The Gao W-9 Arizona form serves as a request for a taxpayer identification number and certification for individuals or entities doing business with the State of Arizona. This form is essential for ensuring that the correct tax information is reported to the IRS, helping to avoid backup withholding. Completing the Gao W-9 is a necessary step for vendors to establish their eligibility for payments from the state.
The Gao W-9 Arizona form serves as a crucial document for individuals and entities engaging in business transactions with the State of Arizona. This form, formally known as the Substitute W-9: Request for Taxpayer Identification Number and Certification, is designed to collect essential taxpayer information, including the Taxpayer Identification Number (TIN) and legal name of the entity or individual. It requires the completion of various sections, such as the type of request—whether it is a new submission or a change of address—and the identification of the entity type, which can range from individuals to corporations and partnerships. Additionally, it prompts users to indicate their status as a minority-owned or veteran-owned business, which is significant for state contracting opportunities. The form also addresses exemptions from backup withholding and FATCA reporting, allowing individuals to certify their status under penalties of perjury. Failure to provide accurate information may result in mandatory withholding of payments, emphasizing the importance of careful completion. As such, understanding the intricacies of the Gao W-9 Arizona form is essential for compliance and successful business operations within the state.
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State of Arizona Substitute W-9: Request for Taxpayer Identification Number and Certification
Submit completed form to the State of Arizona Agency with whom you are doing business with for review and authorization.
Type of Request (Must select at least ONE)
New Location
Change - Select the
Tax ID
Legal Name
Entity Type
Minority Business Indicator
New Request
(Additional Address
type(s) of change from
Main Address
Remittance Address
Contact Information
ID)
the following:
Taxpayer Identification Number (TIN) (Provide ONE Only)
TIN
OR
SSN
-
Entity Name (As it appears on IRS EIN records, IRS Letter CP575, IRS Letter 147C or Social Security Administration Records, Social Security Card. If Individual, Sole Proprietor, Single Member LLC, enter First, Middle, Last Name.)
DBA Name
Entity Type (Must select ONE of the following)
Individual/Sole Proprietor or Single-Member LLC
The US or any of its political subdivisions or instrumentalities
Corporation
A state, a possession of the US, or any of their political subdivisions or
instrumentalities
Partnership
Other: Tax Reportable Entity
Limited Liability Company (LLC) including Corporations &
Description
Partnerships
Other: Tax Exempt Entity
Minority Business Indicator (Must select ONE of the following)
5
Small Business
Small Business- African American
Small Business- Asian
Small Business - Hispanic
Small Business- Native American
Small Business- Other Minority
Small, Woman Owned Business
Small, Woman Owned Business- African American
Small, Woman Owned Business- Asian
Small, Woman Owned Business- Hispanic
Small, Woman Owned Business- Native American
Small, Woman Owned Business- Other Minority
Woman Owned Business
Woman Owned Business- African American
Woman Owned Business- Asian
Woman Owned Business- Hispanic
Woman Owned Business- Native American
Woman Owned Business- Other Minority
Minority Owned Business- African American
Minority Owned Business- Asian
Minority Owned Business- Hispanic
Minority Owned Business- Native American
Minority Owned Business- Other Minority
Non-Profit, IRC §501(c)
Non-Small, Non-Minority or Non-Woman Owned Business
Individual, Non-Business
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7
8
9
10
Veteran Owned Business
YES
NO
Entity Address
Main Address (Where tax information and general correspondence is to be mailed)
Remittance Address (Where payment is to be mailed)
Same as Main
Address Line 1
Address Line 2
City
State
Zip code
Vendor Contact Information
Name
Title
Phone
Ext.
Fax
Email
Exemption from Backup Withholding and FATCA Reporting: Complete this section if it is applicable to you. See instructions for more details
Exemption Code for Backup Withholding
Exemption Code for FATCA Reporting
Certification
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 Withholding, 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 US citizen or other US person, and
4.The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
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. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN.
Signature
Print Name
Date
GAO-W-9 (10/2019)
The State of Arizona Substitute W-9 Form Instructions
The State of Arizona (State), like all organizations that file an information return with the IRS, must obtain your correct Taxpayer Identification Number (TIN) to report income paid to you or your organization. The State uses the Substitute W-9 Form to obtain certification of your TIN in order to ensure accuracy of information contained in its payee/vendor system and to avoid Backup Withholding as mandated by the IRS. According to IRS regulations, the State must withhold 28% of all payments if a vendor/payee fails to provide the State its certified TIN. The Substitute Form W-9 certifies a vendor/payee's TIN. Any vendor/payee who wishes to do business with the State must complete the Substitute W-9 Form.
Part 1 - Type of Request: Select only one.
Part 2 - Taxpayer Identification Number (TIN): Enter your nine-digit TIN. The TIN is either your nine-digit Social Security Number (SSN) assigned by the Social Security Administration (SSA) or Employer Identification Number (EIN) assigned by the Internal Revenue Service (IRS).
Part 3 - Entity Name: Enter the legal name as it appears on IRS EIN records, IRS Letter CP575, IRS Letter 147C or Social Security Administration Records, Social Security Card. If Individual, Sole Proprietor, Single Member LLC, enter First, Middle, Last Name. Enter your DBA in the designated line if applicable.
Part 4 - Entity Type: Select only one for TIN given.
Part 5 - Minority Business Indicator: Select only one for TIN given.
Part 6 - Veteran Owned Business: Select only one for TIN given.
Part 7 - Entity Address: List the locations for tax reporting purposes and where payments should be mailed.
Part 8 - Entity Contact Information: List the contact information.
Part 9 - Backup Withholding and FATCA Exemptions: If you are exempt from Backup Withholding and/or FATCA reporting, enter in the Exemptions box, any code(s) that may apply to you.
Backup Withholding Exemption Codes: Generally, Individuals (including Sole Proprietors) are not exempt from Backup Withholding. Additionally, Corporations are not exempt from Backup Withholding when supplying legal or medical services. If you do not fall under the categories below, leave this field blank. The following codes identify payees that are exempt from Backup Withholding:
Code 1: An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b) (7) if the account satisfies the requirements of section 401(f) (2)
Code 2: The United States or any of its agencies or instrumentalities
Code 3: A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or Instrumentalities
Code 4: A foreign government or any of its political subdivisions, agencies, or instrumentalities
Code 5: A corporation
Code 6: A dealer in securities or commodities required to register in the United States, the District of Columbia, or a possession of the United States Code 7: A futures commission merchant registered with the Commodity Futures Trading Commission
Code 8: A real estate investment trust
Code 9: An entity registered at all times during the tax year under the Investment Company Act of 1940
Code 10: A common trust fund operated by a bank under section 584(a)
Code 11: A financial institution
Code 12: A middleman known in the investment community as a nominee or custodian
Code 13: A trust exempt from tax under section 664 or described in section 4947
FATCA Exemption Codes: The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. If you are only submitting this form for an account you hold in the United States, leave this field blank. The following codes identify payees that are exempt from FATCA Reporting:
Code A: An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a) (37)
Code B: The United States or any of its agencies or instrumentalities
Code C: A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities
Code D: A corporation the stock of which is regularly traded on one or more established securities markets, as described in Reg. section 1.1472-1(c)(1)(i)
Code E: A corporation that is a member of the same expanded affiliated group as a corporation described in Reg. section 1.1472-1(c) (1) (i)
Code F: A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state
Code G: A real estate investment trust
Code H: A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940
Code I: A common trust fund as defined in section 584(a)
Code J: A bank as defined in section 581 Code K: A broker
Code L: A trust exempt from tax under section 664 or described in section 4947(a) (1)
Code M: A tax-exempt trust under a section 403(b) plan or section 457(g) plan
Part 10 - Certification: Please sign, date and provide preparer's name in appropriate space.
Arizona A4 Withholding Percentage - Arizona residents and nonresident employees alike must navigate the A-4 form to ensure compliance with state tax laws.
Making a Contract for Small Business - It may include a clause about the proration of property taxes, utilities, and other expenses related to the property up to the closing date.