Name as shown on tax return:
Business name / disregarded entity name:
If different from above
Select the appropriate federal tax classification:
Individual / Sole Proprietor
C Corporation
S Corporation
Partnership
Trust / Estate
Limited Liability Company (LLC)
LLC Tax Class
-- Select --
C Corporation
S Corporation
Partnership
Other Other Business Type
Are you subject to backup withholding?
Yes
No
Are you exempt from backup withholding?
Yes
No
Exempt payee code (if any)
None
01 - An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2)
02 - The United States or any of its agencies or instrumentalities
03 - A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities
04 - A foreign government or any of its political subdivisions, agencies, or instrumentalities
05 - A Corporation
06 - A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States
07 - A futures commission merchant registered with the Commodity Futures Trading Commission
08 - A real estate investment trust
09 - 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
FATCA reporting code (if any)
None
A - An organization exempt from tax under section 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
Address:
City:
State/Province:
--- SELECT STATE ---
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District Of Columbia
Federated States Of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip/Postal Code:
W9 Zip Code
-
W9 Zip Plus Four
Under penalties 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. citizen or other U.S. person.
The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Digital Signature:
Date:
Name as Shown on Tax Return
Enter the name as shown on your IRS tax return for the Tax ID number entered at registration.
Primary Name on Winning Certificates
Per IRS guidelines, the primary name on winning certificates must be the "name as shown on tax return".
Additional Name(s) on Winning Certificates
If the county permits it, use this field to enter any additional name(s) to be printed on your winning certificates.
If the county has assigned you a Bidder Number in the past, enter it here.
If you have been assigned a number from the Department of Assessment and Taxation, enter it here.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.