Get State Of Maine Substitute W 9 Form

State of Maine Substitute W-9 Vendor Authorization Form Return to Maine Ethics Commission 135 State House Station Augusta ME 04333-0135 207-287-4179 Reset Form PURPOSE To establish or update an account with the State of Maine s accounting system. This form replaces the IRS W-9 form per the IRS W-9 language If a requester gives you a form other than Form W-9 to request your TIN you must use the requester s form if it is substantially similar to this Form W-9. Complete this form if 1 You will receive payment from the State of Maine and/or 2 You are a vendor who provides services or goods to the State of Maine. All items with an asterisk must be completed* TYPE OF REQUEST Must select one. Payment Address TAXPAYER ID NUMBER TIN Provide ONE only Candidate s Social Security Number SSN Organization Type Legal Name Change Choose New Request Individual/Candidate choose ONE Classification Individual OR Sole Proprietorship Nonresident Alien DBA Name Contact Info Ordering Address Committee s Federal Employer ID Number FEIN Company Committee with FEIN Foreign W8 required Corporation Trust State Gov t Partnership Other Gov t Other LEGAL NAME Must provide Legal name filed with IRS tied to the ID number SSN first last name/FEIN business name Alias/DBA Other Info Vendor Customer Number if known VC /VS Completed by Ethics or DAFS Address C/O Phone City/State/Zip Contact Name Ext Send me Email notifications of DD/EFT Email requires Direct Deposit/EFT form to be completed Physical Address if different from payment address Candidate s Signature Current Date 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 witholding or b I have not been notified by the 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 by the IRS. Ref www*irs*gov OFFICE USE ONLY State Agency SHS Information on State Agency Submitting Vendor Form Agency Contact Person Name Title Contact s Phone ME W9 V3 12/15/11. Complete this form if 1 You will receive payment from the State of Maine and/or 2 You are a vendor who provides services or goods to the State of Maine. All items with an asterisk must be completed* TYPE OF REQUEST Must select one. Payment Address TAXPAYER ID NUMBER TIN Provide ONE only Candidate s Social Security Number SSN Organization Type Legal Name Change Choose New Request Individual/Candidate choose ONE Classification Individual OR Sole Proprietorship Nonresident Alien DBA Name Contact Info Ordering Address Committee s Federal Employer ID Number FEIN Company Committee with FEIN Foreign W8 required Corporation Trust State Gov t Partnership Other Gov t Other LEGAL NAME Must provide Legal name filed with IRS tied to the ID number SSN first last name/FEIN business name Alias/DBA Other Info Vendor Customer Number if known VC /VS Completed by Ethics or DAFS Address C/O Phone City/State/Zip Contact Name Ext Send me Email notifications of DD/EFT Email requires Direct Deposit/EFT form to be completed Physical Address if different from payment address Candidate s Signature Current Date 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 witholding or b I have not been notified by the 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 by the IRS.