Miracosta Payee Data Record Form – Fill Out and Use This PDF

PLEASE RETURN or

FAX TO:

MiraCosta Community College District

Attn: Purchasing Department

One Barnard Drive

Oceanside, CA 92056

Phone: (760) 795-6793

FAX: (760) 795-6795

PURPOSE: I nformation contained in this form will be used by the District to prepare State of California Employment Development Department DE542 Reporting, I nternal Revenue Form 1099, and for withholding on payments to nonresident payees. Prompt return of this fully completed form w ill prevent delays w hen processing payment .

( See Pr iv acy Act N o t ice o n p ag e 4 o f in st r u ct ion s)

PART 1

PAYEE DATA

Please print using block letters

Name (I f sole proprietor or single-owner LLC, enter owner’s full name here — Last Name, First Name, and Middle I nitial) (See page 1, Specific I nstructions):



Business name, if different from above—trade or “doing business as (DBA)” name. (See page 1, Specific I nstructions)



Mailing address (Number and Street including Suite No. or Apartment No. – DO NOT USE POST OFFI CE BOX ADDRESS):



City, state and zip code:



Phone number:		Fax number:	Toll free number:
			

PART 7

TYPE OF BUSI NESS ENTERPRI SE

CHECK I F APPLI CABLE AND PROVI DE A COPY OF CERTI FI CATI ON
Disabled Veteran Business Enterprise
Minority Business Enterprise
Woman Owned Business Enterprise	Rev. 7/ 10

Purpose of Form

A person who is required to file an information return with t he I RS must obt ain your correct t axpayer identificat ion number (TI N) to report , for example, income paid to you, real estat e transactions, mortgage int erest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an I RA.

U.S. Person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TI N to the person requesting it (the request er) and, when applicable, to:

1. Certify t hat the TI N you are giving is correct (or you are waiting for a number to be issued,

2. Certify t hat you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee.

Note: I f a request er gives you a form other than Form W-9 to request your TI N, y o u

m u st u se t h e r eq u est er ’s f o r m if it is su b st an t ially sim ila r t o I RS Fo r m W - 9 .

Foreign Person. I f you are a foreign person, use the appropriat e Form W- 8 (see Pub. 515 , Withholding of Tax on Nonresident Aliens and Foreign Entit ies) .

Nonresident alien w ho becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a t ax treat y to reduce or eliminate U.S. tax on certain types of income. However, most tax t reaties cont ain a provision known as a “ saving clause.” Except ions specified in the saving clause may permit an exempt ion from tax to continue for cert ain types of income even after the recipient has ot herwise become a U.S. resident alien for t ax purposes.

I f you are a U.S. resident alien who is relying on exception cont ained in the saving clause of a t ax treaty to claim an exemption from U.S. t ax on cert ain types of income, you must attach a stat ement t hat specified the following five it ems:

1. The treaty country. Generally, this must be the same treaty under which you claimed exempt ion from t ax as a nonresident alien.

2. The treaty article addressing t he income.

3. The art icle number ( or locat ion) in the t ax treaty that cont ains t he saving clause and its exceptions.

4. The type and amount of income that qualifies for t he exemption from t ax.

5. Sufficient facts t o justify the exempt ion from tax under the terms of the t reaty article.

Ex am p le. Article 20 of the U.S.-China income t ax treaty allows an exempt ion from t ax for scholarship income received by a Chinese student t emporarily present in t he Unit ed States. Under U.S. law, this student will become a resident alien for t ax purposes if his or her stay in the United St ates exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China t reaty (dated April 30, 1984) allows t he provisions of Art icle 20 to continue t o apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this except ion (under paragraph 2 of the first protocol) and is relying on t his exception t o claim an exemption from tax on his or her scholarship or fellowship income would att ach to Form W-9 a st atement that includes the information described above to support that exemption.

I f you are a nonresident alien or a foreign entity not subject t o backup withholding, give the requester the appropriate completed Form W-8.

What is backup w ithholding? Persons making cert ain payments t o you must wit hhold and pay to t he I RS 30% of such payments (29% after December 31, 2003; 28% after December 31, 2005) . This is called “ backup withholding.” Payments that may be subject to backup withholding include int erest , dividends, broker and barter exchange t ransactions, rent s, royalties, nonemployee pay, and certain payments from fishing boat operators. Real estat e transactions are not subject t o backup withholding.

You will not be subject t o backup withholding on payments you receive if you give t he request er your correct TI N, make the proper certifications, and report all your taxable interest and dividends on your t ax ret urn.

Payments you receive w ill be subject to backup w ithholding if: 1.

2.

3.

4.

5.

Certain payees and payment s are exempt from backup withholding. See the Part 4 instructions and t he separat e I nstructions for the Requester of Form W - 9.

Penalties

Failure to furnish TI N. I f you fail t o furnish your correct TI N to a requester, you are subject t o 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 w ith respect to w ithholding. I f you make a false statement wit h no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.

Criminal penalty for falsifying information. Willfully falsifying certificat ions or affirmations may subject you to criminal penalties including fines and/ or imprisonment .

Misuse of TI Ns. I f the request er discloses or uses TI Ns in violation of Federal law, the request er may be subject t o civil and criminal penalties.

Specific I nstructions

PART 1—PAYEE DATA ( NAME)

I f you are an individual, you must generally enter the name shown on your social security card. However, if you have changed your last name, for instance, due t o marriage without informing the Social Security Administ rat ion of the name change, enter your first name, t he last name shown on your social security card, and your new last name.

I f the account is in joint names, list first , and then circle the name of the person or entity whose number you enter in Part 3 of the form.

Sole proprietor. Ent er your individual name as shown on your social security card in the

“Name” box of Part 1. You may enter your business, trade, or “ doing business as (DBA)” name in the “ Business Name” box. You may not enter only the business name.

Limited liability company ( LLC) . I f you are a single- member LLC (including a foreign LLC with a domest ic owner) that is disregarded as an entity separat e from its owner under Treasury regulations section 301.7701.3, enter the ow ner’s name in the “Name” box. Enter the LLC’s name in the “ Business Name” box.

Other entities. Enter your business name as shown on required Federal tax documents in the “ Name” box. This name should mat ch the name shown on the chart er or other legal documents creating the entity. You may enter any business, t rade, or DBA name in t he

“ Business name” box.

PART 2—PAYEE ENTI TY TYPE. Please check appropriat e box.

Note: You are requested to check the appropriat e box for your st atus (individual/ sole

propriet or, corporation, etc.) .

PART 3—PAYEE’S TAXPAYER I DENTI FI CATI ON NUMBER ( TI N)

Enter your TI N in the appropriate box. I f you are a resident alien and you do not have and are not eligible t o get an SSN, your TI N is your I RS individual taxpayer

ident ification number (I TI N) . Ent er it in the social security number box. I f you do not have an I TI N, see How to get a TI N below .

I f you are a sole proprietor, t he Dist rict and the I RS prefer that you enter your social security number. The State of California Employment Development Department requires your SSN on the DE542 report.

I f you are a single-owner LLC that is disregarded as an ent ity separate from its owner (see Limited liability company ( LLC) in Part 1), enter your SSN. I f the LLC is a corporat ion, partnership, etc., ent er the entity’s EI N.

Note: See the chart on page 3 for further clarification of name and TI N combinat ions.

How to get a TI N. I f you do not have a TI N, apply for one immediately. To apply for an SSN, get Form SS- 5, Application for a Social Security Card, from your local Social Security Administ rat ion office or get t his form on-line at w w w .ssa.gov/ online/ sst.html. You may also get this form by calling 1-800-772-1213. Use Form W - 7 , Applicat ion for I RS

I ndividual Taxpayer I dent ification Number, to apply for an I TI N or Form SS- 4, Application for Employer I dentificat ion Number, t o apply for an EI N. Your can get Forms W-7 and SS-

4from the I RS by calling 1-800-TAX-FORM (1-800- 829-3676) or from the I RS’s internet Web Site at w w w .irs.gov.

I f you are asked t o complete Form W-9 but do not have a TI N, write “ Applied For” in the space for the TI N, sign and date t he form, and give it to the requester. For interest and dividend payments, and cert ain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TI N and give it t o the request er before you are subject t o backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup wit hholding on all such payments unt il you provide your TI N t o the request er.

Note: Writ ing “ Applied For” means that you have already applied for a TI N o r that you intend t o apply for one soon.

Caution: A disregarded domestic entity t hat has a foreign owner must use the appropriate Form W-8.

PART 4—EXEMPT FROM BACKUP WI THHOLDI NG

I f you are exempt, enter your name as described above and check the appropriat e box for your st atus, then check t he “ Exempt from backup withholding” box in Part 4.

Generally, individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup wit hholding for certain payment s, such as int erest and dividends.

Note: I f you are exempt from backup wit hholding, you should still complet e this form to

avoid possible erroneous backup wit hholding.

Exempt payees. Backup withholding is not required on any payments made t o t he

following payees:

1. An organizat ion exempt from t ax under section 501(a), any I RA, or a custodial account under sect ion 403(b)(7) if the account satisfies the requirements of section 401(f)(2);

2. The United St ates or any of its agencies or instrumentalit ies;

3. A stat e, the Dist rict of Columbia, a possession of the United St ates, or any of their polit ical subdivisions or inst rument alities;

4. A foreign government or any of its polit ical subdivisions, agencies, or instrumentalit ies; or

5. An int ernational organizat ion or any of its agencies or instrumentalit ies;

6. A corporation;

7. A foreign cent ral bank of issue;

8. A dealer in securities or commodit ies required to regist er in the Unit ed St ates, the District of Columbia, or a possession of t he United St ates.

9. A futures commission merchant regist ered with the commodity Futures Trading Commission;

10. A real estate invest ment trust;

11. An ent ity registered at all times during t he tax year under the I nvestment Company Act of 1940;

12. A common t rust fund operated by a bank under sect ion 584(a);

13. A financial instit ution;

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 chart below shows types of payments that may be exempt from backup withholding. The chart applies t o the exempt recipients listed above, 1 through 15.

I f the payment is for…	THEN the payment is exempt for…
I nterest and dividend payments	All exempt recipients except for 9
Broker transactions	Exempt recipients 1 t hrough 13. Also, a
	person regist ered under the I nvest ment
	Advisers Act of 1940 who regularly acts
	as a broker
Bart er exchange transactions and	Exempt recipients 1 t hrough 5
patronage dividends
Payments over $600 required to be	Generally, exempt recipients 1 through 7
report ed and direct sales over $5,000 1	2

1See Form 1099-MI SC, Miscellaneous I ncome, and it s inst ruct ions.

2However, the following payments made t o a corporation (including gross proceeds paid to an att orney under section 6045(f), even if the att orney is a corporat ion) and report able on Form 1099-MI SC are not exempt from backup withholding: medical and health care payments, attorneys’ fees; and payments for services paid by a Federal executive agency.

PART 5—RESI DENCY STATUS

Each corporat ion, individual, sole proprietor, partnership, estat e or trust doing business wit h the MiraCosta Community College Dist rict must indicate t heir residency status along with t heir t axpayer identificat ion number.

A corporation will be considered a “ resident” if it has a permanent place of business in California. The corporat ion has a permanent place of business in California if it is organized and existing under the laws of t his state or, if a foreign corporation, has qualified t o transact int rastat e business. A corporat ion t hat has not qualified to transact intrastat e business (e.g., a corporation engaged exclusively in int erstat e commerce) will be considered as having a permanent place of business in this state only if it maintains a permanent office in t his state that is permanent ly staffed by it s employees.

For individuals/ sole proprietors, the t erm “ resident” includes every individual who is in California for ot her than a t emporary or t ransitory purpose and any individual domiciled in California who is absent for a temporary or transitory purpose. Generally, an individual who comes t o California for a purpose, which will extend over a long or indefinit e period, will be considered a resident . However, an individual who comes t o perform a particular contract of short duration will be considered a nonresident .

For withholding purposes, a partnership is considered a resident partnership if it has a permanent place of business in California. An est ate is considered a California est ate if the decedent was a California resident at the time of death and a trust is considered a California t rust if at least one t rust ee is a California resident .

More information on residency stat us can be obtained by calling the Franchise Tax Board at the numbers list ed below:

From wit hin the Unit ed Stat es, call	1-800-338- 0505
From out side t he Unit ed Sat es, call	1-916-845- 6600
For hearing impaired wit h TDD, call	1-800-822- 6268

Are You Subject To Nonresident Withholding?

Payments made t o nonresident payees, including corporat ions, individuals, partnerships, estat es and trusts, are subject to withholding. Nonresident payees performing services in

California or receiving rent , lease or royalt y payments from property (real or personal) locat ed in California will have 7% of their t otal payments withheld for st ate income t axes. However, no wit hholding is required if total payments t o the payee are $1500 or less for the calendar year.

A nonresident payee may request that income t axes be wit hheld at a lower rat e or waived by sending a complet ed form FTB 588 to t he address below. A waiver will generally be grant ed when a payee has a hist ory of filing California returns and making timely est imat ed payments. I f payee act ivity is carried on outside of California or partially outside of California, a waiver or reduced withholding rate may be granted. For more informat ion, contact:

Franchise Tax Board

Nonresident Wit hholding Section

Attention: Stat e Agency Wit hholding Coordinator

PO Box 651 Sacramento, CA 95812- 0651

Telephone: ( 916) 845-4900

FAX: ( 916) 845-4831

I f the Franchise Tax Board has authorized a reduced rate of w ithholding or w aiver, attach a copy to this form.

PART 6—CERTI FI CATI ON

To establish t o the withholding agent that you are a U.S. person, or resident alien, sign the PAYEE DATA RECORD Form. The withholding agent may request you to sign even if items 1, 3, and 5 below indicate otherwise.

For a joint account , only the person whose TI N is shown in PART 2 should sign (when required) . Exempt recipients, see Exempt from backup w ithholding on page 2.

Signature requirements. Complete t he certification as indicated in 1 through 5 below.

1.	I nterest, dividend, and barter exchange accounts opened before 1984 and
	broker accounts considered active during 1983. You must give your correct
	TI N, but you do not have t o sign the certification.
2.	I nterest, dividend and barter exchange accounts opened after 1983 and
	broker accounts considered inactive during 1983. You must sign the
	cert ification or backup withholding will apply. I f you are subject t o backup
	withholding and you are merely providing your correct TI N t o the request er, you
	must cross out it em 2 in the certification before signing t he form.
3.	Real estate transactions. You must sign the certification. You may cross out item
	2 of the certification.
4.	Other payments. You must give your correct TI N, but you do not have to sign the
	cert ification unless you have been notified that you have previously given an
	incorrect TI N. “ Other payments” include payments made in the course of the
	request er’s trade or business for rents, royalties, goods (ot her than bills for
	merchandise) , medical and health care services (including payments t o

corporat ions), payments to a nonemployee for services, payments to certain fishing boat crew members and fishermen, and gross proceeds paid t o att orneys (including payment to corporat ions) .

5.	Mortgage interest paid by you, acquisition or abandonment of secured
	property, cancellation of debt, qualified state tuition program payments
	( under section 529) , I RA or Archer MSA contributions or distributions, and
	pension distributions. You must give your correct TI N, but you do not have t o
	sign the certification.

PART 7—TYPE OF BUSI NESS ENTERPRI SE

Please check every box that applies and at tach appropriat e certificat ion.

What Name/ Number to Give the Requester

For this type of account:		Give name and SSN of:
1.	I ndividual	The individual
2.	Two or more individuals (joint	The actual owner of the account or, if
	account)	combined funds, the first individual on the
		account 1
3.	Custodian account of a minor	The minor 2
	(Uniform Gift t o Minors Act)
4.	a. The usual revocable savings trust	The grantor-t rust ee 1
	(grantor is also trustee)
	b. So-Called trust account that is	The actual owner 1
	not a legal or valid trust under
	state law
5.	Sole proprietorship or single-owner	The owner—See Footnote 3
	LLC
For this type of account:		Give name and EI N of:
6.	Sole proprietorship or single-owner	The owner—See 5 above and Footnote
	LLC	3.
7.	A valid trust, estat e, or pension trust	Legal entity 4

8.Corporate or LLC electing corporate

status on Form 8832

The corporation

9.Associat ion, club, religious, charit able,

	educat ional, or other tax-exempt	The organization
	organization
10.	Partnership or multi-member LLC
		The part nership
11.	A broker or registered nominee
		The broker or nominee
12.	Account with t he Depart ment of
	Agriculture in the name of a public	The public entity
	entity (such as a stat e or local
	government, school dist rict , or prison)
	that receives agricult ural program
	payments

1List first and circle the name of the persons whose number you furnish. I f only one person on a joint account has an SSN, t hat person’s number must be furnished.

2Circle the minor’s name and furnish the minor’s SSN.

3You must show your individual name, but you may also ent er your business or “ DBA” name. The District and the I RS prefer that you provide your SSN. The

District needs your SSN for State of California EDD DE542 reporting purposes. You may provide both you SSN and your EI N. The SSN w ill only be used for State of California EDD DE542 reporting; your EI N w ill be used for I RS 1009MI SC reporting

4List first and circle the name of the legal trust , est ate, or pension t rust . (Do not furnish the TI N of t he personal representat ive or t rust ee unless the legal entity itself is not designated in the account tit le.)

Note: I f no name is circled when more than one name is listed, the number will be considered to be t hat of the first name list ed