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Form W-9 Benzle_LLC - REQUEST FOR TAXPAYER IDENTIFICATION...

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Unformatted text preview: REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION The Walt Disney Company and Consolidated Subsidiaries Substitute W-9 Form, DO NOT send to IRS Business Address: (REQUIRED) Remit to Address: (REQUIRED) 6100 Hayden Run Rd. 6100 Hayden Run Rd. Address: Address: City/State/zrp; H'll'ard' Oh 43025 USA City/State/ZIP: Hrllrard,Oh 43026 USA INTERNAL USE ONLY: UPDATE INFORMATION: Re quest Number Vendor Number(s) (if known) Previous Individual/Business Name and/or TIN: PART I - TAX STATUS (REQUIRED) Complete the row of boxes that correspond to your tax status. (COMPLETE ONE ROW ONLY) Individual Individual Name (First Name, Middle Initial, Last Name) Individual's Social Security Number (9 digits) Kyle A. Benzle 269-88-7443 Sole Proprietor or Business Owner‘s Name (Required) Social Security Number (9 digits) Business Trade Name or DBA LLC Sing Ie-Owner ' (Unincorporated) Benzle LLC 269—88—7443 and/or Employer ID Number Benzle LLC Kyle Arthur Benzle Partnership, l-l-P or Partnership's Name on [RS records Employer ID Number (9 digits) Name or Partnership LLC with Multiple Owners (see IRS mailing labels) (Unincorporated) Corporation, including Name (as shown on your income tax return) Employer ID Number (9 digitS) Business, Trade Name or DBA LLC with Corporation Status (Incorporated) Other (Non Profit, 5Cl1°°l51 Name (as shown on your income tax return) Employer ID Number (9 digiIS) Specify Type Government, etc.) PART II -OTHER INFORMATION (REQUIRED) Please check: 1) Have you or will you provide services rendered in California? f Yes (7 NO I— Occasionally 2) Have you or will you receive rent for property located in California? I— Yes I? No l— Occasionally 3) Have you or will you receive royalties for services originally rendered in California? (— YeS ((7 NO (— Occasionally 4) Have you or will you provide rentals of tangible personal property to be used in California? I— Yes (7 NO (— Occasionally Ifyou answer YES or OCCASIONALLY to 1), 2), 3) or 4), submit a completed California Form 590 or you Will be subject to California Nonresident Withholding. PART III - CERTIFICATION AND SIGNATURE (REQUIRED) Under penalties of perjuw, I certify that: l) The number shown on this form in Part I is my correct taxpayer identification number (or I am waiting for a number to be assigned 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 aresult 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 US person (including a U.S. resident alien). Certification Instructions: You MUST cross out item (2) above ifyou have been notified by the IRS thatyou are currently subject to backup withholding because ofunder'repor'ting interest or dividends on your tax return. (Also see Signing the Certification under Specific Instructions.) SIGNATURE: DATE; SEp-18-2008 PRINT NAME: Kyle A‘ Benzle COMPANY/TITLEfDEPT: Benzle l—l-C PHONE NUMBER: 614—975—1 798 FAX NUMBER: NOTE: SUBSTITUTE W—9 FORM WILL BE CONSIDERED INVALID IF REQUIRED AREAS ARE NOT COMPLETED. Form W-9 Rev. (08/2006) ...
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