Virginia State W 9 Form – Fill Out and Use This PDF

	General Instructions				Nonresident alien who becomes a resident alien.
					Generally, only a nonresident alien individual may
	Section references are to the Internal Revenue Code				use the terms of a tax treaty to reduce or eliminate
	unless otherwise noted.				U.S. tax on certain types of income. However, most
	Future developments. The IRS has created a page				tax treaties contain a provision known as a “saving
					clause.” Exceptions specified in the saving clause
	on IRS.gov for information about Form W-9, at
					may permit an exemption from tax to continue for
	www.irs.gov/w9. Information about any future
					certain types of income even after the payee has
	developments affecting Form W-9 (such as
					otherwise become a U.S. resident alien for tax
	legislation enacted after we release it) will be
					purposes.
	posted on that page.
	Purpose of Form				If you are a U.S. resident alien who is relying on an
					exception contained in the saving clause of a tax
	A person who is required to file an information
					treaty to claim an exemption from U.S. tax on
	return with the IRS must obtain your correct
					certain types of income, you must attach a
	taxpayer identification number (TIN) to report, for
					statement to Form W-9 that specifies the following
	example, income paid to you, payments made to
					five items:
	you in settlement of payment card and third party
					1. The treaty country. Generally, this must be the
	network transactions, real estate transactions,
					same treaty under which you claimed exemption
	mortgage interest you paid, acquisition or
					from tax as a nonresident alien.
	abandonment of secured property, cancellation of
					2. The treaty article addressing the income.
	debt, or contributions you made to an IRA.
					3. The article number (or location) in the tax treaty
	Use Form W-9 only if you are a U.S. person
					that contains the saving clause and its exceptions.
	(including a resident alien), to provide your correct
					4. The type and amount of income that qualifies for
	TIN to the person requesting it (the requester) and,
					the exemption from tax.
	when applicable, to:				5. Sufficient facts to justify the exemption from tax
	1. Certify that the TIN you are giving is correct (or
					under the terms of the treaty article.
	you are waiting for a number to be issued),
	2. Certify that you are not subject to backup				Example. Article 20 of the U.S.-China income tax
	withholding, or				treaty allows an exemption from tax for scholarship
	3. Claim exemption from backup withholding if you				income received by a Chinese student temporarily
	are a U.S. exempt payee. If applicable, you are also				present in the United States. Under U.S. law, this
	certifying that as a U.S. person, your allocable share				student will become a resident alien for tax
	of any partnership income from a U.S. trade or				purposes if his or her stay in the United States
	business is not subject to the withholding tax on				exceeds 5 calendar years. However, paragraph 2 of
	foreign partners’ share of effectively connected				the first Protocol to the U.S.-China treaty (dated
	income, and				April 30, 1984) allows the provisions of Article 20 to
	4. Certify that FATCA code(s) entered on this form				continue to apply even after the Chinese student
	(if any) indicating that you are exempt from the				becomes a resident alien of the United States. A
	FATCA reporting, is correct.				Chinese student who qualifies for this exception
	Definition of a U.S. person. For federal tax				(under paragraph 2 of the first protocol) and is
					relying on this exception to claim an exemption
	purposes, you are considered a U.S. person if you
					from tax on his or her scholarship or fellowship
	are:
					income would attach to Form W-9 a statement that
	•＃＄ ＃i	di idual＃ ho＃is＃a＃ｨ.～.＃ itize		＃or＃ｨ.～.＃reside t＃
					includes the information described above to
	alien,				support that exemption.
	•＃＄＃part ership,＃ orporatio ,＃ o			pa ,＃or＃
	associatio ＃ reated＃or＃orga ized＃i			＃the＃ｨ ited＃	If you are a nonresident alien or a foreign entity,
	States or under the laws of the United States,				give the requester the appropriate completed Form
	•＃＄ ＃estate＃ other＃tha ＃a＃foreig		＃estate ,＃or＃		W-8 or Form 8233.
	•＃＄＃do	esti ＃trust＃ as＃defi ed＃i	＃ｚegulatio s＃se tio		＃ What is backup withholding? Persons making
	301.7701-7).				certain payments to you must under certain
	Foreign person. If you are a foreign person or the				conditions withhold and pay to the IRS a percentage
	U.S. branch of a foreign bank that has elected to be				of such payments. This is called “backup
	treated as a U.S. person, do not use Form W-9.				withholding.” Payments that may be subject to

Instead, use the appropriate Form W-8 or Form	backup withholding include interest, tax-exempt
8233 (see Publication 515, Withholding of Tax on	interest, dividends, broker and barter exchange
Nonresident Aliens and Foreign Entities).	transactions, rents, royalties, nonemployee pay,
	payments made in settlement of payment card and
	third party network transactions, 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 furnish your TIN to the requester,

2.You do not certify your TIN when required (see Section 2 Certification – Page 3 for details),

3.The IRS tells the requester that you furnished 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 return (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 Exempt payee code on page 3 and the separate Instructions for the Requestor of Form W-9 for more information.

What is FATCA reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requestor of Form W-9 for more information.

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

1

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

Section 1 -Taxpayer Identification

Check the appropriate Tax Identification Number (TIN) type. Enter your EIN/SSN in the space

provided. If you are a resident alien and you do not have and /or 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.

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. Get 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 get Forms W-

7and SS-4 from the IRS by calling 1-800-TAX-FORM (1-800-829-3676) or from the IRS’s Internet Web Site www.irs.gov.

If you do not have a TIN, apply for a TIN immediately, 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: Writing “Applied For” means that you have already applied for a TIN or that you intend to apply for one soon.

Enter the TIN which coincides with the 'Legal Name' provided on the form.

a.If you are an individual, check the "Social Security Number (SSN)" box and enter the SSN.

b.If you are a Grantor or Revocable Trust, check the "Social Security Number (SSN)" box and enter the SSN of the Grantor.

c. If you are a Resident Alien, check the "Social Security Number (SSN)" box and enter your SSN or

your ITIN (IRS Individual Taxpayer Identification Number).

d.If you are a Sole Proprietor, check the "Social Security Number (SSN)" box and enter the SSN of the sole proprietor.

e.If you are a Single-Member LLC that is disregarded as an entity, check the "Social Security Number (SSN)" box and enter the member's SSN.

Note: If an LLC has one owner, the LLC's default tax status is "disregarded entity". If an LLC has two owners, the LLC's default tax status is "partnership". If an LLC has elected to be taxed as a corporation, it must file IRS Form 2553 (S Corporation) or IRS Form 8832 (C Corporation).

Vendors are requested to enter their Dunn and Bradstreet Universal Numbering System (DUNS), if applicable. See number requirement below.

Dunn and Bradstreet Universal Numbering System

(DUNS) number requirement . The United States Office of Management and Budget (OMB) requires all vendors that receive federal grant funds have their DUNS number recorded with and subsequently reported to the granting agency. If a contractor has multiple DUNS numbers the contractor should provide the primary number listed with the Federal government’s Central Contractor Registration (CCR) at www.ccr.gov . Any entity that does not have a DUNS number can apply for one on-line at http://www.dnb.com/us/ under the DNB D-U-N Number Tab.

Legal Name. If 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 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 enter in Part I of the form. If you are using a name other than that which is listed on a Social Security Card, please enter the legal entity name as filed with the IRS. In general, enter the name shown on your income tax return. Do not enter a Disregarded Entity Name on this line.

Business Name. Business, Disregarded Entity, trade, or DBA ("doing business as") name.

Entity Type. Select the appropriate entity type.

Individual. If you are an individual, you must generally enter the name shown on your income tax return.

Sole proprietor. Enter your individual name as shown on your social security card on the “Legal Name” line. You may enter your business, trade, or

“doing business as (DBA)” name on the “Business Name” line.

Partnership. A partnership is an entity reflecting a relationship existing between two or more persons who join to carry on a trade or business. Enter the partnerships entity's name on the "Legal Name" line. This name should match the name shown on the legal document creating the entity. You may enter your business, trade, or "doing business as (DBA) name on the "Business Name" line.

Trust. A legal entity that acts as fiduciary, agent or trustee on behalf of a person or business entity for the purpose of administration, management and the eventual transfer of assets to a beneficial party. Enter the name of the legal entity on the "Legal Name" line.

Estate. A separate legal entity created under state law solely to transfer property from one party to another. The entity is separated by law from both the grantor and the beneficiaries. Enter the name of the legal entity on the "Legal Name" line.

Government. The Government of any State, any Political Subdivision of any State, any Agency or Instrumentality of a State or of a Political Subdivision of a State.

Non-Profit. A ＃orga izatio ＃that＃is＃orga ized＃a d＃ operated exclusively for exempt purposes and none of its earnings may inure to any private shareholder or individual.

Corporation. ＄＃ o pa ＃re og ized＃ ＃la ＃as＃a＃

single body with its own powers and liabilities, separate from those of the individual members. Enter the entity's name on the "Legal Name" line and any trade or "doing business as (DBA)" name on the "Business Name" line.

S-Corporation. A corporation that is taxed like a partnership: a corporation in which five or fewer people own at least half the stock. Enter the entity's name on the "Legal Name" line and any trade or "doing business as (DBA)" name on the "Business Name" line.

C-Corporation. A business that is taxed as a separate entity: a business taxed under Subchapter C of the Internal Revenue Code and legally distinct from its owners. Enter the entity's name on the "Legal Name" line and any trade or "doing business as (DBA)" name on the "Business Name" line.

Limited liability Company (LLC). An LLC with at least two members is classified as a partnership for federal income tax purposes unless it files Form 8832 and affirmatively elects to be treated as a corporation. Enter the name of the partnership or corporation. An LLC with only one member is treated as an entity disregarded as separate from its owner for income tax purposes (but as a separate

2

entity for purposes of employment tax and certain excise taxes), unless it files Form 8832 and affirmatively elects to be treated as a corporation. If you are a single-member LLC (including a foreign LLC with a domestic owner) that is disregarded as an entity separate from its owner, enter the

owner’s name on the “Legal Name” line. Caution:

A disregarded domestic entity that has a foreign owner must use the appropriate Form W-8.

Entity Classification. Select the appropriate classification type.

Contact Information. Enter your contact information.

Enter your Legal Address. Enter your Remittance Address. A Remittance Address is the location in which you or your entity receives business payments.

Enter your Business Phone Number. Enter your Mobile Phone Number, if applicable. Enter your Fax Number, if applicable. Enter your Email Address.

For clarification on IRS Guidelines, see www.irs.gov.

Exemptions

If you are exempt from backup withholding and/or FATCA reporting, enter in the Exemptions box, any code(s) that may apply to you. See Exempt payee code and Exemption from FATCA reporting code below.

Exempt payee code. 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. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.

Note. If you are exempt from backup withholding, you should still complete this form to avoid possible erroneous backup withholding.

The following codes identify payees that are exempt

from backup withholding:

1 - ＄ ＃orga izatio ＃e e pt＃fro ＃ta ＃u der＃se tio ＃ 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 government or any of its political subdivisions, agencies, or instrumentalities 5 - A corporation

6 - A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States

7 - A futures commission merchant registered with the Commodity Futures Trading Commission

8 - A real estate investment trust

9 - An entity registered at all times during the tax year under the Investment Company Act of 1940

10- A common trust fund operated by a bank under section 584(a)

11 - A financial institution

12 - A middleman known in the investment community as a nominee or custodian

13 - 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 13.

	IF the payment is for. . .	THEN the payment is exempt for. .
	Interest and dividend	All exempt payees except for 7
	payments
	Broker transactions	Exempt payees 1 through 4 and 6
		through 11 and all C corporations.
		S corporations must not enter an
		exempt payee code because they
		are exempt only for sales of
		noncovered securities acquired
		prior to 2012.
	Barter exchange	Exempt payees 1 through 4
	transactions and
	patronage dividends
	Payments over $600	Generally, exempt payees 1
	required to be reported	through 52
	and direct sales over
	$5,0001
	Payments made in	Exempt payees 1 through 4
	settlement of payment
	card or third party
	network transactions

1See Form 1099-MISC, Miscellaneous Income, and its instructions.

2However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney, and payments for services paid by a federal executive agency.

Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements.

A - ＄ ＃orga izatio ＃e e pt＃fro ＃ta ＃u der＃se tio ＃ 501(a) or any individual retirement plan as defined in section 7701(a)(37)

B - The United States or any of its agencies or instrumentalities

C - A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities

D - A corporation the stock of which is regularly traded on one or more established securities markets, as described in Reg. section 1.1472- 1(c)(1)(i)

E - A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1(c)(1)(i)

F - A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state

G - A real estate investment trust

H - A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940

I - A common trust fund as defined in section 584(a) J - A bank as defined in section 581

K - A broker

L - A trust exempt from tax under section 664 or described in section 4947(a)(1)

M - A tax exempt trust under a section 403(b) plan or section 457(g) plan

Section 2 - Certification

To establish to the paying agent that your TIN is correct, you are not subject to backup withholding, or you are a U.S. person, or resident alien, sign the certification on Form W-9. You are being requested to sign by the Commonwealth of Virginia.

For a joint account, only the person whose TIN is shown in Part I should sign (when required).

Real estate transactions. You must sign the certification. You may cross out item 2 of the certification.

Submission:

Commonwealth Vendor Group

Post Office Box 1971

Richmond, VA 23218-1971