The Montana W 9 form is a document used to verify a taxpayer's identification number (TIN) for individuals and businesses operating in Montana. This form is essential for ensuring compliance with tax regulations and must be submitted to the Montana Department of Public Health and Human Services, not the IRS. Completing the Montana W 9 accurately helps prevent delays in payments and avoids potential backup withholding.
The Montana W-9 form is an essential document for individuals and businesses operating within the state, facilitating the accurate collection of taxpayer information. This form is specifically designed for the verification of Taxpayer Identification Numbers (TIN) and is required by the State of Montana to comply with federal regulations set forth by the Internal Revenue Service (IRS). It serves multiple purposes, including ensuring that payments made to vendors and service providers are properly reported for tax purposes. The form requires users to provide their legal name, entity designation, and primary address, among other details. Additionally, it includes a certification section where individuals affirm the accuracy of their TIN and declare their exemption status regarding backup withholding. For those opting for direct deposit, the form also collects banking information, streamlining payment processes. It is crucial to complete this form accurately and submit it promptly, as failure to do so may result in delayed payments or mandatory withholding of taxes. Understanding the nuances of the Montana W-9 form is vital for anyone looking to maintain compliance and ensure smooth financial transactions within the state.
State of Montana
Department of Public Health
Department of Administration
and Human Services
SW9 (4/2009)
PO Box 4210
111 N Sanders
Helena, MT 59604
Phone: 406-444-5932
Send faxes to: 406-444-9763
Substitute W-9
Taxpayer Identification Number (TIN) Verification
DO NOT send to IRS
Print or Type
Please see attachment or reverse for complete instructions.
Legal Name
Entity Designation (check only one type)
(as entered with IRS) If Sole Proprietorship, enter your Last, First, MI
Corporation
S-Corp
C-Corp
Do you provide medical or legal services?
Trade Name
Yes
No
If doing business as (DBA) or enter business name of Sole Proprietorship
Individual
Sole Proprietorship
Primary Address (for 1099 form)
Partnership
PO Box or Number and Street, City, State, ZIP + 4
General
Limited
LLC (for federal tax purposes taxed as)
Estate/Trust
Organization Exempt from Tax
Remit Address (where payment should be mailed, if different from Primary
(under Section 501 (a)(b)(c)(d)(e))
Address) PO Box or Number and Street, City, State, ZIP + 4
Government Entity
Other_________________
Taxpayer Identification Number (TIN) (Provide Only One) (If sole proprietorship provide FEIN, if applicable)
Social Security Number
Federal Employer Identification No
Certification
Under penalties of perjury, I certify that:
1.The number shown on this form is my correct taxpayer identification number, 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.
3.I am a U.S. person (including a US resident alien).
Printed Name
Printed Title
Telephone Number
Signature
Date
Optional Direct Deposit Information (used at agency discretion) (all fields required to receive electronic payments) (Must Include a Voided Check, No Direct Deposit Slips Accepted)
Your Bank Account Number
Checking
Name on Bank Account
Bank Routing No. (ABA)
Savings
THIS IS A:
New Direct Deposit
Change of Existing
Additional Direct Deposit
Email Change Only
Email Address (Please make this LEGIBLE)
If you provide bank information and an email address, we will send a message notifying you when an electronic payment is issued. We will NOT share your email address with anyone or use it for any other purpose than communicating information about your electronic payments to
you. If you have questions about completing this form, please call the Warrant Writer Unit at 406-444-5932.
Instructions for Completing Taxpayer Identification Number Verification
(Substitute W-9)
Legal Name As entered with IRS
Individuals: Enter Last Name, First Name, MI
Sole Proprietorships: Enter Last Name, First Name, MI
LLC Single Owner: Enter owner's Last Name, First Name, MI
All Others: Enter Legal Name of Business
Individuals: Leave Blank
Sole Proprietorships: Enter Business Name
LLC Single Owner: Enter LLC Business Name
All Others: Complete only if doing business as a D/B/A
Primary Address
Address where 1099 should be mailed.
Remit Address
Address where payment should be mailed. Complete only if different from primary address.
Entity Designation
Check ONE box which describes the type of business entity.
Taxpayer Identification Number
LIST ONLY ONE: Social Security Number OR Employer Identification Number. See “What Name and Number to Give the Requester” at right.
If you do not have a TIN, apply for one immediately. Individuals use federal form SS-05 which can be obtained from the Social Security Administration. Businesses and all other entities use federal form SS-04 which can be obtained from the Internal Revenue Service.
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.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to furnish your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, or contributions you made to an IRA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and
certain other payments to a payee who does not furnish a TIN to a payer. Certain penalties may also apply.
What Name and Number to Give the Requester
For this type of account:
Give name and SSN of:
1.
The individual
2.
Two or more individuals (joint
The actual owner of the account
account)
or, if combined funds, the first
individual no the account 1
3.
Custodian account of a minor
The minor 2
(Uniform Gift to Minors Act)
4. a. The usual revocable savings
The grantor-trustee 1
trust (grantor is also trustee)
b. So-called trust account that
The actual owner 1
is not a legal or valid trust
under state law
5.
Sole proprietorship or Single-
The owner
3
Owner LLC
Give name and EIN of:
6.
Sole Proprietorship or Single-
The owner 3
7.
A valid trust, estate, or pension
Legal entity 4
trust
8.
Corporate or LLC electing
The corporation
corporate status on Form
8832
9.
Association, club, religious,
The organization
charitable, educational, or
other tax-exempt organization
10. Partnership or multi-member
The partnership
LLC
11. A broker or registered
The broker or nominee
nominee
12. Account with the Department
The public entity
of Agriculture in the name of a
public entity (such as a state
or local government, school
district or prison) that receives
agricultural program payments
1List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name, but you may also enter your business or “DBA” name. You may use either your SSN or EIN (if you have one).
4 List first and circle the name of the legal trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.)
NOTE: If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed.
Taxpayer Identification Request
In order for the State of Montana to comply with the Internal Revenue Service regulations, this letter is to request that you complete the enclosed Substitute Form W-9. Failure to provide this information may result in delayed payments or backup withholding. This request is being made at the direction of the Montana Department of Administration, State Accounting Division, in order that the State may update its vendor file with the most current information.
Please return or FAX the Substitute Form W-9 even if you are exempt from backup withholding within (10) days of receipt. Please make sure that the form is complete and correct. Failure to respond in a timely manner may subject you to a 28% withholding on each payment, or require the State to withhold payment of outstanding invoices until this information is received per Internal Revenue Code 3406(a).
We are required to inform you that failure to provide the correct Taxpayer Identification Number (TIN) / Name combination may subject you to a $50 penalty assessed by the Internal Revenue Service under Section 6723 of the Internal Revenue Code.
Only the individual’s name to which the Social Security Number was assigned should be entered on the first line.
The name of a partnership, corporation, club, or other entity, must be entered on the first line exactly as it was registered with the IRS when the Employer Identification Number was assigned.
DO NOT submit your name with a Tax Identification Number that was not assigned to your name. For example, a doctor MUST NOTsubmit his or her name with the Tax Identification Number of a clinic he or she is associated with.
Thank you for your cooperation in providing us with this information. Please return the completed form to Department of Public Health and Human Services, Business and Financial Services Division:
DPHHS, BFSD
Fax: 406-444-9763
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