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Name (as shown on your income tax return)
CITY OF COPPELL
Business name, if different from
Check appropriate box: ?Individual/Sole proprietor ?Corporation ?Partnership
?Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) ? Exempt
pOther (see instructions) MUNICIPAL GOVERMENT payee
Address (number, street, and apt. or suite no.)Requester's name and address (optional) Requester's name and address (optional)
255 PARKWAY BLVD. , P.O. BOX 9478
City, state, and ZIP code
COPPELL TEXAS 75019-9478
List account number(s) here (Optional)
~ Taxpayer ldentification Number (TIN)
Social securlty number
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
Employer identiflcatlon number
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose 75-1183207
number to enter.
~ 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 longer subject to
backup withholding, and
3 I am a U.S. citizen or other U.S. person (defined below).
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, payments 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 4.
Sign Here Signature of ,
U.S. person I ~ „
July 27, 2009
General Instru t10~'1 Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
Section references are to the Internal Revenue Code unless . An individual who is a U.S. citizen or U.S. resident alien,
otherwise noted.
• A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United States,
A person who is required to file an information return with the IRS must • An estate (other than a foreign estate), or
obtain your correct taxpayer identification number (TIN) to report, for • A domestic trust (as defined in Regulations section 301.7701-7).
example, income paid to you, real estate transactions, mortgage
interest you paid, acquisition or abandonment of secured property, Special rules for partnerships. Partnerships that conduct a trade or
cancellation of debt, or contributions you made to an IRA. business in the United States are generally required to pay a
Use Form W-9 only if you are a U.S. person (including a withholding tax on any foreign partr~ers' share of income from such
resident alien), to provide your correct TIN to the person business. Further, in certain cases where a Form W-9 has not been
requesting it (the requester) and, when applicable, to: received, a partnership is required to presume that a partner is a
1. Certify that the TIN you are giving is correct (or you are waiting for foreign person, and pay the withholding tax. Therefore, if you are a
a number to be issued), U.S. person that is a partner in a partnership conducting a trade or
2. Certify that you are not subject to backup withholding, or business in the United States, provide Form W-9 to the partnership to
3. Claim exemption from backup withholding if you are a U.S. establish your U.S. status and avoid withholding on your share of
exempt payee. If applicable, you are also certifying that as a partnership income.
U.S. person, your allocable share of any partnership income from a The person who gives Form W-9 to the partnership for purposes of
U.S. trade or business is not subject to the withholding tax on foreign establishing its U.S. status and avoiding withholding on its allocable
partners' share of effectively connected income. share of net income from the partnership conducting a trade or
Note. If a requester gives you a form other than Form W-9 to business in the United States is in the following cases:
request your TIN, you must use the requester's form if it is • The U.S. owner of a disregarded entity and not the entity,
substantially similar to this Form W-9.
Cat. No. 10231X Form W-9 (Rev. 10-2007)
_ _ ~ .