2004-06-23 City Executive Session, WS & CC Meeting

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REQUEST FOR TAXPAYER IDENTIFICATION NUMBER Instructions for Substitute Fonu W-9 (Section references are to the Internal Revenue Code.) Purpose of Form Complete this fonn and give it to the payer of interest, dividends and certaill other payments (including broker and barter exchange transactions) so that you will not be subject to the 31% backup withholding that became effective January I, 1984. Use this form to report and certif'y your taxpayer identification number (TIN) to the payer, to certif'y that you are not subject to backup withholding because of under-reporting of interest and dividends on your tax return, and to claim exemption from backup withholding if you are an exempt payee, lfyou do not complete this form properly and return it to the payer, the payer may be required to withhold 31 % of payments made to you. What is Backup Withholding The Interest and Dividend Tax Compliance Act of 1983 requires payers to withhold and pay to the Internal Revenue Service ("lRS") 31 % of payments of interest, dividends, and certain other payments under certain conditions. This is called "backup withholding". If you give the payer your correct TIN, certif'y your TIN when required, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: (1) You do not furnish your TIN to the payer, or (2) The lRS notifies the payer that you fumished an incorreet TIN, or (3) You are notified by the lRS that you are subject to backup withholding because you failed to report all your interest and dividends on your tax return (for interest and dividend accounts only), or (4) You fail to certif'y to the payer that you are not subject to backup withholding under (3) above (for interest and dividend accounts opened after 1983 only), or (5) You fail to certiJy your TIN. This applies only to interest, dividood, broker or barter exchange accounts opened after 1983, or broker accounts considered inactive in 1983. For other paymoots, you are subject to backup withholding only if(l) or (2) above applies. How to Obtain a TIN lfyon do not have a TIN, you should apply for one immediately. To appJy for the number obtain Form SS-5, Application for a Social Security Card (for individuals), or Form SS-4, Application for Employer Identification Number (for businesses and all other entities), at your Jocal office of the Social Security Administration or the lRS. Complete and file the appropriate form according to its instructions. 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 payer. You will thoo bave 60 days to obtsin a TIN and furnish it to the payer. During the 6O-day period, the paymoots you receive will not be subject to the 31 % backup withholding. However, if the payer does not receive your TIN from you within 60 days, backup withholding will begin and conTinue until you furnish the TIN to the payer. Note: Writing "Applied For" on the form means that you have already applied/or a TIN, OR that you intend to apply for one in the near fUture. As soon as you receive your TIN, complete another Form W-9, including your new TIN, sign and date the form, aud give it to the payer. Northland Securities, Inc. . 45 South 7th Street . Suite 2500 . Minneapolis, MN 55402 . 1-800-851-2920 . www.northlandsecllrities.com NA 1001 {Hl/02} .