W-9 (Substitute)

Substitute W-9 form
This form serves as a substitute IRS Form W-9. Full instructions can be found on the IRS Form W-9.

PSU Foundation receives a copy of this form upon submission. Please do not email a copy of the form to us.
Name of Contact Person
If you are filling out this form as an Individual/Sole Proprietor, this is your name
Email Address of Contact Person
If you are filling out this form as an Individual/Sole Proprietor, this is your email address

Taxpayer Information
Name of individual/entity
If you are filling out this form as an Individual/Sole Proprietor, this is your name and should be the same as above
Business name/disregarded entity name, if different from above.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Federal Tax Classification - Select the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Select only one of the following seven boxes.

Other
If you select the “LLC” box above and, select the appropriate code (C, S, or P) for the tax classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box for the tax classification of its owner.
If you selected "Partnership” or “Trust/estate,” or selected “LLC” and entered “P” as its tax classification, and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check this box if you have any foreign partners, owners, or beneficiaries.
Exemptions
Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3 of W-9 form)
Exempt payee code (if any)
Exemption from Foreign Account Tax Compliance Act (FATCA) reporting code (if any)
(Applies to accounts maintained outside the United States.)
Tax Identification 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 generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.

Note: If the account is in more than one name, see the instructions for line 1. See also What Name and Number To Give the Requester for guidelines on whose number to enter.
Tax Identification Number
Signature and Certification
I am subject to backup withholding:
You must select 'Yes' 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, this does not apply.

Please see IRS Tax Topic no. 307 for additional information.
PLEASE READ THE FOLLOWING INFORMATION.

YOU HAVE SELECTED THAT YOU ARE SUBJECT TO BACKUP WITHHOLDING. PSU FOUNDATION WILL WITHHOLD 24% OF THE PAYMENT ISSUED TO YOU AND REMIT IT TO THE INTERNAL REVENUE SERVICE AS FEDERAL WITHHOLDING TAX.

What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 24% of such payments. This is called “backup withholding.” Payments that may be subject to backup withholding include, but are not limited to, interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third-party network transactions, 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 TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return.

Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester;
2. You do not certify your TIN when required (see the instructions for Part II for details);
3. The IRS tells the requester that you furnished an incorrect TIN;
4. 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
5. You do not certify to the requester that you are not subject to backup withholding, as described in item 4 under “By signing the filled-out form” above (for reportable interest and dividend accounts opened after 1983 only).

Certain payees and payments are exempt from backup withholding. See Exempt payee code, later, and the separate Instructions for the Requester of Form W-9 for more information.
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 a U.S. citizen or other U.S. person (defined below); and
- The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. 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 for Part II.
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 (defined below); and
- The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. 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 for Part II.
Signature of US Person
Should be Empty:

Substitute W-9 form

Taxpayer Information

Exemptions

Tax Identification Number

Signature and Certification