pric to have awd to hold for a perLod of 3 hours beg/Li/Li-we OP 1 at :36 Iwo( t ' L Q; � o Last uw t� 3& ow the /--)- dad of 20/3 0a r� -tui agrees to pCT Mr. Tow LarleLws Lw the suwt of . Ann . cw additLow, 't\I agrees to pau Mr. Towel LarleLws 1/2 of the above amou.wt prLor to awd settLwg up of equ.%pmewt for the purpose of disc jocizeLwg. This deposit Ls NONR eFIAND -F,Le! ! ! This agreemewt shall, be bLwdLwg upow awd shaLL Lwsure to the bet/Left of each partLes assLgwed. Iw witwess whereof, the partLes have hereuwto set their hawds awd seal of this Lwstrumewt ow the dad of 't_s(f)(,) 201.3 5t,g watu.re Date Da e Your busLwess Ls apprecLated! ! ! Thawhs, Larleiws FXpress wtertaLwwtewt For n W-9 (Rev. December2011) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. N a c c m E 0 cpi E c -i pI z 1 Q Nagw{ag,shown on our Income tax retum) // 2 �/ /I�� t' S IN.) Business ah5e/disregard en�name, if different from above b'KI,.El :4JS G/UfZ 1 GA,s,J /'-‘,6,10 Check appropriate igIndividuaVsole bo for federal tax classification: Trust/estate ► Exempt payee proprietor Ili C Corporation i S Corporation Partnership ii company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) I. • 111 Limited liability Other (see instructions) Address (number, street, and apt. or suite no.) S-0 551%vs-E-- jr Requester's name and address (optional) state, and ZIP code rEc5/ 9/'J �L `ja, S J List account number(s) here (optional) ar axpayer Identification Number (TIN) 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 the Part I instructions on page 3. For other entitles, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Part II Social security number a J 3 I 6 6 Employer identification number Certification Under penalties of perjury, I certify that: 1. 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 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 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. citizen or other U.S. person (defined below). Certification Instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S, person ► General Instruction Section references are to the li5temal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain 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 IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be Issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership Income from a U.S. trade or business Is not subject to the withholding tax on foreign partners' share of effectively connected income. Date ► Note. If a requester gives you afform oth� than Form W-9 to request your TIN, you must use the requester's f rm if it Is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person If you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized In the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations section 301.7701-7). Special rules for partnerships. Partnerships that conduct a trade or business In the United States are generally required to pay a withholding tax on any foreign partners' share of income from such business. Further, In certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner In a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No. 10231X Form W-9 (Rev. 12-2011) Form W-9 (Rev. 12-2011) Page 2 i The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business In the United States is in the following cases: • The U.S. owner of a disregarded entity and not the entity, • The U.S. grantor or other owner of a grantor trust and not the trust, and • The U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person, do not use Form W-9. Instead, use the appropriate Form W-8 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a "saving clause." Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese 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 in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity not subject to backup withholding, give the requester the appropriate completed Form W-8. What Is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS a percentage of such payments. This is called "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not fumish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II Instructions on page 3 for details), 3. The IRS tells the requester that you fumished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax retum (for reportable Interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See the instructions below and the separate Instructions for the Requester of Form W-9. Also see Special rules for partnerships on page 1. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 If the name or TIN changes for the account, for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false Information with respect to withholding. If you make a false statement with no reasonable basis that results In no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying Information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Name If you are an individual, you must generally enter the name shown on your income tax retum. However, if you have changed your last name, for instance, due to marriage without informing the Social Security Administration of the name change, enter your first name, the last name shown on your social security card, and your new last name. If the account is in joint names, list first, and then circle, the name of the person or entity whose number you entered in Part I of the form. Sole proprietor. Enter your individual name as shown on your Income tax return on the "Name" line. You may enter your business, trade, or "doing business as (DBA)" name on the "Business name/disregarded entity name" line. Partnership, C Corporation, or S Corporation. Enter the entity's name on the "Name" line and any business, trade, or "doing business as (DBA) name" on the "Business name/disregarded entity name" line. Disregarded entity. Enter the owner's name on the "Name" line. The name of the entity entered on the "Name" line should never be a disregarded entity. The name on the "Name" line must be the name shown on the income tax retum on which the Income will be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a domestic owner, the domestic owner's name is required to be provided on the "Name" line. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on the "Business name/disregarded entity name" line. If the owner of the disregarded entity is a foreign person, you must complete an appropriate Form W-8. Note. Check the appropriate box for the federal tax classification of the person whose name is entered on the "Name" line (Individual/sole proprietor, Partnership, C Corporation, S Corporation, Trust/estate). Limited Liability Company (LLC). If the person identified on the "Name" line Is an LLC, check the "Limited liability company" box only and enter the appropriate code for the tax classification in the space provided. If you are an LLC that is treated as a partnership for federal tax purposes, enter "P" for partnership. If you are an LLC that has filed a Form 8832 or a Form 2553 to be taxed as a corporation, enter "C" for C corporation or "S" for S corporation. If you are an LLC that is disregarded as an entity separate from its owner under Regulation section 301.7701-3 (except for employment and excise tax), do not check the LLC box unless the owner of the LLC (required to be identified on the "Name" line) is another LLC that is not disregarded for federal tax purposes. If the LLC Is disregarded as an entity separate from its owner, enter the appropriate tax classification of the owner identified on the "Name" line. Form W-9 (Rev. 12-2011) Page 3 Other entities. Enter your business name as shown on required federal tax documents on the "Name" line. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on the "Business name/ disregarded entity name" line. Exempt Payee If you are exempt from backup withholding, enter your name as described above and check the appropriate box for your status, then check the "Exempt payee" box in the line following the "Business name/ disregarded entity name," sign and date the form. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as Interest and dividends. Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding. The following payees 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, 3. A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities, 4. A foreign govemment or any of its political subdivisions, agencies, or instrumentalities, or 5. An intemational organization or any of its agencies or instrumentalities. Other payees that may be exempt from backup withholding include: 6. A corporation, 7. A foreign central bank of issue, 8. A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States, 9. A futures commission merchant registered with the Commodity Futures Trading Commission, 10. A real estate investment trust, 11. An entity registered at all times during the tax year under the Investment Company Act of 1940, 12. A common trust fund operated by a bank under section 584(a), 13. A financial institution, 14. A middleman known in the Investment community as a nominee or custodian, or 15. A trust exempt from tax under section 664 or described in section 4947. The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 15. IF the payment is for ... THEN the payment is exempt for... Interest and dividend payments All exempt payees except for 9 Broker transactions Exempt payees 1 through 5 and 7 through 13. Also, C corporations. Barter exchange transactions and patronage dividends Exempt payees 1 through 5 Payments over $600 required to be reported and direct sales over $5,0001 Generally, exempt payees 1 through 72 ' See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attomeys' fees, gross proceeds paid to an attomey, and payments for services paid by a federal executive agency. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS 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 77N below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single -member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on page 2), enter the owner's SSN (or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership, enter the entity's EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local Social Security Administration office or get this form online at www.ssa.gov. You may also get this form by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.gov/businesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM (1-800-829-3676). If you are asked to complete Form W-9 but do not have a TIN, write "Applied For" in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend 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 the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering "Applied For" means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8. Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if item 1, below, and items 4 and 5 on page 4 indicate otherwise. For a joint account, only the person whose TIN Is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on the "Name" line must sign. Exempt payees, see Exempt Payee on page 3. Signature requirements. Complete the certification as indicated in items 1 through 3, below, and items 4 and 5 on page 4. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during 1983. You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during 1983. You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out Item 2 of the certification. Form W-9 (Rev. 12-2011) Page 4 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. "Other payments" include payments made in the course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA,-Coverdell ESA, Archer- MSA or - RSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: Give name and SSN of: 1. Individual 2. Two or more individuals (loint account) 3. Custodian account of a minor (Uniform Gift to Minors Act) 4. a. The usual revocable savings trust (grantor is also trustee) b. So-called trust account that Is not a legal or valid trust under state law 5. Sole proprietorship or disregarded entity owned by an Individual 6. Grantor trust filing under Optional Form 1099 Filing Method 1 (see Regulation section 1.671-4(b)(2)(1)(A)) The Individual The actual owner of the account or, if combined funds, the first individual on the account' The minor: The grantor -trustee' The actual owner' The owner' The grantor' For this type of account: Give name and EIN of: 7. Disregarded entity not owned by an individual 8. A valid trust, estate, or pension trust 9. Corporation or LLC electing corporate status on Form 8832 or Form 2553 10. Association, club, religious, charitable, educational, or other tax-exempt organization 11. Partnership or multi -member LLC 12. A broker or registered nominee 13. Account with the Department of Agriculture In the name of a public entity (such as a state or local govemment, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Farm 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulation section 1.671-4(b)(2)(i)(8)) The owner Legal entity ' The corporation The organization The partnership The broker or nominee The public entity The trust ' List first and circle the name of the person whose number you furnish. If only one person on a Joint account has an SSN, that person's number must be furnished. 2 Circle the minor's name and furnish the minor's SSN. ' You must show your Individual name and you may also enter your business or "DBA" name on the 'Business name/disregarded entity' name line. You may use either your SSN or EIN Of you have one), but the IRS encourages you to use your SSN. List flrst and circle the name of the trust, estate, or pension trust. po not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated In the account title.) Also see Special rules for partnerships on page 1. 'Note. Grantor also must provide a Form W-9 to trustee of trust. Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, social security number (SSN), or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax retum using your SSN to receive a refund. To reduce your risk: • Protect your SSN, • Ensure your employer Is protecting your SSN, and • Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit Form 14039. For more infomiation, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll -free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059. Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via emails. Also, the IRS does not request personal detailed information through email or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited email claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration at 1-800-366-4484. You can forward suspicious emails to the Federal Trade Commission at: span@uce.gov or contact them at www.ftc.gov/idtheft or 1-877-IDTHEFT (1-877-438-4338). Visit IRS.gov to leam more about identity theft and how to reduce your risk. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (Including federal agencies) who are required to file Information retums with the IRS to report interest, dividends, or certain other income paid to you; mortgage Interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file Information retums with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. possessions for use In administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil 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 retum. Under section 3406, payers must generally withhold a percentage of taxable Interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent Information.