"Substitute Form W-9" - Minnesota

Substitute Form W-9 is a legal document that was released by the Minnesota Management and Budget - a government authority operating within Minnesota.

Form Details:

  • The latest edition currently provided by the Minnesota Management and Budget;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Minnesota Management and Budget.

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PLEASE COMPLETE AND RETURN TO:
Minnesota Management & Budget
Vendor File Maintenance
400 Centennial Building
658 Cedar Street
St. Paul, MN 55155
SUBSTITUTE FORM W-9
Fax: (651) 797-1306
Vendor.mmbefax@state.mn.us
Name (DBA) and Physical Address:
Date:
Supplier Number (if known):
SUBJECT:
Request for Taxpayer Information. (Failure to furnish a taxpayer identification number makes you subject
to a penalty of $50.)
The purpose of this form is to obtain or confirm your correct taxpayer name and identification number. Federal and state tax
regulations require that we have this information from recipients of certain payments in order to report such payments to the
Internal Revenue Service on the Form 1099 Return.
Please complete items 1, 2, and 3 below. If you have any questions, phone (651) 201-8201 for assistance. Send, fax or e-mail the
completed form to the address in the upper right corner.
1. Check your tax filing status below and enter your social security number or federal employer identification number. If you
have been issued a separate Minnesota tax identification number, write it in the space provided. If you have recently applied
for a taxpayer number, write "Applied For" in the space for the number.
(Check One)
Individual/Sole Proprietor: Use SSN
Limited Liability Company (Select One)
Single Member LLC: Use SSN
SOCIAL SECURITY NUMBER (SSN)
Partnership
C-Corporation (C-Corp)
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
S-Corporation (S-Corp)
Corporation
MINNESOTA TAX ID NUMBER (IF APPLICABLE)
Trust/Estate
Tax Exempt: Use FEIN and list the organization's IRS
Exempt Payee Code (if any)
Other:
2. Print the full Legal/Withholding name belonging to the social security number or employer identification number provided above.
3. Certification. Under penalty of perjury, I certify the number shown on this form is my correct taxpayer identification number.
Signature:
Phone No:
Date:
Email Address:__________________________________________________________________________________
PRIVACY ACT NOTICE - Internal Revenue code Section 6109 requires you to furnish your correct taxpayer
identification number to payers who must file information returns with IRS. IRS uses the numbers for identification
purposes and to help verify the accuracy of your tax return. Payers must generally withhold 28% of taxable interest
and certain other payments to a payee who does not furnish a TIN to a payer.
PLEASE COMPLETE AND RETURN TO:
Minnesota Management & Budget
Vendor File Maintenance
400 Centennial Building
658 Cedar Street
St. Paul, MN 55155
SUBSTITUTE FORM W-9
Fax: (651) 797-1306
Vendor.mmbefax@state.mn.us
Name (DBA) and Physical Address:
Date:
Supplier Number (if known):
SUBJECT:
Request for Taxpayer Information. (Failure to furnish a taxpayer identification number makes you subject
to a penalty of $50.)
The purpose of this form is to obtain or confirm your correct taxpayer name and identification number. Federal and state tax
regulations require that we have this information from recipients of certain payments in order to report such payments to the
Internal Revenue Service on the Form 1099 Return.
Please complete items 1, 2, and 3 below. If you have any questions, phone (651) 201-8201 for assistance. Send, fax or e-mail the
completed form to the address in the upper right corner.
1. Check your tax filing status below and enter your social security number or federal employer identification number. If you
have been issued a separate Minnesota tax identification number, write it in the space provided. If you have recently applied
for a taxpayer number, write "Applied For" in the space for the number.
(Check One)
Individual/Sole Proprietor: Use SSN
Limited Liability Company (Select One)
Single Member LLC: Use SSN
SOCIAL SECURITY NUMBER (SSN)
Partnership
C-Corporation (C-Corp)
FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN)
S-Corporation (S-Corp)
Corporation
MINNESOTA TAX ID NUMBER (IF APPLICABLE)
Trust/Estate
Tax Exempt: Use FEIN and list the organization's IRS
Exempt Payee Code (if any)
Other:
2. Print the full Legal/Withholding name belonging to the social security number or employer identification number provided above.
3. Certification. Under penalty of perjury, I certify the number shown on this form is my correct taxpayer identification number.
Signature:
Phone No:
Date:
Email Address:__________________________________________________________________________________
PRIVACY ACT NOTICE - Internal Revenue code Section 6109 requires you to furnish your correct taxpayer
identification number to payers who must file information returns with IRS. IRS uses the numbers for identification
purposes and to help verify the accuracy of your tax return. Payers must generally withhold 28% of taxable interest
and certain other payments to a payee who does not furnish a TIN to a payer.