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W-9 re lease agreementFrom: "Stephani P. Kleinsmith" <skleinsmith@centurytel.net> To: City_of_CoppelI.Town_Center(GSIEB) Date: 1/21/02 7:32PM Subject: Sprint lease for Andy Brown Park Hello Mr. Sieb. My name is Stephani Kleinsmith and I work for David Prejean at Crafton Communications. Hopefully, on Tuesday night, the council will approve Sprint's lease for Andy Brown Park. With that being said, I need for to get a W-9 for the city to accompany the lease. I have attached a copy of the form. Could you please fill it out and fax it over to me at (940) 498-11787 If I need to request this information from someone else, please let me know. Thank you for your help with this, Stephani Stephani Kleinsmith Crafton Communications (972) 898-0890 (940) 498-1178 (fax) FormW-9 Request for Taxpayer Give form to the (Rev. D~ember 200o) Identification Number and Certification requester. Do not 3epar. ment of the Treasur~ send to the IRS. Name (See Specific Instructions on page 2.) CITY OF COPPELL Business name., ir d~Rerent from above. (See. Specific Instructions on page 23 ,~- Check appropriate box: [] Individual/Sole proprietor [] Corporation [] Partnership [] Other I~ .-~J~.~o-];~-jl~-{;oq'~~-. ~ Address (number. street, and apt. or suite no.) Requester's name and address (optional) E ?5_5 PARKI,IAY RI.VD., P.O. ROX 9&TR City. state, and ZIP code COPPELL, TF_.XA~ 75019 I1'-~,m! Taxpayer Identification Number (TIN) L,st account number(s} here (optional) Enter your TIN in the appropriate box. For individuals, this is your social security number [ So~ial securit, number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part l I J~ I J~ I I I instructions on page 2. For other entities, it is your ~ For U.S. Payees Exempt From employer identification number (fIN). If you do not or Backup Withholding (See the have a number, see How to get a TIN on page 2. Employer identification number [ instructions on page 2.) Note: If the account is in more than one name, see the chart on page 2 for guidelines on whose number 7 5~ 1 I 81 312 l0I 7 to enter. 1~ EXI!I~T [I~11[ 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 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 renter subject to backup withholding, and 3. I am a U.S. person (including a U,S. resident alien). 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. For mortgage interest paid. acquisition or abandonment of secured property, cancellation of debt. contributions to an individual retirement arrangement (IRA), and generally, payment5 other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN, (See the instructions on page 2.) Sign Signature of ( ) /' . ' Here U.S. person ~/~f./t.~Cl.~// Date ~ JAI~JAR¥ 23, 2002 Purpose of Form ithholding? Persons making 5. You do not certify to the requester that you certain payments to you must withhold and pay are not subject to backup withholding under 4 A person who is required to file an information to the IRS 31% of such payments under certain above (for reportable interest and dividend return with the IRS must get your correct conditions. This is called "backup withholding." accounts opened after 1983 only). taxpayer identification number (TIN) to report, for Payments that may be subject to backup Certain payees and payments are exempt example, income paid to you. real estate withholding include interest, dividends, broker from backup withholding. See the Part II transactions, mortgage interest yOu paid. and barter exchange transactions, rents, instructions and the separate InstrucUons for acquisition or abandonment of secured property, royalties, nonemployee pay. and certain the Requester of Form W-9. cancellation of debt. or contributions you made payments from fishing boat operators. Real to an IRA. estate transactions are not subject to backup Penalties Use Form W-9 only if you are a U.S. person withholding. Failure to furnish TIN. If you fail to furnish your (including a resident alien), to give your correct If you give the requester your correct TIN, correct TIN to a requester, you are subject to a TIN to the person requesting it (the requester) make the proper certifications, and report all penalty of $50 for each such failure unless your and. when applicable, to: your taxable interest and dividends on your tax failure is due to reasonable cause and not to 1. Certify the TIN you are giving is correct (or return, payments you receive will not be subject willful neglect. you are waiting for a number to be issued), to backup withholding. Payments you receive 2. Certify you are not subject to backup will be subject to backup withholding if: Civil penalty for false information with respect to withholding. If you make a false statement withholding, or 1. You do not furnish your TIN to the with no reasonable basis that results in no 3. Claim exemption from backup ~vithholding if requester, or backup withholding, you are subject to a $500 you are a U.S. exempt payee. 2. You do not certify your TIN when required penalty. If you are a foreign Parson, use the (see the Part III instructions on page 2 for Criminal penalty for falsifying information. appropriate Form W-8. See Pub. 515, details), or Willfully falsifying certifications or affirmations Withholding of Tax on Nonresident Aliens and 3. The IRS tells the requester that you may subject you to criminal penalties including Foreign Corporations. furnished an incorrect TIN. or fines and/or imprisonment. Note: Ifa requester gives you a form other than 4. The IRS tells you that you are subject to Misuse of TINs. If the requester discloses or Form w-g to request your TIN. you must use the backup withholding because you did not report uses TINs in violation of Federal law, the requester's form if it is substantially .similar to this all your interest and dividends on your tax return requester may be subject to civil and criminal Form W-9. (for reportable interest and dividends only), or penalties. Cat. No. 10231X Fcxm W-9 (Rev. 12-2000) Form W-9 (Rev. 12-2000) Page Specific Instructions such payments until you provide your TiN to the report interest, dividends, and certain other requester, income paid to you. mortgage interest you paid, Name. If you are an individual, you must Note: Writing "Applied For" means that you have the acquisition or abandonment of secured generally enter the name shown on your social already applied for a TIN or that you intend to property, cancellation of debt, or contributions secudty card. However. if you have changed you made to an IRA or MSA, The IRS uses the your last name, for instance, due to marriage apply for one soon. numbers for identification purposes and to help without informing the Social Security Part II--For U,S. Payees Exempt From Backup verify the accuracy of your tax return. The IRS Administration of the name change, enter your Withholding may also provide this information to the first name. the last name show~ on yOur social Department of Justice for civil and criminal secunty card. and your new last name. Individuals (including sole proprietors) are not litigation, and to cities, states, and the District of exempt from backup withholding. Corporations Columbia to carry out their tax laws. If the account is in joint names, list first and are exempt from backup withholding for certain then circle the name of the person or entity payments, such as interest and dividends. For You must provide your TIN whether or not you whose number yOu enter in Part I of the form. more information on exempt payees, see the are required to file a tax return, Payers must Sole proprietor. Enter your individual name separate Instructions for the Requester of generally withhold 31% of taxable interest, as shown on your social secunty card on the Form W-9. dividend, and cerLain other payments to a payee. who does not give a TIN to a payer. Certain "Name" line, You may enter your business, If you are exempt from backup withholding, penalties may also apply. trade, or "doing business as [DBA)" name on the you should still complete this form to avoid "Business name" line. possible erroneous backup withholding. Enter Limited liabilit~ company (LLC). If you are a your correct TIN in Part I, wdto "Exempt" in What Name and Number To single-member LLC (including a foreign LLC with Part I1. and sign and date the form. Give the Requester a domestic owner) that is disregarded as an If you are a nonresident alien or a foreign entity separate from its owner under Treasury entity not subject to backup withholding, give For this type of account: Give name and SSN of: regulations section 301.7701-3. enter the the requester the appropriate completed Form 1. ndw~dual The individJal owner's name on the "Name" line. Enter the W-8. LEG's name on the "Business name'* line. 2. Two or mo'e The actual owner of the Part III--Certification individuals 0oint account or ~ combined Caution: A disregarded domestic entity that has account) funds~ the first mdi¥idual on the account ' a foreign owner must use the appropriate To establish to the withholding agent that you Form W-8. are a U,S, person, or resident alien, sign Form 3. Custodian account et The minor a turner (Jnltorm Gilt Other entities. Enter your business name as W-9. You may be requested to sign by the to Minors Act) shown on required Federal tax documents on withholding agent even if items 1, 3, and 5 4. a. The usual The §"antor-t'u~ee ' the "Name" line. This name should match the below indicate otherwise. 'evocable savincjs tr~lst (granto, is name shown on the charter or other legal For a joint account, only the person whose also t.,ustee) document creating the entity. You may enter any TIN is shown in Part I should sign (when b..So-called t'ust The actual owne' ' business, trade, or DBA name on the "Business required), account that is not name" line. 1. Interest, dividend, and herter exchange a legal or valid trust under state law Part I--Taxpayer Identification Number (TIN) accounts opened before 1984 and broker 5. Sole proprietorship The owner accounts considered active during 1983. You Enter your TIN in the appropriate box. must give your correct TIN. but you do not have Fo~ this t~pe of account: Give name and LIN of: if you are a resident alien and you do not to sign the certification. have and are not eligible to get an SSN. your 2. Interest, dividend, broker, and barter 6. Sole prop-rote'ship The owne' TIN is your IRS individual taxpayer identification exchange accounts opened after 1983 and 7. A valid t-ust, estate or Legal entity pension trust number (ITIN). Enter it in the social security broker accounts considered inactive during 8. Corporate The corporation number box. If you do not have an ITIN. see, 1983. You must sign the certification or backup S. As,~3ciation. club The orcjanization HOw to get a TIN below, withholding will apply. If you are subject to religious, charitable. If yOU are a sole proprietor and yOu have an backup withholding and you are merely providing educational or other LIN. you may enter either yOur SSN or LIN. your correct TIN to the requester, you must tax-exempt Howeve, r, the IRS prefers that you use your SSN. cross out item 2 in the certification before or§anization If you are an LLC that is disregarded as an signing the form. 10. Partnership The partnership 11. A broker or -egistered The b'oker or nominee eetity separate from its owner (see Limited 3. Real estate transactions. You must sign nominee. liability company (LLC) above), and are owned the certification. You may cross out item 2 of the 12. Account with the The public entity by an individual, enter your SSN (or "pre-LLC" certification. Depa'tment of Agriculture In the name EIN. if desired). If the owner of a disregarded 4. Other payments. You must give your of a pdblic ent,ty (such LLC is a corporation, partnership, otc.. enter the correct TIN, but you do not have to sign the as a state or local owner's LIN. certification unless you have been notified that government, school Note: .See the chart on this page for further you have previously given an incorrect TIN. district, or p'ison) that receives agricultural clarification of name and TIN combinations. "Other payments" include payments made in the program payments course or the requester's trade or business for How to get a TIN. If you do not have a TIN. rents, royalties, goods (other than bills for . apply for one immediately. To apply for an SSN. merchandise), medical and health care services List first and circle the, narne of the person whose numbe, you lurmsh. ~f ont~' one person on a joint get Form SS-5, Application for a Social Security (including payments to corporations}, payments account has an SSN. that person's number must be Card, from your local Social Security to a nonemployee for services, payments to furnished. Administration office. Get Form W-'/, Application certain fishing boat crew members and for IRS Individual Taxpayer Identification fishermen, and gross proceeds paid to attorneys ~ Circle the minor's name and fu-nish the minor's SSN Number. to apply for an ITIN or Form SS-4, (including payments to corporations). "You mJSl show your ~ndivldual name. but you may also Application for Employer Identification Number. enter your business or "DBA" name You may use either tO apply for an LIN. You can get Forms W.7 and 5. Mortgage interest paid by you, your SSN or E~N [if you have one). SS-4 from the IRS by calling 1-800-TAX-FORM acquisition or abandonment of secured ' LiSt first and circle the name of the le9al t-asr, estate. (1-800-829-3676) or from the IRS's Intefnet Web property, cancellation of debt. qualified state or pension trust. (Do ~ot furnish the T;N of the personal Site at www.irs.gov, tuition program pa:yments, IRA or MSA -epresoatative or trdstee unless the lethal entity it.~elf is contributions or distributions, and pension not designated in the acco Jet title If you do not have a TIN, write "Applied For" distributions. You must give your correct TIN, Note: If no name is circled when more than one in the space for the TIN, sign and date the form, but you do not have to sign the certification, name is listed, the number w#l be considered to and give it to the. requester, For interest and be that of the first name listed. dividend payments, and certain payments made Privacy Act Notice with respect to readily tradable instruments. generally you will have 60 days to get a TIN and Section 6109 of the Internal Revenue Code give it to the requester before you are subject to requires you to give your correct TIN to persons backup withholding on payments, The 60-day who must file information returns with the IRS to rule does not apply to other types of payments. YOU will be subject to backup withholding on all 01×23×2002 15:16 ID=CITY OF COPPELL FINANCE DATE S,R-TIME DISTANT STATION ID MODE PAGES RESULT 01/23 00'41" 940 498 1178 CALLING 01 OK 0000 01,'23/2002 15:15 CITY OF COPPELL FINANCE -> 994049811?8 N0.656 1201 6-9 Request for Taxpayer Give form to Identification Number and Certification Do ~n~ ~f ~ C%~ O~ c~, ~. ~ z~P ~ i CO~L, ~ 75019 ~l Taxpayer Iden~ficat~on Numb~ ~IN) L~ ac~..t .um~5) E~m~ your ~N in ~e appropde[e box. 15SN}. ~, for a resident oliefl, ~le p~p~r, or ~isr~ ~tity, s~ t~ Patti I ~ [ .~ J ] ~m~ on ~ 2. For o~er ~titias, i~ is your ~ For U.S, pay~s empl~ MentiF~ca~,on num~ (BIN}. If y~ do not or ~c~ ~~ ~ ~e ha~ ~ ~m~. s~ ~w to get a TiN o~ page 2, I imp~r MemirmtHn nu~r [ instructio~ on pa~ 2.) the ~,~ ~ ~ 2 f~ ~line5 ~ ~ose ~r : , ~ C~c~on ~. The n~mbe; shown ~ tills ~rm is my co. ct taxpayer ~e~;:~ca~o~ ~umDer (~ I em weiLi~ ~or ~ numDe~ ~ De i~ucQ 2- I am ~[ ~a~;~ ~O DaCkup wRh~Old;~ D~ause: (a) I am exempt i~Qm oacKup wi;hl~olumg, Of ~) I h='~ ~ot ~e~ R~e.~e ~a (IRS) [~at I ;m subject to baCAup wi~l~oldm9 ~s a ;e~ulL of a fadure ~ ~QA ~11 i~;ere~[ or Oh]i~o~, or (~) ~od~a~ me ~; I am ~o I~ su~jec[ Lo ~ck~p wi;~l~ln~, and Ca~fi~n (ns~ons. You muse cr~s OL~t ~em 2 above if you have Deen ~0[Ifled Dy the IRS O~at y~ am c~entiy subj~c [o backup ~Cold.ng ~ceuse ~ou have failee to report ~11 Interest aha eivl~ends on ~our tax re~um. For ~B1 eG~te ~nSaC[~ons, For m~ag6 q~5C pal~. acqdlS~10~ ~ aeaflgonmam ~ ~cure~ ~oper[y, cepCelletlon of ee~[. c~ibuu~s ~ an ,ndividu81 racirem~t ~-~*em~et ~'~. aA~ oeneml~, oavm~ts Othe~ d~an interest a~d d,v(den~s. ~u are hOE required [~ sign tile Cetufica[ion, buL y~' must