Form Fa Pds W9 – Fill Out and Use This PDF

W-9 Form University of Florida

Mail: SG Finance, Attn: Michele Williams, PO Box 118514, Gainesville, FL, 32611-5350

or Fax: 352-846-2979 or e-mail mwilliams@sg.ufl.edu

Please complete the following information. We are required by law to

Use this form only if you are a U.S. person (including U.S. resident alien). If

obtain this information from you when making a reportable payment to you.

you are a foreign person, use the appropriate Form W-8. If you were a

If you do not provide us with this information, your payments may be

nonresident alien and have now become a resident alien, read the note below

subject to 28% federal income tax backup withholding. Also, if you do not

and attach a statement, if necessary.

provide us with this information, you may be subject to a $50.00 penalty

imposed by the Internal Revenue Service under section 6723.

Federal law on backup withholding preempts any state or local law

Note to U.S. Resident Aliens who formerly were Nonresident Aliens:

remedies, such as any right to a mechanic's lien. If you do not furnish a

valid TIN, or if you are subject to backup withholding, the payor is required

If there is a tax treaty between the U.S. and your country, and it contains a

to withhold 28% of its payment to you. Backup withholding is not a failure

''saving clause'' to exempt certain types of income from U.S. tax even after

to pay you. It is an advance tax payment. You should report all backup

you have become a Resident Alien, and you want to claim that exemption, fill

withholding as a credit for taxes paid on your federal income tax return.

out all of this form AND attach a page showing:

Instructions:

1. The treaty country

1. Complete Part 1 by completing the one row of boxes that corresponds

2. The treaty article about the income

to your tax status

3. The article number for the ''saving clause''

2. Complete Part 2 if you are exempt from Form 1099 reporting

4. The type and amount of income that qualified for the saving clause

3. Complete Part 3 by filling in all lines

5. Facts that provide a sufficient explanation of why the saving clause applies

4. Return this completed form to us in the enclosed envelope

Individuals:

-

-

Individual Name First name

Middle initial

Last name

Individual's Social Security Number

-

-

Sole Proprietor

Business Owner's Name: (REQUIRED)

Business Owner's Social Security Number

Business or Trade Name (OPTIONAL)

(or an LLC with one

-

owner):

(First Name)

(Middle initial)

or Employer ID Number

(Last Name)

Corporation

Tax Exempt Entity

The United States or

A state, the District of

A foreign government or

Note that there is no

under 501 (a) (includes

any of its agencies or

Columbia, a possession

any of its political subdivisions

corporate exemption

501 (c) (3), or IRA)

instrumentalities

of the United States, or

or an international

for medical and

any of their political

organization in which the

healthcare payments

subdivisions or agencies

United States participates

or payments for legal

under a treaty or Act of

services

Congress

Person completing this form (please print):

Title:

Tax Correspondence Address:

Telephone: (

)

(Remit address if different)

Signature of U.S. Person:

Date:

FA-PDS-W9 09/2009