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sd-10-EFTA01456620Dept. of JusticeOtherEFTA Document EFTA01456620
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Summary
Form W (Rev. August 2013) Deportment of the Treasury Internal Revenue Service -9 Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Name (as shown o your ncome tax return) Mort, Inc Business nameideregarded entity name. it deferent from above Check appropriate box for federal tax classifcalkm: K IndwiduaUsole proprietor K C Corporation K S Corporation K Partnership K Trust/estate K Limited liability company. Enter
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Form W
(Rev. August 2013)
Deportment of the Treasury
Internal Revenue Service
-9
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Name (as shown o your ncome tax return)
Mort, Inc
Business nameideregarded entity name. it deferent from above
Check appropriate box for federal tax classifcalkm:
K IndwiduaUsole proprietor
K C Corporation
K S Corporation
K
Partnership
K Trust/estate
K
Limited liability company. Enter the tax classification (C=C corporation. S=5 corporation. P•partnershp)S
K
Other (see instructions) ►
Exemptions (see instructions):
Exempt payee code if any)
Exemption from FATCA reporting
code (if any)
Address (number, street, and apt. or suite no.)
6100 Red Hook Quarter, 83
City, state. and 2IP code
St. Thomas, USVI 00802
List account numbei(s) here (optional)
Part I
Requester
name and address (optional)
Taxpayer Identification Number (TIN)
Enter your [IN in the appropriate box. f he 1lN provided must match the name given on the 'Name" line
to avoid backup withholding. For individuals, this is your social security number ISSN). 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.
Not*. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Part II
I Social security number
Employer Identification number
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), and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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 3.
Sign
Signature of
Here
U.S, person►
Dave►
General Instructions
Section references are to the Internal Revenue Code urine otherwise noted.
Future developments. The IFS has created a page on IRS.gov for information
about Form W-9. at www.iragov/w9. Information about any future developments
affecting Form W-9 (such as legislation enacted alter we release it) vest be posted
on that page.
Purpose of Form
A person who a required to file an information return with the IRS must obtain your
correct taxpayer identification number (MiN) to report. for example. income paid to
you. payments made to you in settlement of payment card and third party network
transactions real estate transactions. mortgage interest you paid acquisition or
abandonment of secured property. cancellation of debt, or contributions you made
to an IRA.
Use Form W-9 only if you are a U.S. person Oncludng a resident alien). to
provide your correct TIN to the person requesting it (the requester) and. when
applicable. to:
1. Certify that the TIN you are giving is correct (or you are waiting for a number
to be issued).
2. Certify that you are not subject to backup withholding. or
3. Claim exemption from backup mimicking if you are a U.S. exempt payee. If
appkcable. you are also certifying that as a U.S. person. your allocable share of
any partnership income from a U.S. trade or bus mess is not subject to the
wkhhciding tax on foreign partners' share of elfectivety connected income, and
4. Certify that FATCA ceders) entered on this form fit any) ind cat ing that you are
exempt from the FATCA reporting, is correct.
Note. If you are a U.S. person and a requester gives you a form other than Form
W-9 to request your TIN, you must use the requester's form if it is substantally
similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S.
person if you are:
• An individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or organized in the
United States or under the laws of the United States
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or business in
the Unted States are generally required to pay a withholding tax under section
1446 on any foreign partners' share of effectively connected taxable ncome from
such business. Further, in certain cases where a Form W-9 has not been received,
the rules under section 1446 require a partnership to presume that a partner is a
foreign person, and pay the section 1446 withholding tax. Therefore. if you are a
U.S. person that is a partner in a partnership conducing a trade or business in the
United States. !sonde Form W-9 to the partnership to establish your U.S. status
and avoid section 1446 withholding as your share of partnership income.
Cat. No. 10231X
Form W-9 (Rev. 8-2013)
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
SONY GM_00282082
DB-SDNY-0115878
EFTA01456620
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