HomeMy WebLinkAbout7565889 Postmark Gift Shop Consignment Agreement2.pdf - DocuSign Envelope ID:598B4984-6222-463A-8211-51 F082FDE56A
Art Exhibition and Loan Agreement
City of Auburn's Postmark Center for the Arts Gallery
Consignment Agreement
Postmark Center for the Arts Gift Shop
(Limited 70/30% Introductory consignment rate)
THIS AGREEMENT made and entered into on this = of S"Q, 2024, by and between
the CITY OF AUBURN, a municipal corporation of the State of Washington ("City"), and
5A u Q,5\1 ("Artist"), who is located at 4-Cl2- C)Ae Si Iv1 0 r w U In i` S° /
e1,
In consideration of the conditions and the mutual promises and covenants contained in this (A-J A
Agreement, the parties agree as follows: c�
1. Scope of Agency
The Artist appoints the City as agent for the works of art consigned under this agreement
for the purposes of display and sale. The City will not permit the artwork(s) to be used for
any other purposes without he written consent of the Artist. The City shall serve as agent
for the Artist in consideration for a percentage of the pre-tax revenue derived from sale of
the artwork(s). This agency shall cover only artwork submitted by the Artist while this
agreement is in force.
2. Consignment of Artwork
The Artist consigns to the City and the City accepts on consignment the artwork(s) listed on
the attached inventory schedule which is incorporated by reference. During the term of the
consignment, according to section 3, the City shall have the exclusive right to possession
of the Artwork.
Additional artwork may be later incorporated into this contract by listing on a separate
inventory schedule and by mutual agreement of the parties. All inventory schedules shall
be signed by the Artist and a representative of the City. Only those inventory schedules
provided to the Artist by the City will be accepted.
3. Length of Consignment
The Artist and the City agree that the length of this consignment will be for a 90 day duration
between the dates shown on the inventory attachment ("initial consignment period'), unless
otherwise changed by the parties according to section 16 of this agreement. At the end of
the initial term, the agreement shall become terminable upon 20 days written notice by
either party. If the Artist submits new inventory, the term of the consignment for all Artwork
shall be extended for the length of time shown on the inventory schedule. At the end of that
term, the agreement shall again become terminable upon 20-days written notice by either
party. The Artist agrees that all Artwork left in the store after this agreement is terminated
by either party will be returned to the Artist. The Artwork may be picked up by the Artist or
shipped at the Artist's expense.
The City shall have the right to store, either at the City or in public storage all Artwork that
remains in the City's possession for more than two weeks after the conclusion of the
consignment period. The City may charge storage fees at market rate and carry insurance
on the Artwork. The Artist agrees that the City shall have a lien on the Artwork for the
amount of any unpaid storage and insurance charges. If the Artist has not claimed the
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(I I' ( [
AUBURN
WASHINGTON
Artwork after six months from the last day of the consignment period, the work shall be
deemed an unrestricted gift to the City.
4. Terms of Payment
The Artist shall establish a price. within market value, for each item of artwork on the
inventory list. The City shall sell the artwork(s) at the price listed plus all required tax
amounts. The Artist agrees that the City's commission will be 30% of the pre-tax price. The
remaining 70% of the pre-tax price will be remitted to the Artist after sale. Payment to the
Artist for sold artwork will be remitted following the 90-day contract period (quarterly) and
will include all amounts for artwork sold in that 90 days of sale.
5. Discounts
Artist agrees that the City at its discretion may discount prices on artwork up to 15%. The
portion of the discounted sale amount paid to the Artist and the portion that is retained by
the City as commission shall be the same percentages as described in section 3 The City
may discount any artwork more than 15% only with the Artist's consent.
6. Artist's Warranty
Artist warrants the Artwork identified in the Inventory Schedule is:
a. The Artist's original creation or is artwork that the Artist has obtained full copyright to:
and
b. The Artist's unencumbered property while for sale in City's indoor center.
7. Promotion
The Artist acknowledges that images of the consigned artwork shall be used by the City for
the purposes of social media marketing and promotion on platforms including Facebook,
Twitter, Pinterest, and Instagram. The Artist grants the City the right of photographic
reproduction and use of images of the Artwork for publicity purposes in exhibit
announcements, in the City's publications (including, but not limited to, its magazine), the
City's website, and other media. The Artist will indemnify and hold the City harmless from
any liability arising out of the City's use of such images for publicity purposes.
The City agrees to tag the Artist's social media accounts in any posting featuring consigned
artwork subject to this agreement. The Artist agrees to endeavor to tag the City's posts
regarding the Auburn Arts and Culture Center using approved hashtags
8. Display
The City will have the artwork(s) available for purchase at its gift shop inside the Postmark
Center for the Arts at 20 Auburn Ave, Auburn, WA 98002 ("Center') during the Center's
hours of operation. The Artist grants to the City the right to display the artwork anywhere
within the Center, but is not required by this Agreement to display the artwork.
9. Delivery and Installation
The Artist, at his or her sole cost and expense, will be responsible for the transportation and
delivery of the Artwork to and from the Center. The City shall be responsible for installation
and/or storing of the Artwork(s), and all decisions regarding placement in the Center will be
at the sole discretion of the City.
10. Direct sales commission
If the Artist sells the artwork directly to a purchaser during the term of this agreement.
including any extension of the agreement, the City is entitled to a commission of 25°/0 of the
selling price. The Artist shall remit the amount to the City within 30 days of the date of sale
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CITY OF
AUBURN
WASH INGTON
or shall not be relieved of liability to the City for damages sustained by virtue of any breach
of this agreement by the Lender.
11. Damages & Insurance
The Artist agrees that the City is not liable or responsible for damage to Artwork(s) in transit.
Any works damaged during shipping from the Artist to the City shall be returned to Artist. at
the Artist's expense.
The City assumes the risk of loss or damage to the Artwork, other than damage due to
normal wear and tear. while on consignment in the Center. The City agrees to repair or
reimburse the Artist for such damage or loss to the extent the City's insurance policy
coverage. For all damage which is subject to the insurance deductible. the City shall
reimburse the Artist for 70% of the price of the Artwork(s). If the Artwork is damaged to the
extent it becomes aesthetically compromised and/or cannot be repaired or cleaned to the
satisfaction of the City. Artist shall remove the Artwork from the Center at Artist's sole
expense. If Lender chooses to insure the Artwork, City disclaims any responsibility for any
error or deficiency in information furnished to Lender's insurers or for lapses in Lender's
insurance coverage.
12. Maintenance and Repair
The Artist acknowledges that the Artwork may be displayed publicly in a space that receives
direct sunlight and is not humidity controlled. The Artist understands that no compensation
will be made for wear and tear to the Artwork and the City will not maintain the work. The
parties agree that during the term of the consignment period maintenance of the Artwork is
anticipated to be minima!, but when needed must be completed by the Artist at its sole
expense and risk. No maintenance or cleaning will be conducted by the City.
13. Indemnification
The Artist agrees to indemnify and hold the City, its elected officials, officers, employees.
agents and volunteers harmless from any and all claims, demands, losses, actions and
liabilities (including costs and attorney fees) to or by any and all persons or entities,
including, without limitation, their respective agents, licensees, or representatives, arising
out of, resulting from, or related to this Agreement to the extent caused by the negligent
acts, errors, omissions of the Artist, the Artist's partners, shareholders, agents, employees,
or by Artist's breach of this Agreement. The provisions of this Section shall survive the
expiration or termination of this Agreement with respect to any event occurring prior to such
expiration or termination.
14. Accounting
The City shall keep accurate records reflecting the inventory and sale of the consigned
artwork. With payment to the Artist, the City shall provide a record of the total amount sold
by the City, the artwork sold, and the current inventory levels.
15. Agent Commission
The terms and conditions of this Agreement shall bind Artist's agent, if any. The City shall
not be responsible for any additional commissions that may be due and owing to Artist's
agent.
16. Amendment
All amendments of this agreement, including extensions of the initial consignment period,
shall be made in writing, signed by the party or parties to be bound, or such party's or parties'
duly authorized representative(s) and specifying with particularity the nature and extent of
such amendment, modification or waiver.
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AUBURN
WAS H1NGTON
17. Miscellaneous
Neither party to this Agreement shall assign any right or obligation hereunder in whole or in
part. without the prior written consent of the other party hereto.
This Agreement is for the exclusive benefit of the parties and it does not create a contractual
relationship with or exist for the benefit of any third party.
Any waiver by any party of any default of the other party shall not affect or impair any right
arising from any subsequent default.
This Agreement contains the entire understanding of the parties and supersedes all prior
agreements and understandings, oral or written, regarding the matters contained herein.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed
effective the day and year first set forth above.
CITY OF AUBURN ARTIST
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Form W-9 Request for Taxpayer Give Form to the
(Rev.December 201i) Identification Number and Certification requester.Do not
Department of the Treasury send to the IRS.
Internal Revenue Service
Name(as shown on your income tax return)
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Part I Taxpayer Identification Number(TIN)
Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line I Social security number I
to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a r
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entities,it is your employer identification number(EIN).If you do not have a number,see Now to get a
TIN on page 3.
Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose I Employer identification number I
number to enter. I I
Part II 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.
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General Instructions Note.If 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 substantially similar
Section references are to the Internal Revenue Code unless otherwise to this Form W-9.
noted. Definition of a U.S.person.For federal tax purposes,you are
Purpose of Form considered a U.S.person if you are:
A person who is required to file an information return with the IRS must •An individual who is a U,S.citizen or U.S.resident alien,
obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or
example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States.
you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or
of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301,7701-7).
Use Form W-9 only if you are a U.S.person(including a resident
alien),to provide your correct TIN to the person requesting it(the Special rules for partnerships.Partnerships that conduct a trade or
requester)and,when applicable,to: business in the United States are generally required to pay a withholding
tax on any foreign partners'share of income from such business.
1.Certify that the TIN you are giving is correct(or you are waiting for a
Further,in certain cases where a Form W-9 has not been received,a
number to be issued), partnership is required to presume that a partner is a foreign person,
2.Certify that you are not subject to backup withholding,or and pay the withholding tax.Therefore,if you are a U.S.person that is a
3.Claim exemption from backup withholding if you are a U.S.exempt partner in a partnership conducting a trade or business in the United
payee.If applicable,you are also certifying that as a U.S.person,your States,provide Form W-9 to the partnership to establish your U.S.
allocable share of any partnership income from a U.S.trade or business status and avoid withholding on your share of partnership income.
is not subject to the withholding tax on foreign partners'share of
effectively connected income.
Cat.No.10231X Form W-9(Rev.12-2011)
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Form W-9(Rev.12-2011) Page 2
The person who gives Form W-9 to the partnership for purposes of Certain payees and payments are exempt from backup withholding.
establishing its U.S.status and avoiding withholding on its allocable See the instructions below and the separate Instructions for the
share of net income from the partnership conducting a trade or business Requester of Form W-9.
in the United States is in the following cases: Also see Special rules for partnerships on page 1.
•The U.S.owner of a disregarded entity and not the entity,
•The U.S.grantor or other owner of a grantor trust and not the trust, Updating Your Information
and You must provide updated information to any person to whom you
The U.S.trust(other than a grantor trust)and not the beneficiaries of claimed to be an exempt payee if you are no longer an exempt payee
•
• trust. and anticipate receiving reportable payments in the future from this
tperson.For example,you may need to provide updated information if
Foreign person.If you are a foreign person,do not use Form W-9. you are a C corporation that elects to be an S corporation,or if you no
Instead,use the appropriate Form W-8(see Publication 515. longer are tax exempt.In addition,you must furnish a new Form W-9 if
Withholding of Tax on Nonresident Aliens and Foreign Entities). the name or TIN changes for the account,for example.if the grantor of a
Nonresident alien who becomes a resident alien.Generally,only a grantor trust dies.
nonresident alien individual may use the terms of a tax treaty to reduce Penalties
or eliminate U.S.tax on certain types of income.However,most tax
treaties contain a provision known as a"saving clause."Exceptions Failure to furnish TIN.If you fail to furnish your correct TIN to a
specified in the saving clause may permit an exemption from tax to requester,you are subject to a penalty of$50 for each such failure
continue for certain types of income even after the payee has otherwise unless your failure is due to reasonable cause and not to willful neglect.
become a U.S.resident alien for tax purposes. Civil penalty for false information with respect to withholding.If you
If you are a U.S.resident alien who is relying on an exception make a false statement with no reasonable basis that results in no
contained in the saving clause of a tax treaty to claim an exemption backup withholding,you are subject to a$500 penalty.
from U.S.tax on certain types of income,you must attach a statement Criminal penalty for falsifying information.Willfully falsifying
to Form W-9 that specifies the following five items: certifications or affirmations may subject you to criminal penalties
1.The treaty country.Generally,this must be the same treaty under including fines and/or imprisonment.
which you claimed exemption from tax as a nonresident alien.
Misuse of TINS.If the requester discloses or uses T1Ns in violation of
2.The treaty article addressing the income, federal law,the requester may be subject to civil and criminal penalties.
3.The article number(or location)in the tax treaty that contains the
saving clause and its exceptions. Specific Instructions
4.The type and amount of income that qualifies for the exemption Name
from tax.
5.Sufficient facts to justify the exemption from tax under the terms of If you are an individual,you must generally enter the name shown on
the treaty article. your income tax return.However,if you have changed your last name,
for instance,due to marriage without informing the Social Security
Example.Article 20 of the U.S.-China income tax treaty allows an Administration of the name change,enter your first name,the last name
exemption from tax for scholarship income received by a Chinese shown on your social security card,and your new last name.
student temporarily present in the United States.Under U.S.law,this
student will become a resident alien for tax purposes if his or her stay in If the account is in joint names,list first,and then circle,the name of
the United States exceeds 5 calendar years.However,paragraph 2 of the person or entity whose number you entered in Part I of the form.
the first Protocol to the U.S.-China treaty(dated April 30,1984)allows Sole proprietor.Enter your individual name as shown on your income
the provisions of Article 20 to continue to apply even after the Chinese tax return on the"Name"line,You may enter your business,trade,or
student becomes a resident alien of the United States.A Chinese "doing business as(DBA)"name on the"Business name/disregarded
student who qualifies for this exception(under paragraph 2 of the first entity name"line.
protocol)and is relying on this exception to claim an exemption from tax Partnership,C Corporation,or S Corporation.Enter the entity's name
on his or her scholarship or fellowship income would attach to Form on the"Name"line and any business,trade,or"doing business as
W-9 a statement that includes the information described above to (DBA)name"on the"Business name/disregarded entity name"line.
support that exemption, Disregarded entity.Enter the owner's name on the"Name"line.The
If you are a nonresident alien or a foreign entity not subject to backup name of the entity entered on the"Name"line should never be a
withholding,give the requester the appropriate completed Form W-8. disregarded entity.The name on the"Name"line must be the name
What is backup withholding?Persons making certain payments to you shown on the income tax return on which the income will be reported.
must under certain conditions withhold and pay to the IRS a percentage For example.if a foreign LLC that is treated as a disregarded entity for
of such payments.This is called"backup withholding." Payments that U.S.federal tax purposes has a domestic owner,the domestic owner's
may be subject to backup withholding include interest,tax-exempt name is required to be provided on the"Name"line.If the direct owner
interest,dividends,broker and barter exchange transactions,rents, of the entity is also a disregarded entity,enter the first owner that is not
royalties,nonemployee pay,and certain payments from fishing boat disregarded for federal tax purposes.Enter the disregarded entity's
operators.Real estate transactions are not subject to backup name on the"Business name/disregarded entity name"line,If the owner
withholding. of the disregarded entity is a foreign person,you must complete an
You will not be subject to backup withholding on payments you appropriate Form W-8.
receive if you give the requester your correct TIN,make the proper Note.Check the appropriate box for the federal tax classification of the
certifications,and report all your taxable interest and dividends on your person whose name is entered on the"Name"line(IndividuaVsole
tax return, proprietor,Partnership,C Corporation,S Corporation,Trust/estate).
Payments you receive will be subject to backup Limited Liability Company(LLC).If the person identified on the
withholding if: "Name"line is an LLC,check the"Limited liability company"box only
1.You do not furnish your TIN to the requester, and enter the appropriate code for the tax classification in the space
provided.If you are an LLC that is treated as a partnership for federal
2.You do not certify your TIN when required(see the Part II tax purposes,enter"P"for partnership.If you are an LLC that has filed a
instructions on page 3 for details), Form 8832 or a Form 2553 to be taxed as a corporation,enter"C"for
3.The IRS tells the requester that you furnished an incorrect TIN, C corporation or"5"for S corporation.If you are an LLC that is
4.The IRS tells you that you are subject to backup withholdingdisregarded as an entity separate from its owner under Regulation
because you did not report all your interest and dividends on your tax sectionc the LLC b 3(except for owemner
thehet and(requiredexcise t to doe not
return(for reportable interest and dividends only),or check LLC box"Nunlame"line)
s not another LLC isnt be
identified on the"Name"line)is LLC that is not disregarded for
5.You do not certify to the requester that you are not subject to federal tax purposes.If the LLC is disregarded as an entity separate
backup withholding under 4 above(for reportable interest and dividend from its owner,enter the appropriate tax classification of the owner
accounts opened after 1983 only). identified on the"Name"line.
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Form W-9(Rev.12-20111 Page 3
Other entities.Enter your business name as shown on required federal Part I.Taxpayer Identification Number(TIN)
tax documents on the"Name"line.This name should match the name
shown on the charter or other legal document creating the entity.You Enter your TIN in the appropriate box.If you are a resident alien and
may enter any business,trade,or DBA name on the"Business name) you do not have and are not eligible to get an SSN,your TIN is your IRS
disregarded entity name"line. individual taxpayer identification number(ITIN).Enter it in the social
security number box.If you do not have an ITIN,see How to ger a TiN
Exempt Payee below.
If you are exempt from backup withholding,enter your name as If you are a sole proprietor and you have an EIN,you may enter either
described above and check the appropriate box for your status,then your SSN or EIN.However,the IRS prefers that you use your SSN.
check the"Exempt payee"box in the line following the"Business name/ If you are a single-member LLC that is disregarded as an entity
disregarded entity name,"sign and date the form. separate from its owner(see Limited Liability Company(LLC)on page 2),
Generally,individuals(including sole proprietors)are not exempt from enter the owner's SSN(or EIN,if the owner has one),Do not enter the
backup withholding.Corporations are exempt from backup withholding disregarded entity's EIN.If the LLC is classified as a corporation ar
for certain payments,such as interest and dividends. partnership,enter the entity's EIN.
Note_If you are exempt from backup withholding,you should still Note.See the chart on page 4 far further clarification of name and TIN
complete this form to avoid possible erroneous backup withholding. combinations.
The following payees are exempt from backup withholding: How to get a TIN.If you do not have a TIN,apply for one immediately.
To apply for an SSN,get Form SS-5,Application for a Social Security
1,An organization exempt from tax under section 501(a),any IRA,or a Card,from your local Social Security Administration office or get this
custodial account under section 403(b)(7)if the account satisfies the form online at www.ssa.gov.You may also get this form by calling
requirements of section 401(f)(2), 1-800-772-1213.Use Form W-7,Application for IRS Individual Taxpayer
2.The United States or any of its agencies or instrumentalities, Identification Number,to apply for an 1TIN,or Form 55-4,Application for
3.A state,the District of Columbia,a possession of the United States, Employer Identification Number,to apply for an EIN.You can apply for
or any of their political subdivisions or instrumentalities, an EIN online by accessing the IRS website at www.irs.govlbusinesses
and clicking on Employer Identification Number(EIN)under Starting a
4.A foreign government or any of its political subdivisions,agencies, Business.You can get Forms W-7 and SS-4 from the IRS by visiting
or instrumentalities,or IRS,gov or by calling 1-800-TAX-FORM(1-800-829-3676).
5.An international organization or any of its agencies or If you are asked to complete Form W-9 but do not have a TIN,write
instrumentalities. "Applied For"in the space for the TIN,sign and date the farm,and give
Other payees that may be exempt from backup withholding include: it to the requester.For interest and dividend payments,and certain
6.A corporation, payments made with respect to readily tradable instruments,generally
you will have 60 days to get a TIN and give it to the requester before you
7.A foreign central bank of issue, are subject to backup withholding on payments.The 60-day rule does
8.A dealer in securities or commodities required to register in the not apply to other types of payments.You will be subject to backup
United States,the District of Columbia,or a possession of the United withholding on all such payments until you provide your TIN to the
States, requester.
9.A futures commission merchant registered with the Commodity Note.Entering"Applied Far"means that you have already applied for a
Futures Trading Commission, TIN or that you intend to apply for one soon.
10.A real estate investment trust, Caution:A disregarded domestic entity that has a foreign owner must
11.An entity registered at all times during the tax year under the use the appropriate Form W-8.
Investment Company Act of 1940, Part II. Certification
12.A common trust fund operated by a bank under section 584(a), To establish to the withholding agent that you are a U.S.person,or
13,A financial institution, resident alien,sign Form W-9,You may be requested to sign by the
14.A middleman known in the investment community as a nominee or withholding agent even if item 1,below,and items 4 and 5 on page 4
custodian,or indicate otherwise.
15.A trust exempt from tax under section 664 or described in section For a joint account,only the person whose TIN is shown in Part I
4947, should sign(when required). In the case of a disregarded entity,the
The following chart shows types of payments that may be exempt person identified an the"Name"line must sign.Exempt payees,see
from backup withholding.The chart applies to the exempt payees listed Exempt Payee on page 3.
above,1 through 15. Signature requirements.Complete the certification as indicated in
items 1 through 3,below,and items 4 and 5 an page 4.
IF the payment is for... THEN the payment is exempt 1.Interest,dividend,and barter exchange accounts opened
for... before 1984 and broker accounts considered active during 1983.
Interest and dividend payments All exempt payees except You must give your correct TIN.but you do not have to sign the
certification.
for 9
2.Interest,dividend,broker,and barter exchange accounts
Broker transactions Exempt payees 1 through 5 and 7 opened after 1983 and broker accounts considered inactive during
through 13.Also,C corporations. 1983.You must sign the certification or backup withholding will apply.If
Barter exchange transactions and Exempt payees 1 through 5 you are subject to backup withholding and you are merely providing
patronage dividends your correct TIN to the requester,you must cross Out item 2 in the
certification before signing the form.
Payments over$600 required to be Generally,exempt payees 3.Real estate transactions.You must sign the certification,You may
reported and direct sales over 1 through 7 cross out item 2 of the certification.
$5,000
See Form 1099-MISC.Miscellaneous Income,and its instructions.
However,the following payments made to a corporation and reportable on Form
1099-Ml$C are not exempt from backup withholding:medical and health care
payments,anameys'fees,gross proceeds paid to an attorney,and payments for
services paid by a federal executive agency.
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DocuSign Envelope ID:598B4984-6222-463A-8211-51 F082FDE56A
Form W-9(Rev.12-2011) Page 4
4.Other payments.You must give your correct TIN,but you do not Note.If no name is circled when more than one name is listed,the
have to sign the certification unless you have been notified that you number will be considered to be that of the first name listed.
have previously given an incorrect TIN."Other payments"include
payments made in the course of the requester's trade or business for Secure Your Tax Records from Identity Theft
rents,royalties,goods(other than bills for merchandise),medical and Identity theft occurs when someone uses your personal information
health care services(including payments to corporations),payments to such as your name,social security number(SSN),or other identifying
a nonemployee for services,payments to certain fishing boat crew information,without your permission,to commit fraud or other crimes.
members and fishermen,and gross proceeds paid to attorneys An identity thief may use your SSN to get a job or may file a tax return
(including payments to corporations). using your SSN to receive a refund.
5.Mortgage interest paid by you,acquisition or abandonment of To reduce your risk:
secured property,cancellation of debt,qualified tuition program •Protect your 55N,
payments(under section 529),IRA,Coverdell ESA,Archer MSA or
HSA contributions or distributions,and pension distributions.You •Ensure your employer is protecting your SSN,and
must give your correct TIN,but you do not have to sign the certification. •Be careful when choosing a tax preparer.
If your tax records are affected by identity theft and you receive a
What Name and Number To Give the Requester notice from the IRS,respond right away to the name and phone number
For this type of account: Give name and SSN of: printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
1.Individual The individual think you are at risk due to a lost or stolen purse or wallet,questionable
2.Two or more Individuals(joint The actual owner of the account or, credit card activity or credit report,contact the IRS Identity Theft Hotline
account) if combined funds,the first at 1-800-908-4490 or submit Form 14039.
individual on the account'
3.Custodian account of a minor For more information,see Publication 4535,Identity Theft Prevention
The minor(Uniform Gift to Minors Act) and Victim Assistance.
4.a.The usual revocable savings The grantor-trustee' Victims of identity theft who are experiencing economic harm or a
trust)grantor is also trustee) system problem,or are seeking help in resolving tax problems that have
b.So-called trust account that is The actual owner not been resolved through normal channels,may be eligible for
not a legal or valid trust under Taxpayer Advocate Service(TAS)assistance.You can reach TAS by
state law calling the TAS tall-free case intake line at 1-877-777-4778 or TTYITDD
5.Sole proprietorship or disregarded The owner' 1-800-829-4059.
entity owned by an individual
6.Grantor trust filing under Optional The grantor Protect yourself from suspicious emails or phishing schemes.
Form 1099 Filing Method 1(see Phishing is the creation and use of email and websites designed to
Regulation section 1.671-4(b)(2)[)(A)) mimic legitimate business emails and websites.The most common act
For this type of account: Ghre name and UN of: is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
7.Disregarded entity not owned by an The owner private information that will be used for identity theft.
Individual
8.A valid trust,estate,or pension trust Legal entity' The IRS does not initiate contacts with taxpayers via emails.Also,the
9.Corporation or LLC electing The corporation IRS does not request personal detailed information through email or ask
corporate status on Form 8832 or taxpayers for the PIN numbers,passwords,or similar secret access
Form 2553 information for their credit card,bank,or other financial accounts.
10.Association,club,religious, The organization If you receive an unsolicited email claiming to be from the IRS.
charitable,educational,or other forward this message to phishing@irs.gov.You may also report misuse
tax-exempt organization of the IRS name,logo,or other IRS property to the Treasury Inspector
11.Partnership or multi-member LLC The partnership General for Tax Administration at 1-800-366-4484.You can forward
12.A broker or registered nominee The broker or nominee suspicious emails to the Federal Trade Commission at:sparriOuce.gov
13.Account with the Department of The public entity or contact them at www.ftc.govlidtheft or 1-877-IDTHEFT
Agriculture in the name of a public (1-877-438-4338).
entity(such as a state or local Visit IRS.gov to learn more about identity theft and how to reduce
government,school district.or your risk.
prison)that receives agricultural
program payments
14,Grantor trust filing under the Form The trust
1041 Filing Method or the Optional
Form 1099 Filing Method 2(see
Regulation section 1.671-4(b)(2)(l)(BD
List first and circle the name of the person whose number you furnish.It only one person an a
feint account has an SSN,that persons number must be furnished.
'Circle the minor's name and furnish the minor's SSN.
1 You must show your Individual name and you may also enter your business or'OSA'name an
'Business nameldisregarded enirty"name line.You may use either your SSN or EN Of you
have one),but the IAS encourages you to use your SSN.
lost first and circle the'lame of the trust,estate,or pension trust.(Do not furnish the TIN 4}the
personal representative or trustee unless the legal entity itself is not designated inthe account
title.]Also see Special ruiso for parfnership5 on page 1.
'Note.Grantor also must provide a Form W-9 to trustee or trusl.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons(including federal agencies)who are required to file Information returns with
the IRS to report Interest,dividends,or certain other income paid to you:mortgage interest you paid;the acquisition or abandonment of secured property;the cancellation
of debt;or contributions you made to an IRA,Archer MSA,or HSA.The person collecting this form uses the information on the form to Tile information returns with the IRS,
reporting the above information.Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities,states,the District
of Columbia,and U.S.possessions for use In administering their laws.The information also may be disclosed to other countries under a treaty,to federal and state agencies
to enforce civil and criminal laws,or to federal law enforcement and intelligence agencies to combat terrorism.You must provide your TIN whether or not you are required to
file a tax return.Under section 3406,payers must generally withhold a percentage of taxable interest,dividend.and certain other payments to a payee who does not give a
TIN to the payer.Certain penalties may also apply for providing false or fraudulent information.
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