NSD W9 Substitute W9 Form.pdf

Complete and sign the Request for Taxpayer Identification Number (W-9)

Substitute

Form W-9 Request for Taxpayer Identification Number, Certification and UBI Number

Return to: Northshore School District

3330 Monte Villa Pkwy, Bothell WA 98021 email: accountspayable@nsd.org

1. Legal Name (as shown on your income tax return)

2. Business Name, if different from Legal Name above – eg. doing business as (DBA) Name

3.Check ONLY ONE box below (see W-9 instructions for additional information)

Individual or Sole Proprietor

LLC filing as a sole proprietor

Partnership

Corporation

S-Corp

LLC filing as Corporation

LLC filing as Partnership

LLC filing as S-Corp

Non Profit Organization

Volunteer

Board /Committee Member

Local Government

State Government

Federal Government

(including tribal)

Tax-exempt organization

Trust/Estate

4. If exempt from backup withholding, check here: (see instructions for W-9 to determine if you are exempt from backup withholding)

6. LEGAL Address (number, street, and apt. or suite no.) 6. ORDER TO Address (number, street, and apt. or suite no.) if different from legal

7. ORDER TO City, state, and ZIP code if different from legal

7. LEGAL City, state, and ZIP code 6. REMIT TO Address (number, street, and apt. or suite no.) if different from legal

7. REMIT TO City, state, and ZIP code if different from legal

Contact Name & Title Contact Email & Phone Number

Type of business

Social security number

OR

Employer identification number

UBI

8.Taxpayer Identification Number (TIN)

Enter your EIN OR SSN in the appropriate box to the right (do not enter both) For individuals, this is your social security number (SSN).

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

NOTE: The EIN or SSN must match the Legal Name as reported to the IRS. For a resident alien, sole proprietor, or disregarded entity, or to find out how to get a Taxpayer Identification Number, see the W9 Instructions. If the account is in more than one name, see the W9 Instructions for guidelines on whose number to enter.

SECTION 9 MUST BE COMPLETED TO BE A VENDOR OF NORTHSHORE SCHOOL DISTRICT

9. Washington State Tax Registration Number (UBI)

Enter your UBI number in the box below & to the right or check the appropriate exception box below.

A UBI is not required if: (MUST CHECK BOX BELOW if not submitting UBI #)

You have no physical address in Washington and gross sales in Washington are under

$100,000 OR

You have no employees or representatives in Washington OR

You are a non-profit organization receiving majority of funding through donations OR

You have no retail sales and income is lower than $12,000

10. Certification Under penalty of perjury, I certify that:

• 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

• 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

• I am a U.S. person (including a U.S. resident alien).

(For additional information about the W-9 see the W-9 Instructions.)

SIGNATURE of U.S. PERSON

Date:

For Northshore School District Use Only

Vendor #: Date:

https://www.irs.gov/pub/irs-pdf/fw9.pdf https://www.irs.gov/pub/irs-pdf/fw9.pdf https://www.irs.gov/pub/irs-pdf/fw9.pdf https://www.irs.gov/pub/irs-pdf/fw9.pdf