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Jan 28 05 10: 11a
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<br />City of North Qlmsted 440 777 5'774
<br />6' •. ?
<br />Requestfor;laxpayer
<br />fdentifcation iVumber and Certifccation
<br />Giee farm to 2he
<br />sequester. {)a nai
<br />setfd to the ERS..
<br />?r<?me?t a ? im?yey ?
<br />':[mof Revenu4 ?nv?Ce
<br />taame 4ea 5p?g lruvucaons on page 21
<br />? city of rrorth oim$tea
<br />-:7m YR"9
<br />Rev. Oecemne! 204N
<br />Busmess nartta, d tlAferenc hoin ntmva lSee Spe«Tie le.ewcuom on paqe 21
<br />_.. ?
<br />CheckapPropnatenor. 13 tnd?viduaV5a(epmAneta [3 Carpaanon Q Pannrntllp oUW r..AF4A1-r'-i.gality_.....
<br />aoca[as lwnwet, suea. anq apt, ar syue rO.?
<br />5200 nover Center Raad
<br />Cisy. Uacc.. ana uP caa. _
<br />Noxth 0Imstecl Ohio 44070
<br />Enter yaur TJN in me appropriate hwc. For
<br />tnakvictcrels. this is your sacia! Se^_siricy rn,mber
<br />(55N}. tfoaeevae; fnt a redidafttsUea, Sale
<br />prapdainr, ar disregarded mlticp, sae tfie Part !
<br />insuucitens on gaga 2. far other en[iries„ ii is wur
<br />emploj+er idenui'icauon nninber fE7M. if yau da noc
<br />have a ewmber., see Havr to get a T1N un page 2.
<br />Note: If the account Is fn more rhan ane reme_ see
<br />trre rl,arr ort page 2 tar gufdelines on wrinse numaer
<br />ra wiet: "
<br />cir
<br />3 p? ?ida Otio? sn?es
<br />?.? { 2 jD 4 g
<br />ana aouress tapmnail
<br />Lisi actoum numnedsj here Sapaoneq
<br />Par U.S.. Paqees Facempt Fram
<br />' Backup 4Yithhaltling (See crie
<br />- --- unsnrtiarts on paae 2.)
<br />10-
<br />Under penalnes of petjaty. I Gersity tttaG
<br />t. ih$ nutnbet shoM att this fociit is my Correct taxpayer identlHp[fon numbes (w' 1 am wakfng for a number to be issued to me)., and
<br />2. f atat nnt suqJeCC ta Oaciwp waEtftddirg becam4: (a) t am exmpi from baCkup withholding, or (4) 1 have not 6M naaCfted by ihe kftemei
<br />Revernle Service QRSl tftt f 8m subject to Backup iai[Ltalding as a resvlt of a fademe co tepoit att tnCeren or dt,ddends, or (c) chr IR5 has
<br />rtodflerJ crie Naz 1 am no facrger subjeet w treckup vddftldinq, and
<br />3.. lam a US.. pesson (iifetuding a US., tesident aGen).
<br />Cettiliesttore af5ntsdlaas. You must Co;s ou[ item 2 above N yau havd been notified by the !RS thai you aFe cxnTently suEgeCi to b8ckup
<br />withtwlding trecaeue you have fatieQ to report aA interest and diviclends on yaur tax rewm. Fot real esrm aaetsactians, item i does = applg,
<br />Fa morcgage incergst pafd. acynisibon ar ebartaanmerrz of secuced praperty, cance6atlon af deht convihusiens m aR iadividusl reticEmenc
<br />acrangement {!RA}. a-tt genuaUy, payrttents other than mteresi and d'r?dertds. yotc are nac required m sign the Cecvfcatian. trvt yau rhast
<br />provide your cotrecc TiN. (See Lhe iristructforn on page 21)
<br />9 Siqnatura of "
<br />us. r? Alaw ?
<br />Purgase a# Farm
<br />A pessnn wtm is requiW to tle an kd'armauaa
<br />reaxn wah tde tRS rttts5t gec yair casact
<br />ca"yar K1wvdftagon ntanbar {ilM ua re{xxt. far
<br />smrnple. lncarne Raid to you, met es;aFe
<br />tTd1152CU?[IS. (ROClgdL3e LSLCfeSC yo4t Qaid,
<br />ae$ids(don or abandonrnant of stuaed prapetsy,
<br />cancenacion af debc oc corslht+dom yvu made
<br />:a an IRA.
<br />!]sa Form WS atsfy if you are n i1.S, persmn
<br />lindudsng a trsidects afien}. w give ynra cerzect
<br />7tN to me per;on tequesdng ft (tbe reqcxster}
<br />amt. when applicatife, tn;
<br />l. Cectify tnr TtN yvu are giving is carect lo+'
<br />you are waWg trx n nucrtber to be iSsve4,
<br />Z. Cariify you arn not syqect m b-2wp
<br />141ifftkulg, Of 3. Claim ezernptim frncR btckuR whhho" K
<br />you nre 2 U.S., ezgrqt payee.
<br />U 7ov ace a forefgn pcsor4 rua thn
<br />appmptiate Fotm W-8. See Ptdt. 575,
<br />Wlthhoftltn9 of Tax on NorveAaertt Afiens and
<br />faeign Covporaaans.. -
<br />ISote: U a tequester' geves ynu a irnm anret tha»
<br />Form W-9 to request yarr TInL you musr use Uie
<br />requesrer's form r(h is substantraky srmirar to Nus
<br />Form W 4.
<br />Mac is dadmp wRti+old'u+g2 Cecsons maftlng
<br />Cmm psyetta 1t5 ta yLw ttte6i v+rthbotd 8nd PsY
<br />to the.iRS 3196 oE sfx3t paymNnts unaer• cetmin
<br />cwdtions'. 72ils is ca?t 'badcaR vaithhoidlcg?
<br />Paymern ttm may be suGjea to bndacp
<br />a,w?g?e OumsL a? krOket
<br />royattles. natenpfoyea AaY atri tutsbc
<br />payroerrs lranr Tist+ing 6oat apeta[A[s. Reel
<br />esFaro vansac[torts are nnt sb,jea m ba: icup
<br />,-ea
<br />Wdfth*9•.
<br />N You 9ivp the reqt+euer y'ar cotreai 1TN.
<br />make [ha prePrr cwdk*tlonS. and repat a9
<br />yoir taxabte tntmest ard drvideads on yair mz
<br />rev= PaYmmm You ieCriv@ wilf m he subject
<br />to ea"..hm svirdrialdniy. Psry-oz eecrJrs
<br />vvK[ bs subsees to rwawoidkv t1;
<br />I. YOU CSA nDi ftti1t5f1 7fJUr. T1N LO t(Te
<br />reque.mer. a
<br />2. You dtr not centy yoir PN when teRtaed
<br />(sec the Aart lR irmcucdores an page Z fa
<br />do[aw, a
<br />3» 1'he iR5 tells ihe requener that ycu
<br />furrushetl an incatrEa T1N, ar
<br />4. The ERS te11s ycita Uwt yau are su6Ject to
<br />oadcuF wtchtwtdtnq hecause yow did npt ceporC
<br />ad yaur -erest aafd dhddentls art yaur:ax recwts
<br />dor repaFapfe kwest aea 6ividends onlyi, or
<br />Cat. No, 1023tX
<br />5. Yvu da nnt eervey to ete rcqasscer chst yau
<br />ara ncX sab}eCt to WWP Mhhofding tarix t
<br />ebove Or rapocreC[a tntacea and dividend
<br />actowxs a{ered after 1983 onlyt,.
<br />C?tacr ?yse: a? ?,ymcxs rr_ ?ceesepe
<br />ifCw. wyL+? wl&zh,7l' ?:i. Gt-- ttL.° p::..7L L
<br />I+uu? :na tha separace tnct%=tM fa
<br />&& Reqm-sta u! Forni t!V-4,.
<br />PenaEties
<br />Fd[um to trqnis!? 71N_ lf yau faa m fusn[s!3 yora
<br />carrect T1N ur a re9uestes You are suhjeci sa s
<br />penattp dt 10 fa 68c1t suC1t fN7ur8 tulless yaY
<br />(ailve 35 dne to reasonaflte caum kid nar cp
<br />xAltui csegktz,
<br />C,SvH penat.ry For iaba aKoeiasdon wqlx fwwFm=
<br />10 widYioid'ng.. lf ycxt make a(alse stacimeet
<br />Wit11 il0 leaSOREblB 1335t5 CUC 185tlR5 177 1!G
<br />baesaip wia+nadmg. yoa are sut,Jecr xo a ssoo
<br />pemtty.,
<br />Cr4airtai PertatcY for fats3fyiog hstoRrsatioet.
<br />LYwwy falsr(yieg cersificadons a' atl:srwsiarn
<br />may suCiecs you [o airninal pen'alties inciutliny
<br />flRes ana/e+r impnsanmertt..
<br />Wasuse of 71Ns. ![ the repuescer cgsUoses ar
<br />uszs T1Ns m vtatatian of Federnt law. the
<br />reqttester may he subSea to civit and cnmMat
<br />pena?nes.. '
<br />Fam V{(••9 lRev. 12•2000)
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