W9 Ma Form PDF Details

In navigating the complexities of financial and tax transactions within the state of Massachusetts, the Form W-9, specifically the Massachusetts Substitute W-9 Form, stands out as a critical document. Revised in April 2009, this form serves a dual purpose: it requests a taxpayer's identification number and certification, ensuring compliance with tax regulations while facilitating smooth business operations between entities and the state. Individuals and businesses engaging in transactions that necessitate the reporting of income, mortgage interest, real estate transactions, or contributions to retirement accounts, for instance, need to provide their correct taxpayer identification number to avoid the ramifications of backup withholding. Backup withholding, a measure enforced to ensure tax compliance, affects payments like interest, dividends, and non-employee compensation, withholding a designated percentage of income when specific conditions are unmet by the payee. The form requires detailed information, including legal names, business names if applicable, addresses, and the taxpayer identification number—either a Social Security Number for individuals or an Employer Identification Number for entities. Additionally, it carries a certification part where the payee attests, under the penalty of perjury, to the accuracy of the information provided and their tax status, directly impacting their transactions with the Commonwealth of Massachusetts. The form is a testament to the structured approach Massachusetts takes towards fiscal responsibility and transparency, embodying the intersection of state compliance requirements and individual or business financial responsibilities.

QuestionAnswer
Form NameW9 Ma Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesw9 w form print, w 9 form ma, form w 9 taxpayer, w9 form 9

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Form W-9

(Massachusetts Substitute W-9 Form)

Rev. April 2009

Request for Taxpayer Identification Number and Certification

Completed form should be given to the requesting department or the department you are currently doing business with.

Name ( List legal name, if joint names, list first & circle the name of the person whose TIN you enter in Part I-See Specific Instruction on page 2)

 

 

Business name, if different from above. (See Specific Instruction on page 2)

 

 

or type

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check the appropriate box:

Individual/Sole proprietor

 

Corporation Partnership Other -----------------------------------------------

print

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Legal Address: number, street, and apt. or suite no.

 

 

 

suite no.

 

 

 

 

 

 

 

Remittance Address: if different from legal address number, street, and apt. or

Please

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City, state and ZIP code

 

 

 

 

City, state and ZIP code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Phone # (

)

Fax # (

)

 

 

 

 

 

 

Email address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part I

Taxpayer Identification Number (TIN)

 

 

 

 

 

 

 

 

 

 

 

Enter your TIN in the appropriate box. For individuals, this is your social

 

 

 

Social security number

 

 

 

security number (SSN). However, for a resident alien, sole proprietor, or

 

 

 

 

 

 

 

 

 

฀฀฀-฀฀-฀฀฀฀

 

 

 

disregarded entity, see the Part I instruction on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

page 2. For other entities, it is your employer identification number (EIN). If

 

 

 

OR

 

 

 

you do not have a number, see How to get a TIN on page 2.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Employer identification number

 

 

 

 

 

Note: If the account is in more than one name, see the chart on page 2 for

 

 

 

 

 

 

 

 

 

 

 

฀฀-฀฀฀฀฀฀฀

 

 

 

 

 

guidelines on whose number to enter.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Vendors:

 

 

 

 

 

 

 

 

 

DUNS

 

 

 

 

 

Dunn and Bradstreet Universal Numbering System (DUNS))

 

 

 

฀฀฀฀฀฀฀฀฀

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Part II 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 Services (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 an U.S. person (including an U.S. resident alien).

4. I am currently a Commonwealth of Massachusetts’s state employee: (check one): No____ Yes _____ If yes, in compliance with the State Ethics

Commission requirements.

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 return. For real estate transactions, item 2 does not apply.

Sign

Authorized Signature ►

 

 

Date ►

Here

 

 

 

 

 

 

Purpose of Form

conditions. This is called “backup withholding.”

5. You do not certify to the requester that you are

A person who is required to file an information

Payments that may be subject to backup

not subject to backup withholding under 4 above

withholding include interest, dividends, broker and

(for reportable interest and dividend accounts

return with the IRS must get your correct

barter exchange transactions, rents, royalties,

opened after 1983 only).

taxpayer identification number (TIN) to report, for

nonemployee pay, and certain payments from

 

example, income paid to you, real estate

Certain payees and payments are exempt from

fishing boat operators. Real estate transactions

transactions, mortgage interest you paid,

backup withholding. See the Part II instructions

are not subject to backup withholding.

acquisition or debt, or contributions you made to

on page 2.

 

 

an IRA.

 

 

 

 

 

If you give the requester your correct TIN, make

 

 

 

 

Penalties

Use Form W-9 only if you are a U.S. person

the proper certifications, and report all your

taxable interest and dividends on your tax return,

 

(including a resident alien), to give your correct

Failure to furnish TIN. If you fail to furnish your

payments you receive will not be subject to

TIN to the person requesting it (the requester)

correct TIN to a requester, you are subject to a

backup withholding. Payments you receive will

and , when applicable, to:

penalty of $50 for each such failure unless your

be subject to backup withholding if:

 

 

 

 

failure is due to reasonable cause and not to

1. Certify the TIN you are giving is correct (or

 

 

1.

You do not furnish your TIN to the

willful neglect.

you are waiting for a number to be issued).

 

requester, or

 

 

 

 

Civil penalty for false information with respect

2. Certify you are not subject to backup

 

 

2.

You do not certify your TIN when required

to withholding. If you make a false statement

withholding

 

(see the Part II instructions on page 2 for

with no reasonable basis that results in no backup

 

 

 

If you are a foreign person, use the

 

details), or

withholding, you are subject to a $500 penalty.

appropriate Form W-8. See Pub 515,

3.

The IRS tells the requester that you furnished

Criminal penalty for falsifying information.

Withholding of Tax on Nonresident Aliens and

 

an incorrect TIN, or

Willfully falsifying certifications or affirmations

Foreign Corporations.

 

 

 

may subject you to criminal penalties including

 

 

4. The IRS tells you that you are subject to

What is backup withholding? Persons making

fines and/or imprisonment.

certain payments to you must withhold a

 

backup withholding because you did not

 

 

report all your interest and dividends only), or

Misuse of TINs. If the requester discloses or uses

designated percentage, currently 28% and pay to

 

the IRS of such payments under certain

TINs in violation of Federal law, the requester may

be subject to civil and criminal penalties.

 

 

 

Form MA- W-9 (Rev. April 2009)

Specific Instructions

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.

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

Limited liability company (LLC). 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 under Treasury regulations section 301.7701-3, enter the owner’s name on the “Name” line. Enter the LLC’s name on the “Business name” line.

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

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” line.

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 an LLC that is disregarded as an entity separate from its owner (see Limited liability company (LLC) above), and are owned by an individual, enter your SSN (or “pre-LLC” EIN, if desired). If the owner of a disregarded LLC is a corporation, partnership, etc., enter the owner’s EIN.

Note: See the chart on this page 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. 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-7 and 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, 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.

Part II - Certification

To establish to the paying agent that your TIN is correct or you are a U.S. person, or resident alien, sign Form W-9.

For a joint account, only the person whole 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.

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.

Privacy Act Notice

Section 6109 of the Internal Revenue Code requires you to give your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA or MSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the Department of Justice for civil and criminal litigation, and to cities, states, and the District of Columbia to carry out their tax laws

You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold a designated percentage, currently 28% of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to a payer. Certain penalties may also apply.

What Name and Number to Give the Requester

For this type of account:

Give name and SSN of:

 

 

 

1.

Individual

The individual

2.

Two or more

The actual owner of the

 

individuals (joint

account or, if combined

 

account)

funds, the first

 

 

individual on the

 

 

account 1

3.

Custodian account of

The minor 2

 

a minor (Uniform Gift

 

 

to Minors Act)

The grantor-trustee 1

4.

a. The usual

 

revocable savings

 

 

trust (grantor is

 

 

also trustee)

The actual owner 1

 

b. So-called trust

 

account that is not

 

 

a legal or valid

 

 

trust under state

 

 

law

The owner 3

5.

Sole proprietorship

For this type of account:

Give name and EIN of:

 

 

 

6.

Sole proprietorship

The owner 3

7. A valid trust, estate, or

Legal entity 4

 

pension trust

 

8.

Corporate

The corporation

9.

Association, club,

The organization

 

religious, charitable,

 

 

educational, or other

 

 

tax-exempt organization

 

10.

Partnership

The partnership

11. A broker or registered

The broker or nominee

 

nominee

 

12.

Account with the

The public entity

 

Department of

 

 

Agriculture in the name

 

 

of a public entity (such

 

 

as a state or local

 

 

government, school

 

 

district, or prison) that

 

 

receives agricultural

 

 

program payments

 

1List 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.

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

3You must show your individual name, but you may also enter your business or “DBA” name. You may use either your SSN or EIN (if you have one).

4. List first and circle the name of the legal trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.)

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.

If you have questions on completing this form, please contact the Office of the State Comptroller. (617) 973-2468.

Upon completion of this form, please send it to the Commonwealth of Massachusetts Department you are doing business with.

Page 2

Form MA- W-9 (Rev. April 2009)

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Certification instructions You, Purpose of Form A person who is, and Authorized Signature  Date in download w9

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