Central Maine Babe Ruth Baseball

Umpire Online IRS Form W-9

* Name:

* Address:

* City, State ZIP:

* TIN:

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.

I have read and understand the certification instructions. *

* Email (This will be your e-signature.):

Date:

* indicates required fields

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Umpire Online IRS Form W-9