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Choose the correct type and enter the 9-digit ID number without dashes.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What information is required for legal and remittance addresses?",{"text":113,"@type":109},"Provide the legal address (address lines, city, state, zip, and county) and, if different, the remittance address used specifically for payment.",{"name":115,"@type":106,"acceptedAnswer":116},"When should the “Modification to Existing Vendor Records” section be completed?",{"text":117,"@type":109},"Complete it when there are changes to the remittance address, tax identification number (TIN) such as SSN/EIN/ITIN, or the vendor name. 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Social Security Number (SSN),\u003Cbr>OR\u003Cbr>Employer Identification Number (EIN),\u003Cbr>OR\u003Cbr>Individual Taxpayer Identification Number (ITIN)*2. |  |  | Please select the appropriate Taxpayer Identification Number (EIN, SSN, or ITIN) type and enter your 9-digit ID number. The U.S. Taxpayer Identification Number is being requested per U.S. Tax Law. Failure to provide this information in a timely manner could prevent or delay payment to you or require The State of NC to withhold 28% for backup withholding tax. |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- |\n| *4. Legal Name (as shown on your income tax return): |  |  | 3. Dunn & Bradstreet Universal Numbering System (DUNS) (see instructions) |  |  |  |  |\n| 5. Business Name/DBA/Disregarded Entity Name, if different from Legal Name: |  |  |  |  |  |  |  |\n| Contact Information |  |  |  |  |  |  |  |\n| *6. Legal Address |  | 7. Remittance Address (Location specifically used for payment that is different from Legal Address, if applicable) |  |  |  |  |  |\n| *Address Line 1: |  | Address Line 1: |  |  |  |  |  |\n| Address Line 2: |  | Address Line 2: |  |  |  |  |  |\n| *City *State *Zip (9 digit) |  | City State Zip (9 digit) |  |  |  |  |  |\n| *County |  | County |  |  |  |  |  |\n| *8. Contact Name: |  |  |  |  |  |  |  |\n| *9. Phone Number: |  |  |  |  |  |  |  |\n| 10. Fax Number: |  |  |  |  |  |  |  |\n| 11. Email Address: |  |  |  |  |  |  |  |\n| *12. Entity Type |  |  |  |  | *13. Entity Classification |  | 14. Exemptions (see instructions) |\n| Individual/Sole Proprietor/Single-member LLC C-Corporation S-Corporation\u003Cbr>Partnership Trust/Estate Other \u003Cbr>Limited liability company. Enter the tax classification (C=C corporation,\u003Cbr>S=S corporation, P=Partnership)  \u003Cbr>Note: Check the appropriate box in the line above for the tax classification of the singlemember owner. 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 another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner. |  |  |  |  | Medical Services\u003Cbr>Legal/Attorney Services\u003Cbr>NC Local Govt\u003Cbr>Federal Govt\u003Cbr>NC State Agency\u003Cbr>Other Govt\u003Cbr>Other (specify) |  | Exempt payee code (if any): |\n|  |  |  |  |  |  |  | Exemption from FATCA reporting code (if any): |\n| Under penalties of perjury, I certify that:\u003Cbr>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\u003Cbr>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 because 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\u003Cbr>3. I am a U.S. citizen or other U.S. person (defined later in general instructions), and\u003Cbr>4. The FATCA code(s) entered on this form (if any) indicting that I am exempt from FATCA reporting is correct.\u003Cbr>Certification instructions: Please refer to the IRS Form W-9 located on the IRS Website ([https://www.irs.gov/](https://www.irs.gov/)): |  |  |  |  |  |  |  |\n| *Printed Name: |  |  |  | *Printed Title: |  |  |  |\n| *Authorized U.S. Signature: |  |  |  |  |  | * Date: |  |\n\nPlease complete the “Modification to Existing Vendor Records” section below If there have been any changes to the following: Tax Identification Number (TIN), Legal Name, Business Name, Remittance Add","cbCaifL556ywBatb","https://ap.wps.com/l/cbCaifL556ywBatb","pdf",216870,"English","# Section 1 - Taxpayer Identification\n## Section 2 - Certification\n# Modification to Existing Vendor Records\n## Section 1: Address change\n## Section 2: TIN change\n## Section 3: Vendor name change","[{\"question\":\"Which taxpayer identification number types can be used on the Substitute W-9 form?\",\"answer\":\"The form allows SSN, EIN, or ITIN. Choose the correct type and enter the 9-digit ID number without dashes.\"},{\"question\":\"What information is required for legal and remittance addresses?\",\"answer\":\"Provide the legal address (address lines, city, state, zip, and county) and, if different, the remittance address used specifically for payment.\"},{\"question\":\"When should the “Modification to Existing Vendor Records” section be completed?\",\"answer\":\"Complete it when there are changes to the remittance address, tax identification number (TIN) such as SSN/EIN/ITIN, or the vendor name. Fill the applicable sections below and sign with the authorized signature and date.\"}]","State of North Carolina - Substitute W-9 Form | PDF",1789808720]