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Payee Data Record FN-030 - California
| Payee Data Record Form. This is a California form and can be used in Finance Santa Clara Local County . |
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PAYEE DATA RECORD (in lieu of IRS W-9) Required in lieu of IRS W-9 form when receiving payments from the Judicial Council of California - Administrative Office of the Courts (AOC) on behalf of the Superior Courts of California See page two for additional instructional information and Privacy Statement. Complete all information on this form, sign, date, and return the form. Prompt return of this fully completed form will prevent delays when processing payments. Information provided in this form will be used to prepare Information Returns (1099). If this form was provided to you by one of the Superior Courts of California, return the form to the court. If this form was provided to you by the Judicial Council of California - Administrative Office of the Courts, submit the completed form to TCAFS.VendorRequest@jud.ca.gov or mail the form to the following address: Judicial Council of California - Administrative Office of the Courts Trial Court Administrative Services Division Vendor Maintenance Unit P.O. Box 981268 West Sacramento, CA 95798 1 Instructions SECTIONS 2 THRU 5 TO BE COMPLETED BY VENDOR PAYEE'S LEGAL NAME - AS SHOWN ON FEDERAL INCOME TAX RETURN BUSINESS NAME - IF DIFFERENT FROM ABOVE E-MAIL ADDRESS BUSINESS ADDRESS (if different from remittance mailing address) CITY, STATE, ZIP CODE 2 Legal Name REMITTANCE MAILING ADDRESS CITY, STATE, ZIP CODE , PHONE NUMBER , FACSIMILE NUMBER 3 Payee Entity Type Complete One Box Only NOTE A taxpayer identification number is required ENTER FEDERAL EMPLOYER IDENTIFICATION NUMBER (FEIN) PARTNERSHIP LIMITED LIABILITY COMPANY CORPORATION MEDICAL INDIVIDUAL/SOLE PROPRIETOR CORPORATION CORPORATION LEGAL OTHER EXEMPT (NON-PROFIT) GOVERNMENT ESTATE OR TRUST ____________________________________________________________________________________________________________________________ ENTER SOCIAL SECURITY NUMBER (SSN) - - If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN; however, the IRS prefers that you use your SSN. An employee vendor is not required to provide a SSN. 4 Resident Status check the appropriate box California Resident - Qualified to do business in California or maintains place of business California Nonresident (see reverse side) - Payments to non-resident for services may be subject to State Income Tax withholding. No services performed in California Copy of Franchise Tax Board waiver of State Withholding attached Under penalties of perjury, I certify that: 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 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 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, as defined by the IRS. I hereby certify under the penalty of perjury that the information provided on this document is true and correct. Should my information change, I will promptly notify the AOC at the address listed in Section 1. VENDOR REPRESENTATIVE'S NAME (Type or Print) TITLE E-MAIL 5 Certification NOTE See instructions on page 2 Vendor Contact Information and signature AUTHORIZED VENDOR SIGNATURE DATE TELEPHONE SECTION 6 TO BE COMPLETED BY COURT 6 Please choose from the AOC Vendor category below to help us expedite payment ARBITRATOR VOLUNTEER GRAND JURY OTHER (description required) RENT DECEASED FINAL PAYMENT PAYMENT TERMS EMAIL Vendor Category CONTRACTOR COURT APPT. COUNSEL COURT REPORTER EMPLOYEE COURT CONTACT NAME INTEREST PAYMENTS ONLY MEDIATOR COURT INTERPRETER: (indicate language) GARNISHMENT TRUSTEE PHONE NUMBER Court Contact FOR AOC USE ONLY (Form updated 02/01/2013) Assigned Vendor Number FN-030 REV 03/05/13 American LegalNet, Inc. www.FormsWorkFlow.com Assigned By: Requirement to Complete Payee Data Record A completed Payee Data Record (in lieu of the IRS W-9) is required for payments and will be kept on file at the Judicial Council of California Administrative Office of the Courts, Trial Court Administrative Services Division. Since each state agency with which you do business must have a separate Payee Data Record on file, it is possible for a payee to receive a similar form from various state agencies. SECTIONS 2 THRU 5 TO BE FILLED OUT BY VENDOR Enter the payee's legal name. Sole proprietorships must also include the owner's full name. An individual must list his/her legal name as it appears on his/her Federal Income tax return. If a different name is used, that name should also be entered, beneath the legal name. 2 The mailing address should be the address at which the payee chooses to receive correspondence. The business address is the physical location of business, if different than mailing address. The phone number, e-mail address, and facsimile number should also be provided. Check the box that corresponds to the payee business type. Check only one box. Corporations must check the box that identifies the type of corporation. The State of California requires that all parties entering into business transactions that may lead to payment(s) from the State provide their Taxpayer Identification Number (TIN). The TIN is required by the California Revenue and Taxation Code Section 18646 to facilitate tax compliance enforcement activities and the preparation of Form 1099 and other information returns as required by the Internal Revenue Code Section 6109(a). The TIN for individuals is their Social Security Number (SSN). A sole proprietor may have both a Federal Employer Identification Number (FEIN) and a SSN, the IRS prefers that sole proprietors user their SSN. Only partnerships, estates, trusts, and corporations will enter their FEIN. 3 Are you a California resident or non-resident? A corporation will be defined as a "resident" if it has a permanent place of business in California or is qualified through the Secretary of State to do business in California. A partnership is considered a resident partnership if it has a permanent place of business in California. An estate is a resident if the decedent was a California resident at the time of death. A trust is a resident if at least one trustee is a California resident. For individuals and sole proprietors, the term "resident" includes every individ
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