Transcription of Division of Finance Substitute Form W-9 - Alaska
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Division of Finance Substitute Form W-9 - Alaska
Revised 11/07/2018 State of AlaskaDepartment of AdministrationRETURN COMPLETED form TO:Department of AdministrationDivision of Box 110204 Juneau, AK 99811-0204Or FAX to: (907) 465-2169 Questions? Email Identification Number (TIN) VerificationSubstitute form W-9DO NOT send to IRSS ocial Security Number (SSN)Employer Identification Number (EIN)Taxpayer Identification Number (TIN) Provide Only One (If sole proprietorship provide EIN, if applicable)Printed NamePrinted TitleTelephone NumberSignatureDateEmail AddressCertificationThe Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup penalties of perjury, I certify that:1. The number shown on this form is my correct taxpayer identification number, AND2. 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, AND3.
Revised 11/07/2018 State of Alaska Department of Administration RETURN COMPLETED FORM TO: Department of Administration Division of Finance P.O. Box 110204
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