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Form W-9Request for TaxpayerDo NOT send to the IRS.

Send form securely to MSU Denver (online link below).
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Substitute Form for IRS Rev. Oct 2018Identification Number and Certification
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MSUDenver Rev 02.02.22IRS Instructions may be found at:
https://www.irs.gov/forms-instructions
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Print or type. See Instructions.1
Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
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Business name/disregarded entity name, if different from above.
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Check appropriate box for federal tax classification of the person whose name is entered on line 1.
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Check only ONE of the following seven boxes.
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Individual/sole proprietor
C Corporation
S Corporation
Partnership
Trust/Estate
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LLC - Single Member
Limited Liability Company
Limited Liability Company
Limited Liability Company
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Filing as Sole Proprietor
Filing as C-Corporation
Filing as S-Corporation
Filing as Partnership
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Note:
Check the appropriate box in the line above for the tax classification of the single-member owner.
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Do NOT check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
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another LLC that is NOT disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded
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from the owner should check the appropriate box for the tax classification of its owner.
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Other (see W-9 instructions)
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Exemptions (codes apply only to certain entities, not individuals; see W-9 instructions):
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Exempt payee code (if any):
Exemption from FATCA reporting code (if any):
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(Applies to accounts maintained outside the U.S.)
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Provider of Medical Services?
YesNo
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Provider of Legal Services?
YesNo
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Address (number, street, and apt. or suite no.) See W-9 instructions.
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City, State, and ZIP code
Requester's name and address
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MSU Denver - Accounts Payable
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List account number(s) here (optional)
Campus Box 98, PO Box 173362
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Denver, CO 80217-3362
Submit Securely Online ↓
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Part I
Taxpayer Identification Number (TIN)
https://secureshare.msudenver.edu/filedrop/securedropbox
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Enter your TIN in the appropriate box. The TIN provided must match the name given
Social Security Number (SSN)
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on line 1 to avoid backup withholding. For individuals, this is generally your social
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security number (SSN). However, for a resident alien, sole proprietor, or disregarded
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entity, see the Instructions for Part I in the instructions. For other entities, it is your
or
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employer identification number (EIN).
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If you do not have a number, see How to get a TIN, in the instructions.
Employer Identification Number (EIN)
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Note:
If the account is in more than one name, see the instructions for line 1.
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Also see What Name and Number to give the requestor (in the W-9 instructions)
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for guidelines on whose number to enter.
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Part IICertification
Please complete Page 2 for voluntary Self-Certification of your Ownership Category and Businesses Characteristics. →
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Under penalties of perjury, I certify that:
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The number shown on this form is my correct taxpayer identification number (or I am waiting for number to be issued to me); and
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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
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(IRS) that I am subject to backup withholding as a result of a failure to report all interest of dividends, or (c) the IRS has notified me that I am no longer
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subject to backup withholding; and
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3
I am a U.S. citizen or other U.S. person (defined in the W-9 instructions); and
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The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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Certifications 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
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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
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or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than
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interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II.
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The Internal Revenue Service does not require your consent to any provisions of this document other than the certifications required
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to avoid backup withholding.
Go to: www.irs.gov/FormW9 for IRS instructions and the latest information.
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Sign HereSignature of U.S. person u
Date u
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