Peter Schuman et al v. Microchip Technology Incorporated et al

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AUTHENTICATED
U.S. GOVERNMENT
INFORMATION

GPO

Case 4:16-cv-05544-HSG Document 257 _ Filed 08/07/26 Page 1 of 23

Michael Rubin (SBN 80618)

Matthew Murray (SBN 271461)

Marisa C. Lowe (SBN 366248)

ALTSHULER BERZON LLP

177 Post Street, Suite 300

San Francisco, CA 94108

Telephone: (415) 421-7151

Facsimile: (415) 362-8064

Email: mrubin@altber.com
mmutray@altber.com
mlowe@altber.com

Cliff Palefsky (SBN 77683) William B. Reilly (SBN 177550)
Keith Ehrman (SBN 106985) LAW OFFICE OF WILLIAM REILLY
MCGUINN, HILLSMAN & PALEFSKY 86 Molino Avenue
220 Jackson St., Suite 350 Mill Valley, CA 94941
San Francisco, CA 94111 Telephone: (415) 225-6215
Telephone: (415) 421-9292 Facsimile: (415) 634-2897
Facsimile: (415) 403-0202 Email: bill@williambreilly.com
Email: cp@mhpsf.com

keith@mhpsf.com

Attorneys for Plaintiffs
(Counsel for Defendants listed on the next page)

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF CALIFORNIA

OAKLAND DIVISION

PETER SCHUMAN, an individual, and Case No. 4:16-CV-05544-HSG
WILLIAM COPLIN, an individual, on behalf
of themselves and on behalf of others CLASS ACTION
similarly situated,
JOINT STIPULATION AND ORDER RE:

Plaintiffs, SCHEDULE OF DATES FOR
SETTLEMENT ADMINISTRATION (as
V. modified)
Hearing Date: October 15, 2026
MICROCHIP TECHNOLOGY Time: 2:00 p.m.

INCORPORATED, a corporation; ATMEL

CORPORATION, a corporation; and ATMEL Courtroom. : 2, Floor 4

CORPORATION U.S. SEVERANCE Judge: Hon. Haywood S. Gilliam, Jr.

GUARANTEE BENEFIT PROGRAM, an ; ;

employee benefit plan, Action Filed: September 29, 2016
Defendants.

Joint Stipulation and Order Re: Schedule of Dates for Settlement Administration

S Case No. 4:16-cv-05544-HSG

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Joint Stipulation and Order Re: Schedule of Dates for Settlement Administration
Case No. 4:16-cv-05544-HSG
OGLETREE, DEAKINS, NASH, SMOAK & STEWART, P.C., SBN 00504800
Mark G. Kisicki, Esq. (CA SBN 150057)
mark.kisicki@ogletreedeakins.com
Elizabeth M. Soveranez (AZ SBN 024009) admitted pro hac vice
elizabeth.soveranez@ogletreedeakins.com
Esplanade Center III, Suite 800
2415 East Camelback Road
Phoenix, AZ 85016
Tel.: 602.778.3700
Fax: 602.778.3750
Mark Schmidtke (IN SBN 1733-45) admitted pro hac vice
56 S. Washington Street, Suite 302
Valparaiso, IN 46383
Tel.: 219.242.8668
Fax: 219.242.8669
mark.schmidtke@ogletreedeakins.com
Erika L. Leonard (GA SBN 565965) admitted pro hac vice
301 Congress Avenue, Suite 1150
Austin, TX 78701
Tel.: 512.344.4700
Fax: 512.344.4701
erika.leonard@ogletree.com
Attorneys for Defendants
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 2 of 23

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28 	1
Joint Stipulation and Order Re: Schedule of Dates for Settlement Administration
Case No. 4:16-cv-05544-HSG
Pursuant to the Court’s direction, ECF 255, Plaintiffs Peter Schuman and William Coplin
and Defendants Microchip Technology Incorporated, Atmel Corporation, and Atmel Corporation
U.S. Severance Guarantee Benefit Program have met and conferred and agreed to the following
deadlines for initial class notice, the motion for attorneys’ fees and costs and incentive awards,
class member objections or opt outs, the motion for final approval, and the final approval hearing:
Pursuant to the Court’s direction, the updated proposed class notice is attached as Exhibit
A.
Dated: August 6, 2026 	Respectfully submitted,
ALTSHULER BERZON LLP
MICHAEL RUBIN
MATTHEW J. MURRAY
MARISA C. LOWE
MCGUINN, HILLSMAN & PALEFSKY
CLIFF PALEFSKY
KEITH EHRMAN
LAW OFFICE OF WILLIAM REILLY
WILLIAM REILLY
By: _/s/ Michael Rubin____________________
Attorneys for Plaintiffs and Certified Class
OGLETREE, DEAKINS, NASH,
SMOAK & STEWART, P.C.
MARK G. KISICKI
ELIZABETH M. SOVERANEZ
Event 	Date
Deadline for emailing or mailing notice to all Class Members 	August 17, 2026
Filing deadline for attorneys’ fees and costs motion 	August 17, 2026
Filing deadline for incentive awards motion 	August 17, 2026
Deadline for Class Members to opt-out or object to settlement
and/or application for attorneys’ fees and costs and incentive
awards (at least 45 days after the filing of the motion for
attorneys’ fees and incentive awards)
October 1, 2026
Filing deadline for final approval motion 	October 8, 2026
Final fairness hearing and hearing on motions 	October 15, 2026
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 3 of 23

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28 	2
Joint Stipulation and Order Re: Schedule of Dates for Settlement Administration
Case No. 4:16-cv-05544-HSG
MARK SCHMIDTKE
ERIKA L. LEONARD
By: __/s/ Erika S. Leonard__________
Attorneys for Defendants
Local Rule 5-1(h)(3) E-Signature Attestation
I attest that each of the other Signatories have concurred in the filing of this document.
/s/ Michael Rubin
Michael Rubin
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 4 of 23

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Joint Stipulation and Order Re: Schedule of Dates for Settlement Administration
Case No. 4:16-cv-05544-HSG
ORDER
It is so ORDERED that the Court sets the following deadlines and approves the proposed
class notice for dissemination to class members.
DATED:
Hon. Haywood S. Gilliam, Jr.
United States District Judge
Event 	Date
Deadline for emailing or mailing notice to all Class Members 	August 17, 2026
Filing deadline for attorneys’ fees and costs motion 	August 17, 2026
Filing deadline for incentive awards motion 	August 17, 2026
Deadline for Class Members to opt-out or object to settlement
and/or application for attorneys’ fees and costs and incentive
awards (at least 45 days after the filing of the motion for
attorneys’ fees and incentive awards)
October 1, 2026
Filing deadline for final approval motion 	October 8, 2026
Final fairness hearing and hearing on motions 	October 15, 2026 at 2 p.m.
8/7/2026
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 5 of 23

Case 4:16-cv-05544-HSG Document 257 _ Filed 08/07/26 Page 6 of 23

EXHIBIT A

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Notice to Former Atmel Employees of Class Action Settlement
Authorized by the U.S. District Court for the Northern District of California
Peter Schuman and William Coplin v. Microchip Technology Inc., Atmel Corp., and Atmel Corp.
U.S. Severance Guarantee Benefit Program, Case No. 4:16-cv-05544-HSG
U.S. District Court, Northern District of California
TO: [Name]
DATE: [Date]
RE: NOTICE OF CLASS ACTION SETTLEMENT
This is a court-approved notice to inform you of your rights under the settlement (“Settlement”)
of a certified class action lawsuit, Schuman et al. v. Microchip Technology Inc. et al., filed in the
U.S. District Court for the Northern District of California (the “Court”). More information is
available at www.MicrochipClassAction.com.
As a former Atmel employee, you are entitled to a settlement payment even if you
previously signed a claims release in 2016 or 2017 in exchange for 50% of the amount that
you would have been entitled to under the Atmel Severance Plan.
The lawsuit was brought by the two named plaintiffs (Peter Schuman and William Coplin) on
behalf of all former U.S.-based employees of Atmel Corporation (“Atmel”) who were employed
on April 4, 2016 (the closing date of the Atmel-Microchip merger) and were terminated by
Microchip Technology Inc. (“Microchip”) without cause between April 4, 2016 and March 19,
2017. The lawsuit alleged that these former Atmel employees are owed severance benefits that
were never paid to them under the Atmel Corporation U.S. Severance Guarantee Benefit
Program (the “Atmel Plan”), and that such severance benefits are owed even to those employees
who signed releases after their termination because, according to plaintiffs, the releases were
obtained in violation of Microchip’s fiduciary duties. Microchip, Atmel, and the Atmel Plan
denied those claims, and asserted that no severance benefits were due under the Plan and that the
releases executed by former Atmel employees were valid and enforceable.
Based on Microchip’s records, the unpaid portion of your severance benefits under the Atmel
Plan was [insert dollar amount]. If the Settlement terms are approved by the Court in the
upcoming final approval hearing (see below), you will be entitled to receive [insert
percentage] of that unpaid amount (i.e., $_____) plus compound annual interest at 3.96%
(the one-year federal Treasury bill rate) from your date of termination through the Effective Date
of the Settlement.1 No attorneys’ fees will be deducted from your share of the Settlement, as the
terms of the proposed Settlement include that Microchip will separately pay Class Counsel’s fees
and expenses in an amount the Court determines is reasonable.
In order to receive your payment, all you need to do is submit a Form W-4 and a Form W-
9 (see Appendices A and B) to Microchip using the secure link here. While you must submit
those forms no later than 45 days after the Effective Date to be paid, you are encouraged to
1 The Effective Date for the Settlement will depend on when the Court grants final approval and whether any class
members object to the settlement terms and/or appeal the denial of any objections.
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 7 of 23

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submit them promptly after receiving this notice to the designated secure FTP link here.
You will receive a separate notice after the final approval hearing informing you whether the
Settlement has received final approval and, if you have not yet submitted your forms, reminding
you that you need to submit your W-4 and W-9 forms to receive your settlement payment and
providing the deadline for you to do so.
The reason for needing to submit both a W-4 and W-9 is that your settlement share will be paid
by two checks. The unpaid severance portion will be treated as wage income and will have
payroll taxes withheld by Microchip and remitted to the federal government. The interest portion
will be treated as non-wage income and will not have any taxes withheld.
For more information about the Settlement, its terms and key deadlines, your various options,
and who to contact with questions, please read below. Additional information and resources can
be found at www.MicrochipClassAction.com.
What is the lawsuit about? In 2016, a class action lawsuit was filed against Microchip, Atmel,
and the Atmel Plan based on Microchip’s alleged failure to honor the terms of the Plan by failing
to pay terminated employees the full severance benefits the Plan provided. The lawsuit alleged
that Microchip improperly denied employees’ claims for benefits and breached its fiduciary
duties, including by improperly obtaining releases from terminated employees in exchange for a
50% severance payment. The defendants disputed these allegations, contending they had no
liability under the Plan and that the releases were enforceable.
How will my payment be calculated? Under the proposed Settlement, class members who
previously signed an agreement releasing their claims against Microchip in exchange for
severance benefits equal to half the amounts provided by the Atmel Plan will receive 80% of the
unpaid portion plus compound annual interest at 3.96% from their date of termination through
the Settlement’s Effective Date, while class members who did not sign a release will receive
100% of the unpaid portion plus compound annual interest at the same 3.96% rate from their
date of termination through the Settlement’s Effective Date.
What do I need to do to receive my payment? In order to receive your settlement payment,
you do not need to file a formal claim. If the Court grants final approval to the Settlement, you
only need to submit a completed Form W-4 and a Form W-9 (see Appendices A and B) to
Microchip at this secure link here (https://ogletreedeakins.sharefile.com/r-
rdfc72061589c4201bfd0665e945e4fad) to receive your settlement payment.
The deadline for submitting the required forms and receiving a payout is 45 days after the
Effective Date, although you are encouraged to submit your required forms promptly to facilitate
prompt payment of your share. A separate notice will be sent to class members after the final
approval hearing to inform you whether the Court has granted final approval and the deadline for
submitting the required forms to participate in the settlement, and a notice will also be posted on
www.MicrochipClassAction.com of the Court’s ruling and any other developments.
Payments will be made within 30 days after the later of the Effective Date or receipt by
Microchip of your timely Forms W-4 and W-9. All payment checks issued pursuant to the
Settlement shall be void 180 days after issuance. All amounts not claimed nine months after the
Effective Date (e.g., if a class member does not cash or deposit one or both of their Settlement
checks) will be sent to the California State Controller Unclaimed Property Division.
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How will the lawyers be paid? Three law firms have served as co-counsel for the class since
this case was filed nearly a decade ago: McGuinn, Hillsman & Palefsky; Altshuler Berzon LLP;
and the Law Office of William Reilly. To date, Class Counsel have not received any
compensation for their work or any reimbursement for the expenses they incurred. The proposed
Settlement provides that Microchip will pay the total sum of $3.5 million for Class Counsels’
fees and expenses, subject to the approval of the Court, an amount that will be entirely separate
and apart from the amounts paid to members of the settlement class. Class Counsel are not
seeking to be paid a portion of the settlement payments to class members. Rather, they are
seeking only to be paid this additional amount under the fee-shifting provisions of ERISA, the
statute under which this class action was brought. Class Counsel have informed the Court that
their $3.5 million request is less than the amount that would result by multiplying the number of
hours they spent on this litigation in the past decade times the attorneys’ hourly market rates, and
adding their litigation expenses. Plaintiffs will file a motion for attorneys’ fees and expenses with
the Court by August 17, 2026. The Court will determine the final amount that Microchip will pay
for attorneys’ fees and expenses at the final approval hearing.
What else does the proposed Settlement provide? In addition to the payments to class
members and Class Counsel described above, the proposed Settlement also provides that
Microchip will pay an additional $10,000 service award to each of the two named Plaintiffs who
brought the class action (Peter Schuman and William Coplin) to compensate them for their
substantial efforts on behalf of the class during the 10 years this case has been litigated. Plaintiffs
will file a motion for service awards with the Court by August 17, 2026. Again, the Court will
determine the final amounts that Microchip will pay for the service awards at the final approval
hearing.
Upon the Effective Date, all Settlement class members (i.e., all those who do not opt out of the
settlement by the deadline as set forth below and are thus entitled to settlement payments) shall
be deemed to have released all claims against Microchip and the other defendants. This release
will encompass “any and all claims for relief, damages, and remedies . . . for any and all claims,
causes of action, damages, or remedies by the Class Members that were pleaded or alleged in the
Complaint or Amended Complaint in the Action or that could have been pleaded or alleged in
the Complaint or Amended Complaint based upon the factual allegations alleged therein, against
Defendant and each of them.” The referenced documents can be found at
www.MicrochipClassAction.com.
What are my options?
• Option 1: Stay in the Settlement and timely submit completed W-4 and W-9 forms to
receive payment. To receive your settlement payment, you need to timely submit your
W-4 and W-9 forms (see Appendices A and B) to Microchip at the link here no later than
45 days after the Effective Date. A separate notice will be sent to class members after the
final approval hearing to inform you whether the Court has granted final approval and the
deadline for submitting the required forms to participate in the settlement.
• Option 2: Opt out of the Settlement. If you do not want to be legally bound by the
Settlement, you may exclude yourself by sending a letter with your name, address,
telephone, and signature, stating the case name and number (Schuman v. Microchip Tech.
Inc., Case No. 4:16-cv-05544-HSG) and your intent to opt out to Class Counsel (Keith
Ehrman, McGuinn, Hillsman & Palefsky, 220 Jackson St., Suite 350, San Francisco, CA
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94111) by October 1, 2026. If you opt out, you will not receive payment and cannot
object to the Settlement. However, you will not be bound or affected by the Settlement or
anything that might otherwise happen in this lawsuit.
• Option 3: Object to the Settlement. You may ask the Court to deny approval of the
Settlement by filing an objection. You cannot ask the Court to order a different
settlement; the Court can only approve or reject the proposed Settlement as a whole. Any
objection to the proposed Settlement must be in writing. All written objections and
supporting papers must: (1) include the class member’s name, mailing address, and e-
mail address (if any); (2) clearly identify the case name and number (Schuman v.
Microchip Tech. Inc., Case No. 4:16-cv-05544-HSG); (3) state with specificity the
grounds for objection; (4) state whether it applies only to the objector, to a specific subset
of the Class, or to the entire Class; (5) be submitted to the Court either by filing
electronically or in person at any location of the United States District Court for the
Northern District of California or by mailing to the Class Action Clerk, the United States
District Court for the Northern District of California, 1301 Clay St., Suite 400 S,
Oakland, CA 94612; and (6) be filed or postmarked on or before October 1, 2026. You
may retain an attorney, at your own expense, if you wish to be represented by counsel in
submitting an objection.
• Option 4: Do nothing. If you do nothing, i.e., if you neither timely opt out or submit
your W-4 and W-9 forms, you will not receive your settlement share (which will be paid
in your name to the California State Controller Unclaimed Property Division), but you
will still be bound by the Settlement and its “release” provisions.
When is the Final Approval Hearing? The Court preliminarily approved the proposed
Settlement on August 3, 2026 and later authorized this notice. The Court will hold a hearing at
the Ronald V. Dellums Federal Building, Courtroom 2, Floor 4, 1301 Clay St., Suite 400 S,
Oakland, CA 94612 on October 15, 2026 at 2:00 p.m. to consider final approval of the
Settlement and whether to approve a request by Class Counsel for attorneys’ fees and costs, and
for service awards to the two named Plaintiffs. You may appear at the hearing, but you are not
required to. The hearing date may change without further notice to the Class, so please confirm
at the Settlement Website at www.MicrochipClassAction.com or the Court’s PACER site at
ecf.cand.uscourts.gov.
More information? This notice summarizes the proposed Settlement. For complete information
about the Settlement and its terms and key deadlines, a copy of the Settlement Agreement, Class
Counsel’s request for fees and expenses and a service award to the two named plaintiffs, and
related Court documents, and to learn how to exercise your various options under the Settlement,
go to www.MicrochipClassAction.com. You may also access the Court documents in this case,
for a fee, at the Court’s online system at ecf.cand.uscourts.gov, or by visiting the Clerk’s Office
in-person at the Ronald V. Dellums Federal Building, 1301 Clay St., Suite 400 S, Oakland, CA
94612.
You may also contact one of the Class Counsel, Keith Ehrman of the Law Offices of McGuinn,
Hillsman & Palefsky, at Keith@mhpsf.com or (415) 421-9292 with any questions.
PLEASE DO NOT TELEPHONE THE COURT OR THE COURT’S CLERK’S OFFICE
TO INQUIRE ABOUT THIS SETTLEMENT
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 10 of 23

Case 4:16-cv-05544-HSG Document 257 _ Filed 08/07/26 Page 11 of 23

APPENDIX A

Form W-4 2026
Employee’s Withholding Certificate
Department of the Treasury
Internal Revenue Service
Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.
Give Form W-4 to your employer.
Your withholding is subject to review by the IRS.
OMB No. 1545-0074
Step 1:
Enter
Personal
Information
(a) First name and middle initial 	Last name
Address
City or town, state, and ZIP code
(b) Social security number
Does your name match the
name on your social security
card? If not, to ensure you get
credit for your earnings,
contact SSA at 800-772-1213
or go to www.ssa.gov.
(c) 	Single or Married filing separately
Married filing jointly or Qualifying surviving spouse
Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)
Caution: To claim certain credits or deductions on your tax return, you (and/or your spouse if married filing jointly) are required to have a social security
number valid for employment. See page 2 for more information.
TIP: Consider using the estimator at www.irs.gov/W4App to determine the most accurate withholding for the rest of the year if you:
are completing this form after the beginning of the year; expect to work only part of the year; or have changes during the year in your
marital status, number of jobs for you (and/or your spouse if married filing jointly), dependents, other income (not from jobs),
deductions, or credits. Have your most recent pay stub(s) from this year available when using the estimator. At the beginning of next
year, use the estimator again to recheck your withholding.
Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can
claim exemption from withholding, and when to use the estimator at www.irs.gov/W4App.
Step 2:
Multiple Jobs
or Spouse
Works
Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse
also works. The correct amount of withholding depends on income earned from all of these jobs.
Do only one of the following.
(a) Use the estimator at www.irs.gov/W4App for the most accurate withholding for this step (and Steps 3–4). If
you or your spouse have self-employment income, use this option; or
(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below; or
(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This
option is generally more accurate than Step 2(b) if pay at the lower paying job is more than half of the pay at
the higher paying job. Otherwise, Step 2(b) is more accurate . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	.
Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will
be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)
Step 3:
Claim
Dependent
and Other
Credits
If your total income will be $200,000 or less ($400,000 or less if
married filing jointly):
(a) Multiply the number of qualifying children under age 17 by
$2,200 . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	3(a) $
(b) Multiply the number of other dependents by $500 	. 	. 	. 	3(b) $
Add the amounts from Steps 3(a) and 3(b), plus the amount for other credits. Enter the
total here . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	3 	$
Step 4:
Other
Adjustments
(a) Other income (not from jobs). If you want tax withheld for other income you
expect this year that won’t have withholding, enter the amount of other income here.
This may include interest, dividends, and retirement income 	. 	. 	. 	. 	. 	. 	. 	. 	4(a) $
(b) Deductions. Use the Deductions Worksheet on page 4 to determine the amount of
deductions you may claim, which will reduce your withholding. (If you skip this line,
your withholding will be based on the standard deduction.) Enter the result here 	. 	. 	4(b) $
(c) Extra withholding. Enter any additional tax you want withheld each pay period . 	. 	4(c) $
Exempt from
withholding
I claim exemption from withholding for 2026, and I certify that I meet both of the conditions for exemption for
2026. See Exemption from withholding on page 2. I understand I will need to submit a new Form W-4 for 2027 	.
Step 5:
Sign
Here
Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.
Employee’s signature (This form is not valid unless you sign it.) 	Date
Employers
Only
Employer’s name and address 	First date of
employment
Employer identification
number (EIN)
For Privacy Act and Paperwork Reduction Act Notice, see page 4. 	Cat. No. 10220Q 	Form W-4 (2026) Created 12/8/25
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Form W-4 (2026) 	Page 2
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Future Developments
For the latest information about developments related to Form
W-4, such as legislation enacted after it was published, go to
www.irs.gov/FormW4.
Purpose of Form
Complete Form W-4 so that your employer can withhold the
correct federal income tax from your pay. If too little is withheld,
you will generally owe tax when you file your tax return and may
owe a penalty. If too much is withheld, you will generally be due
a refund. Complete a new Form W-4 when changes to your
personal or financial situation would change the entries on the
form. For more information on withholding and when you must
furnish a new Form W-4, see Pub. 505, Tax Withholding and
Estimated Tax.
Exemption from withholding. You may claim exemption from
withholding for 2026 if you meet both of the following
conditions: you had no federal income tax liability in 2025 and
you expect to have no federal income tax liability in 2026. You
had no federal income tax liability in 2025 if (1) your total tax on
line 24 on your 2025 Form 1040 or 1040-SR is zero (or less than
the sum of lines 27a, 28, 29, and 30), or (2) you were not
required to file a return because your income was below the
filing threshold for your correct filing status. If you claim
exemption, you will have no income tax withheld from your
paycheck and may owe taxes and penalties when you file your
2026 tax return. To claim exemption from withholding, certify
that you meet both of the conditions by checking the box in the
Exempt from withholding section. Then, complete Steps 1(a),
1(b), and 5. Do not complete any other steps. You will need to
submit a new Form W-4 by February 16, 2027.
Your privacy. Steps 2(c) and 4(a) ask for information regarding
income you received from sources other than the job associated
with this Form W-4. If you have concerns with providing the
information asked for in Step 2(c), you may choose Step 2(b) as
an alternative; if you have concerns with providing the
information asked for in Step 4(a), you may enter an additional
amount you want withheld per pay period in Step 4(c) as an
alternative.
When to use the estimator. Consider using the estimator at
www.irs.gov/W4App if you:
1. Are submitting this form after the beginning of the year;
2. Expect to work only part of the year;
3. Have changes during the year in your marital status, number
of jobs for you (and/or your spouse if married filing jointly), or
number of dependents, or changes in your deductions or
credits;
4. Receive dividends, capital gains, social security, bonuses, or
business income, or are subject to the Additional Medicare Tax
or Net Investment Income Tax; or
5. Prefer the most accurate withholding for multiple job
situations.
TIP: Have your most recent pay stub(s) from this year available
when using the estimator to account for federal income tax that
has already been withheld this year. At the beginning of next
year, use the estimator again to recheck your withholding.
Self-employment. Generally, you will owe both income and
self-employment taxes on any self-employment income you
receive separate from the wages you receive as an employee. If
you want to pay these taxes through withholding from your
wages, use the estimator at www.irs.gov/W4App to figure the
amount to have withheld.
Nonresident alien. If you’re a nonresident alien, see Notice
1392, Supplemental Form W-4 Instructions for Nonresident
Aliens, before completing this form.
Specific Instructions
Step 1(c). Check your anticipated filing status. This will
determine the standard deduction and tax rates used to
compute your withholding.
Step 2. Use this step if you (1) have more than one job at the
same time, or (2) are married filing jointly and you and your
spouse both work. Submit a separate Form W-4 for each job.
Option (a) most accurately calculates the additional tax you
need to have withheld, while option (b) does so with a little less
accuracy.
Instead, if you (and your spouse) have a total of only two jobs,
you may check the box in option (c). The box must also be
checked on the Form W-4 for the other job. If the box is
checked, the standard deduction and tax brackets will be cut in
half for each job to calculate withholding. This option is accurate
for jobs with similar pay; otherwise, more tax than necessary
may be withheld, and this extra amount of tax withheld will be
larger the greater the difference in pay is between the two jobs.
▲	!CAUTION
Multiple jobs. Complete Steps 3 through 4(b) on only
one Form W-4. Withholding will be most accurate if you
do this on the Form W-4 for the highest paying job.
Step 3. This step provides instructions for determining the
amount of the child tax credit and the credit for other dependents
that you may be able to claim when you file your tax return. To
qualify for the child tax credit, the child must be under age 17 as
of December 31, must be your dependent who generally lives
with you for more than half the year, and must have the required
social security number. You (and/or your spouse if married filing
jointly) must have the required social security number to claim
certain credits. You may be able to claim a credit for other
dependents for whom a child tax credit can’t be claimed, such
as an older child or a qualifying relative. For additional eligibility
requirements for these credits, see Pub. 501, Dependents,
Standard Deduction, and Filing Information. You can also
include other tax credits for which you are eligible in this step,
such as the foreign tax credit and the education tax credits. To
do so, add an estimate of the amount for the year to your credits
for dependents and enter the total amount in Step 3. Including
these credits will increase your paycheck and reduce the amount
of any refund you may receive when you file your tax return.
Step 4.
Step 4(a). Enter in this step the total of your other estimated
income for the year, if any. You shouldn’t include income from
any jobs or self-employment. If you complete Step 4(a), you
likely won’t have to make estimated tax payments for that
income. If you prefer to pay estimated tax rather than having tax
on other income withheld from your paycheck, see Form
1040-ES, Estimated Tax for Individuals.
Step 4(b). Enter in this step the amount from the Deductions
Worksheet, line 15, if you expect to claim deductions other than
the basic standard deduction on your 2026 tax return and want
to reduce your withholding to account for these deductions.
This includes both itemized deductions and other deductions
such as for qualified tips, overtime compensation, and
passenger vehicle loan interest; student loan interest; IRAs; and
seniors. You (and/or your spouse if married filing jointly) must
have the required social security number to claim certain
deductions. For additional eligibility requirements, see Pub. 501.
Step 4(c). Enter in this step any additional tax you want
withheld from your pay each pay period, including any amounts
from the Multiple Jobs Worksheet, line 4. Entering an amount
here will reduce your paycheck and will either increase your
refund or reduce any amount of tax that you owe when you file
your tax return.
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 13 of 23

Form W-4 (2026) 	Page 3
Step 2(b)—Multiple Jobs Worksheet (Keep for your records.)
If you choose the option in Step 2(b) on Form W-4, complete this worksheet (which calculates the total extra tax for all jobs) on only
ONE Form W-4. Withholding will be most accurate if you complete the worksheet and enter the result on the Form W-4 for the highest
paying job. To be accurate, submit a new Form W-4 for all other jobs if you have not updated your withholding since 2019.
Note: If more than one job has annual wages of more than $120,000 or there are more than three jobs, see Pub. 505 for additional
tables; or, you can use the online withholding estimator at www.irs.gov/W4App.
1 	Two jobs. If you have two jobs or you’re married filing jointly and you and your spouse each have one
job, find the amount from the appropriate table on page 5. Using the “Higher Paying Job” row and the
“Lower Paying Job” column, find the value at the intersection of the two household salaries and enter
that value on line 1. Then, skip to line 3 . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	1 	$
2 	Three jobs. If you and/or your spouse have three jobs at the same time, complete lines 2a, 2b, and
2c below. Otherwise, skip to line 3.
a 	Find the amount from the appropriate table on page 5 using the annual wages from the highest
paying job in the “Higher Paying Job” row and the annual wages for your next highest paying job
in the “Lower Paying Job” column. Find the value at the intersection of the two household salaries
and enter that value on line 2a . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	2a $
b 	Add the annual wages of the two highest paying jobs from line 2a together and use the total as the
wages in the “Higher Paying Job” row and use the annual wages for your third job in the “Lower
Paying Job” column to find the amount from the appropriate table on page 5 and enter this amount
on line 2b 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	2b $
c 	Add the amounts from lines 2a and 2b and enter the result on line 2c . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	2c $
3 	Enter the number of pay periods per year for the highest paying job. For example, if that job pays
weekly, enter 52; if it pays every other week, enter 26; if it pays monthly, enter 12, etc. 	. 	. 	. 	. 	. 	3
4 	Divide the annual amount on line 1 or line 2c by the number of pay periods on line 3. Enter this
amount here and in Step 4(c) of Form W-4 for the highest paying job (plus any other additional
amount you want withheld) . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	4 	$
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 14 of 23

Form W-4 (2026) 	Page 4
Step 4(b)—Deductions Worksheet (Keep for your records.)
See the Instructions for Schedule 1-A (Form 1040) for more information about whether you qualify for the deductions on lines 1a, 1b,
1c, 3a, and 3b.
1 	Deductions for qualified tips, overtime compensation, and passenger vehicle loan interest.
a 	Qualified tips. If your total income is less than $150,000 ($300,000 if married filing jointly), enter
an estimate of your qualified tips up to $25,000 . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	1a $
b 	Qualified overtime compensation. If your total income is less than $150,000 ($300,000 if married
filing jointly), enter an estimate of your qualified overtime compensation up to $12,500 ($25,000 if
married filing jointly) of the “and-a-half” portion of time-and-a-half compensation . 	. 	. 	. 	. 	. 	1b $
c 	Qualified passenger vehicle loan interest. If your total income is less than $100,000 ($200,000 if
married filing jointly), enter an estimate of your qualified passenger vehicle loan interest up to $10,000 	1c $
2 	Add lines 1a, 1b, and 1c. Enter the result here . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	2 	$
3 	Seniors age 65 or older. If your total income is less than $75,000 ($150,000 if married filing jointly):
a 	Enter $6,000 if you are age 65 or older before the end of the year 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	3a $
b 	Enter $6,000 if your spouse is age 65 or older before the end of the year and has a social security
number valid for employment . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	3b $
4 	Add lines 3a and 3b. Enter the result here 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	4 	$
5 	Enter an estimate of your student loan interest, deductible IRA contributions, educator expenses,
alimony paid, and certain other adjustments from Schedule 1 (Form 1040), Part II. See Pub. 505 for
more information 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	5 	$
6 	Itemized deductions. Enter an estimate of your 2026 itemized deductions from Schedule A (Form
1040). Such deductions may include qualifying:
a 	Medical and dental expenses. Enter expenses in excess of 7.5% (0.075) of your total income 	. 	6a $
b 	State and local taxes. If your total income is less than $505,000 ($252,500 if married filing
separately), enter state and local taxes paid up to $40,400 ($20,200 if married filing separately) 	. 	6b $
c 	Home mortgage interest. If your home acquisition debt is less than $750,000 ($375,000 if
married filing separately), enter your home mortgage interest expense (including mortgage
insurance premiums) . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	6c $
d 	Gifts to charities. Enter contributions in excess of 0.5% (0.005) of your total income 	. 	. 	. 	. 	6d $
e 	Other itemized deductions. Enter the amount for other itemized deductions 	. 	. 	. 	. 	. 	. 	. 	6e $
7 	Add lines 6a, 6b, 6c, 6d, and 6e. Enter the result here 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	7 	$
8 	Limitation on itemized deductions.
a 	Enter your total income . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	8a $
b 	Subtract line 4 from line 8a. If line 4 is greater than line 8a, enter -0- here and on line 10. Skip line 9 	8b $
9 	Enter: { • $768,700 if you’re married filing jointly or a qualifying surviving spouse
• $640,600 if you’re single or head of household
• $384,350 if you’re married filing separately } . 	. 	. 	. 	. 	9 	$
10 	If line 9 is greater than line 8b, enter the amount from line 7. Otherwise, multiply line 7 by 94% (0.94)
and enter the result here . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	10 $
11 	Standard deduction.
Enter: { • $32,200 if you’re married filing jointly or a qualifying surviving spouse
• $24,150 if you’re head of household
• $16,100 if you’re single or married filing separately } . 	. 	. 	. 	. 	11 $
12 	Cash gifts to charities. If you take the standard deduction, enter cash contributions up to $1,000
($2,000 if married filing jointly) . 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	12 $
13 	Add lines 11 and 12. Enter the result here 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	13 $
14 	If line 10 is greater than line 13, subtract line 11 from line 10 and enter the result here. If line 13 is
greater than line 10, enter the amount from line 12 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	. 	14 $
15 	Add lines 2, 4, 5, and 14. Enter the result here and in Step 4(b) of Form W-4 . 	. 	. 	. 	. 	. 	. 	. 	. 	15 $
Privacy Act and Paperwork Reduction Act Notice. We ask for the information on
this form to carry out the Internal Revenue laws of the United States. Internal Revenue
Code sections 3402(f)(2) and 6109 and their regulations require you to provide this
information; your employer uses it to determine your federal income tax withholding.
Failure to provide a properly completed form will result in your being treated as a
single person with no other entries on the form; providing fraudulent information may
subject you to penalties. Routine uses of this information include giving it to the
Department of Justice for civil and criminal litigation; to cities, states, the District of
Columbia, and U.S. commonwealths and territories for use in administering their tax
laws; and to the Department of Health and Human Services for use in the National
Directory of New Hires. We may also disclose this information to other countries
under a tax treaty, to federal and state agencies to enforce federal nontax criminal
laws, or to federal law enforcement and intelligence agencies to combat terrorism.
You are not required to provide the information requested on a form that is
subject to the Paperwork Reduction Act unless the form displays a valid OMB
control number. Books or records relating to a form or its instructions must be
retained as long as their contents may become material in the administration of
any Internal Revenue law. Generally, tax returns and return information are
confidential, as required by Code section 6103.
The average time and expenses required to complete and file this form will vary
depending on individual circumstances. For estimated averages, see the
instructions for your income tax return.
If you have suggestions for making this form simpler, we would be happy to hear
from you. See the instructions for your income tax return.
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 15 of 23

Form W-4 (2026) 	Page 5
Married Filing Jointly or Qualifying Surviving Spouse
Higher Paying Job
Annual Taxable
Wage & Salary
Lower Paying Job Annual Taxable Wage & Salary
$0 -
9,999
$10,000 -
19,999
$20,000 -
29,999
$30,000 -
39,999
$40,000 -
49,999
$50,000 -
59,999
$60,000 -
69,999
$70,000 -
79,999
$80,000 -
89,999
$90,000 -
99,999
$100,000 -
109,999
$110,000 -
120,000
$0 - 	9,999 	$0 	$0 	$480 	$850 	$850 	$1,020 	$1,020 	$1,020 	$1,020 	$1,020 	$1,020 	$1,020
$10,000 - 19,999 	0 	480 	1,480 	1,850 	2,050 	2,220 	2,220 	2,220 	2,220 	2,220 	2,220 	2,620
$20,000 - 29,999 	480 	1,480 	2,480 	3,050 	3,250 	3,420 	3,420 	3,420 	3,420 	3,420 	3,820 	4,820
$30,000 - 39,999 	850 	1,850 	3,050 	3,620 	3,820 	3,990 	3,990 	3,990 	3,990 	4,390 	5,390 	6,390
$40,000 - 49,999 	850 	2,050 	3,250 	3,820 	4,020 	4,190 	4,190 	4,190 	4,590 	5,590 	6,590 	7,590
$50,000 - 59,999 	1,020 	2,220 	3,420 	3,990 	4,190 	4,360 	4,360 	4,760 	5,760 	6,760 	7,760 	8,760
$60,000 - 69,999 	1,020 	2,220 	3,420 	3,990 	4,190 	4,360 	4,760 	5,760 	6,760 	7,760 	8,760 	9,760
$70,000 - 79,999 	1,020 	2,220 	3,420 	3,990 	4,190 	4,760 	5,760 	6,760 	7,760 	8,760 	9,760 	10,760
$80,000 - 99,999 	1,020 	2,220 	3,420 	4,240 	5,440 	6,610 	7,610 	8,610 	9,610 	10,610 	11,610 	12,610
$100,000 - 149,999 	1,870 	4,070 	6,270 	7,840 	9,040 	10,210 	11,210 	12,210 	13,210 	14,210 	15,360 	16,560
$150,000 - 239,999 	1,870 	4,100 	6,500 	8,270 	9,670 	11,040 	12,240 	13,440 	14,640 	15,840 	17,040 	18,240
$240,000 - 319,999 	2,040 	4,440 	6,840 	8,610 	10,010 	11,380 	12,580 	13,780 	14,980 	16,180 	17,380 	18,580
$320,000 - 364,999 	2,040 	4,440 	6,840 	8,610 	10,010 	11,380 	12,580 	13,860 	15,860 	17,860 	19,860 	21,860
$365,000 - 524,999 	2,720 	5,920 	9,390 	12,260 	14,760 	17,230 	19,530 	21,830 	24,130 	26,430 	28,730 	31,030
$525,000 and over 	3,140 	6,840 	10,540 	13,610 	16,310 	18,980 	21,480 	23,980 	26,480 	28,980 	31,480 	33,990
Single or Married Filing Separately
Higher Paying Job
Annual Taxable
Wage & Salary
Lower Paying Job Annual Taxable Wage & Salary
$0 -
9,999
$10,000 -
19,999
$20,000 -
29,999
$30,000 -
39,999
$40,000 -
49,999
$50,000 -
59,999
$60,000 -
69,999
$70,000 -
79,999
$80,000 -
89,999
$90,000 -
99,999
$100,000 -
109,999
$110,000 -
120,000
$0 - 	9,999 	$90 	$850 	$1,020 	$1,020 	$1,020 	$1,070 	$1,870 	$1,870 	$1,870 	$1,870 	$1,870 	$1,970
$10,000 - 19,999 	850 	1,780 	1,980 	1,980 	2,030 	3,030 	3,830 	3,830 	3,830 	3,830 	3,930 	4,130
$20,000 - 29,999 	1,020 	1,980 	2,180 	2,230 	3,230 	4,230 	5,030 	5,030 	5,030 	5,130 	5,330 	5,530
$30,000 - 39,999 	1,020 	1,980 	2,230 	3,230 	4,230 	5,230 	6,030 	6,030 	6,130 	6,330 	6,530 	6,730
$40,000 - 59,999 	1,020 	2,880 	4,080 	5,080 	6,080 	7,080 	7,950 	8,150 	8,350 	8,550 	8,750 	8,950
$60,000 - 79,999 	1,870 	3,830 	5,030 	6,030 	7,100 	8,300 	9,300 	9,500 	9,700 	9,900 	10,100 	10,300
$80,000 - 99,999 	1,870 	3,830 	5,100 	6,300 	7,500 	8,700 	9,700 	9,900 	10,100 	10,300 	10,500 	10,700
$100,000 - 124,999 	2,030 	4,190 	5,590 	6,790 	7,990 	9,190 	10,190 	10,390 	10,590 	10,940 	11,940 	12,940
$125,000 - 149,999 	2,040 	4,200 	5,600 	6,800 	8,000 	9,200 	10,200 	10,950 	11,950 	12,950 	13,950 	14,950
$150,000 - 174,999 	2,040 	4,200 	5,600 	6,800 	8,150 	10,150 	11,950 	12,950 	13,950 	14,950 	16,170 	17,470
$175,000 - 199,999 	2,040 	4,200 	6,150 	8,150 	10,150 	12,150 	13,950 	15,020 	16,320 	17,620 	18,920 	20,220
$200,000 - 249,999 	2,720 	5,680 	7,880 	10,140 	12,440 	14,740 	16,840 	18,140 	19,440 	20,740 	22,040 	23,340
$250,000 - 449,999 	2,970 	6,230 	8,730 	11,030 	13,330 	15,630 	17,730 	19,030 	20,330 	21,630 	22,930 	24,240
$450,000 and over 	3,140 	6,600 	9,300 	11,800 	14,300 	16,800 	19,100 	20,600 	22,100 	23,600 	25,100 	26,610
Head of Household
Higher Paying Job
Annual Taxable
Wage & Salary
Lower Paying Job Annual Taxable Wage & Salary
$0 -
9,999
$10,000 -
19,999
$20,000 -
29,999
$30,000 -
39,999
$40,000 -
49,999
$50,000 -
59,999
$60,000 -
69,999
$70,000 -
79,999
$80,000 -
89,999
$90,000 -
99,999
$100,000 -
109,999
$110,000 -
120,000
$0 - 	9,999 	$0 	$280 	$850 	$950 	$1,020 	$1,020 	$1,020 	$1,020 	$1,560 	$1,870 	$1,870 	$1,870
$10,000 - 19,999 	280 	1,280 	1,950 	2,150 	2,220 	2,220 	2,220 	2,760 	3,760 	4,070 	4,070 	4,210
$20,000 - 29,999 	850 	1,950 	2,720 	2,920 	2,980 	2,980 	3,520 	4,520 	5,520 	5,830 	5,980 	6,180
$30,000 - 39,999 	950 	2,150 	2,920 	3,120 	3,180 	3,720 	4,720 	5,720 	6,720 	7,180 	7,380 	7,580
$40,000 - 59,999 	1,020 	2,220 	2,980 	3,570 	4,640 	5,640 	6,640 	7,750 	8,950 	9,460 	9,660 	9,860
$60,000 - 79,999 	1,020 	2,610 	4,370 	5,570 	6,640 	7,750 	8,950 	10,150 	11,350 	11,860 	12,060 	12,260
$80,000 - 99,999 	1,870 	4,070 	5,830 	7,150 	8,410 	9,610 	10,810 	12,010 	13,210 	13,720 	13,920 	14,120
$100,000 - 124,999 	1,870 	4,270 	6,230 	7,630 	8,900 	10,100 	11,300 	12,500 	13,700 	14,210 	14,720 	15,720
$125,000 - 149,999 	2,040 	4,440 	6,400 	7,800 	9,070 	10,270 	11,470 	12,670 	14,580 	15,890 	16,890 	17,890
$150,000 - 174,999 	2,040 	4,440 	6,400 	7,800 	9,070 	10,580 	12,580 	14,580 	16,580 	17,890 	18,890 	20,170
$175,000 - 199,999 	2,040 	4,440 	6,400 	8,510 	10,580 	12,580 	14,580 	16,580 	18,710 	20,320 	21,620 	22,920
$200,000 - 249,999 	2,720 	5,920 	8,680 	10,900 	13,270 	15,570 	17,870 	20,170 	22,470 	24,080 	25,380 	26,680
$250,000 - 449,999 	2,970 	6,470 	9,540 	12,040 	14,410 	16,710 	19,010 	21,310 	23,610 	25,220 	26,520 	27,820
$450,000 and over 	3,140 	6,840 	10,110 	12,810 	15,380 	17,880 	20,380 	22,880 	25,380 	27,190 	28,690 	30,190
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Case 4:16-cv-05544-HSG Document 257 _ Filed 08/07/26 Page 17 of 23

APPENDIX B

Form W-9(Rev. March 2024)
Request for Taxpayer
Identification Number and Certification
Department of the Treasury
Internal Revenue Service 	Go to www.irs.gov/FormW9 for instructions and the latest information.
Give form to the
requester. Do not
send to the IRS.
Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below.
Print or type.
See
 Specific Instructions
 on page 3.
1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and enter the business/disregarded
entity’s name on line 2.)
2 Business name/disregarded entity name, if different from above.
3a Check the appropriate box for federal tax classification of the entity/individual whose name is entered on line 1. Check
only one of the following seven boxes.
Individual/sole proprietor 	C corporation 	S corporation 	Partnership 	Trust/estate
LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) 	. 	. 	. 	.
Note: Check the “LLC” box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate
box for the tax classification of its owner.
Other (see instructions)
3b If on line 3a you checked “Partnership” or “Trust/estate,” or checked “LLC” and entered “P” as its tax classification,
and you are providing this form to a partnership, trust, or estate in which you have an ownership interest, check
this box if you have any foreign partners, owners, or beneficiaries. See instructions . 	. 	. 	. 	. 	. 	. 	. 	.
4 Exemptions (codes apply only to
certain entities, not individuals;
see instructions on page 3):
Exempt payee code (if any)
Exemption from Foreign Account Tax
Compliance Act (FATCA) reporting
code (if any)
(Applies to accounts maintained
outside the United States.)
5 Address (number, street, and apt. or suite no.). See instructions.
6 City, state, and ZIP code
Requester’s name and address (optional)
7 List account number(s) here (optional)
Part I 	Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter.
Social security number
– 	–
or
Employer identification number
–
Part II 	Certification
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 (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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. See the instructions for Part II, later.
Sign
Here Signature of
U.S. person 	Date
General Instructions
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/FormW9.
What’s New
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the
appropriate box for the tax classification of its owner. Otherwise, it
should check the “LLC” box and enter its appropriate tax classification.
New line 3b has been added to this form. A flow-through entity is
required to complete this line to indicate that it has direct or indirect
foreign partners, owners, or beneficiaries when it provides the Form W-9
to another flow-through entity in which it has an ownership interest. This
change is intended to provide a flow-through entity with information
regarding the status of its indirect foreign partners, owners, or
beneficiaries, so that it can satisfy any applicable reporting
requirements. For example, a partnership that has any indirect foreign
partners may be required to complete Schedules K-2 and K-3. See the
Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS is giving you this form because they
Cat. No. 10231X 	Form W-9 (Rev. 3-2024)
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Form W-9 (Rev. 3-2024) 	Page 2
must obtain your correct taxpayer identification number (TIN), which
may be your social security number (SSN), individual taxpayer
identification number (ITIN), adoption taxpayer identification number
(ATIN), or employer identification number (EIN), to report on an
information return the amount paid to you, or other amount reportable
on an information return. Examples of information returns include, but
are not limited to, the following.
• Form 1099-INT (interest earned or paid).
• Form 1099-DIV (dividends, including those from stocks or mutual
funds).
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds).
• Form 1099-NEC (nonemployee compensation).
• Form 1099-B (stock or mutual fund sales and certain other
transactions by brokers).
• Form 1099-S (proceeds from real estate transactions).
• Form 1099-K (merchant card and third-party network transactions).
• Form 1098 (home mortgage interest), 1098-E (student loan interest),
and 1098-T (tuition).
• Form 1099-C (canceled debt).
• Form 1099-A (acquisition or abandonment of secured property).
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN.
Caution: If you don’t return Form W-9 to the requester with a TIN, you
might be subject to backup withholding. See What is backup
withholding, later.
By signing the filled-out form, you:
1. Certify that the TIN you are giving is correct (or you are waiting for a
number to be issued);
2. Certify that you are not subject to backup withholding; or
3. Claim exemption from backup withholding if you are a U.S. exempt
payee; and
4. Certify to your non-foreign status for purposes of withholding under
chapter 3 or 4 of the Code (if applicable); and
5. Certify that FATCA code(s) entered on this form (if any) indicating
that you are exempt from the FATCA reporting is correct. See What Is
FATCA Reporting, later, for further information.
Note: If you are a U.S. person and 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.
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien;
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States;
• An estate (other than a foreign estate); or
• A domestic trust (as defined in Regulations section 301.7701-7).
Establishing U.S. status for purposes of chapter 3 and chapter 4
withholding. Payments made to foreign persons, including certain
distributions, allocations of income, or transfers of sales proceeds, may
be subject to withholding under chapter 3 or chapter 4 of the Code
(sections 1441–1474). Under those rules, if a Form W-9 or other
certification of non-foreign status has not been received, a withholding
agent, transferee, or partnership (payor) generally applies presumption
rules that may require the payor to withhold applicable tax from the
recipient, owner, transferor, or partner (payee). See Pub. 515,
Withholding of Tax on Nonresident Aliens and Foreign Entities.
The following persons must provide Form W-9 to the payor for
purposes of establishing its non-foreign status.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the disregarded entity.
• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and
not the grantor trust.
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
and not the beneficiaries of the trust.
See Pub. 515 for more information on providing a Form W-9 or a
certification of non-foreign status to avoid withholding.
Foreign person. If you are a foreign person or the U.S. branch of a
foreign bank that has elected to be treated as a U.S. person (under
Regulations section 1.1441-1(b)(2)(iv) or other applicable section for
chapter 3 or 4 purposes), do not use Form W-9. Instead, use the
appropriate Form W-8 or Form 8233 (see Pub. 515). If you are a
qualified foreign pension fund under Regulations section 1.897(l)-1(d), or
a partnership that is wholly owned by qualified foreign pension funds,
that is treated as a non-foreign person for purposes of section 1445
withholding, do not use Form W-9. Instead, use Form W-8EXP (or other
certification of non-foreign status).
Nonresident alien who becomes a resident alien. Generally, only a
nonresident alien individual may use the terms of a tax treaty to reduce
or eliminate U.S. tax on certain types of income. However, most tax
treaties contain a provision known as a saving clause. Exceptions
specified in the saving clause may permit an exemption from tax to
continue for certain types of income even after the payee has otherwise
become a U.S. resident alien for tax purposes.
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an exemption
from U.S. tax on certain types of income, you must attach a statement
to Form W-9 that specifies the following five items.
1. The treaty country. Generally, this must be the same treaty under
which you claimed exemption from tax as a nonresident alien.
2. The treaty article addressing the income.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption
from tax.
5. Sufficient facts to justify the exemption from tax under the terms of
the treaty article.
Example. Article 20 of the U.S.-China income tax treaty allows an
exemption from tax for scholarship income received by a Chinese
student temporarily present in the United States. Under U.S. law, this
student will become a resident alien for tax purposes if their stay in the
United States exceeds 5 calendar years. However, paragraph 2 of the
first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the
provisions of Article 20 to continue to apply even after the Chinese
student becomes a resident alien of the United States. A Chinese
student who qualifies for this exception (under paragraph 2 of the first
Protocol) and is relying on this exception to claim an exemption from tax
on their scholarship or fellowship income would attach to Form W-9 a
statement that includes the information described above to support that
exemption.
If you are a nonresident alien or a foreign entity, give the requester the
appropriate completed Form W-8 or Form 8233.
Backup Withholding
What is backup withholding? Persons making certain payments to you
must under certain conditions withhold and pay to the IRS 24% of such
payments. This is called “backup withholding.” Payments that may be
subject to backup withholding include, but are not limited to, interest,
tax-exempt interest, dividends, broker and barter exchange
transactions, rents, royalties, nonemployee pay, payments made in
settlement of payment card and third-party network transactions, and
certain payments from fishing boat operators. Real estate transactions
are not subject to backup withholding.
You will not be subject to backup withholding on payments you receive
if you give the requester your correct TIN, make the proper certifications,
and report all your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requester;
2. You do not certify your TIN when required (see the instructions for
Part II for details);
3. The IRS tells the requester that you furnished an incorrect TIN;
4. The IRS tells you that you are subject to backup withholding
because you did not report all your interest and dividends on your tax
return (for reportable interest and dividends only); or
5. You do not certify to the requester that you are not subject to
backup withholding, as described in item 4 under “By signing the filled-
out form” above (for reportable interest and dividend accounts opened
after 1983 only).
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Form W-9 (Rev. 3-2024) 	Page 3
Certain payees and payments are exempt from backup withholding.
See Exempt payee code, later, and the separate Instructions for the
Requester of Form W-9 for more information.
See also Establishing U.S. status for purposes of chapter 3 and
chapter 4 withholding, earlier.
What Is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all U.S. account
holders that are specified U.S. persons. Certain payees are exempt from
FATCA reporting. See Exemption from FATCA reporting code, later, and
the Instructions for the Requester of Form W-9 for more information.
Updating Your Information
You must provide updated information to any person to whom you
claimed to be an exempt payee if you are no longer an exempt payee
and anticipate receiving reportable payments in the future from this
person. For example, you may need to provide updated information if
you are a C corporation that elects to be an S corporation, or if you are
no longer tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account, for example, if the grantor of a
grantor trust dies.
Penalties
Failure to furnish TIN. If you fail to furnish your correct TIN to a
requester, you are subject to a penalty of $50 for each such failure
unless your failure is due to reasonable cause and not to willful neglect.
Civil penalty for false information with respect to withholding. If you
make a false statement with no reasonable basis that results in no
backup withholding, you are subject to a $500 penalty.
Criminal penalty for falsifying information. Willfully falsifying
certifications or affirmations may subject you to criminal penalties
including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of
federal law, the requester may be subject to civil and criminal penalties.
Specific Instructions
Line 1
You must enter one of the following on this line; do not leave this line
blank. The name should match the name on your tax return.
If this Form W-9 is for a joint account (other than an account
maintained by a foreign financial institution (FFI)), list first, and then
circle, the name of the person or entity whose number you entered in
Part I of Form W-9. If you are providing Form W-9 to an FFI to document
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9.
• Individual. Generally, enter the name shown on your tax return. If you
have changed your last name without informing the Social Security
Administration (SSA) of the name change, enter your first name, the last
name as shown on your social security card, and your new last name.
Note for ITIN applicant: Enter your individual name as it was entered
on your Form W-7 application, line 1a. This should also be the same as
the name you entered on the Form 1040 you filed with your application.
• Sole proprietor. Enter your individual name as shown on your Form
1040 on line 1. Enter your business, trade, or “doing business as” (DBA)
name on line 2.
• Partnership, C corporation, S corporation, or LLC, other than a
disregarded entity. Enter the entity’s name as shown on the entity’s tax
return on line 1 and any business, trade, or DBA name on line 2.
• Other entities. Enter your name as shown on required U.S. federal tax
documents on line 1. This name should match the name shown on the
charter or other legal document creating the entity. Enter any business,
trade, or DBA name on line 2.
• Disregarded entity. In general, a business entity that has a single
owner, including an LLC, and is not a corporation, is disregarded as an
entity separate from its owner (a disregarded entity). See Regulations
section 301.7701-2(c)(2). A disregarded entity should check the
appropriate box for the tax classification of its owner. Enter the owner’s
name on line 1. The name of the owner entered on line 1 should never
be a disregarded entity. The name on line 1 should be the name shown
on the income tax return on which the income should be reported. For
example, if a foreign LLC that is treated as a disregarded entity for U.S.
federal tax purposes has a single owner that is a U.S. person, the U.S.
owner’s name is required to be provided on line 1. If the direct owner of
the entity is also a disregarded entity, enter the first owner that is not
disregarded for federal tax purposes. Enter the disregarded entity’s
name on line 2. If the owner of the disregarded entity is a foreign person,
the owner must complete an appropriate Form W-8 instead of a Form
W-9. This is the case even if the foreign person has a U.S. TIN.
Line 2
If you have a business name, trade name, DBA name, or disregarded
entity name, enter it on line 2.
Line 3a
Check the appropriate box on line 3a for the U.S. federal tax
classification of the person whose name is entered on line 1. Check only
one box on line 3a.
IF the entity/individual on line 1
is a(n) . . .
THEN check the box for . . .
• Corporation 	Corporation.
• Individual or
• Sole proprietorship
Individual/sole proprietor.
• LLC classified as a partnership
for U.S. federal tax purposes or
• LLC that has filed Form 8832 or
2553 electing to be taxed as a
corporation
Limited liability company and
enter the appropriate tax
classification:
P = Partnership,
C = C corporation, or
S = S corporation.
• Partnership 	Partnership.
• Trust/estate 	Trust/estate.
Line 3b
Check this box if you are a partnership (including an LLC classified as a
partnership for U.S. federal tax purposes), trust, or estate that has any
foreign partners, owners, or beneficiaries, and you are providing this
form to a partnership, trust, or estate, in which you have an ownership
interest. You must check the box on line 3b if you receive a Form W-8
(or documentary evidence) from any partner, owner, or beneficiary
establishing foreign status or if you receive a Form W-9 from any
partner, owner, or beneficiary that has checked the box on line 3b.
Note: A partnership that provides a Form W-9 and checks box 3b may
be required to complete Schedules K-2 and K-3 (Form 1065). For more
information, see the Partnership Instructions for Schedules K-2 and K-3
(Form 1065).
If you are required to complete line 3b but fail to do so, you may not
receive the information necessary to file a correct information return with
the IRS or furnish a correct payee statement to your partners or
beneficiaries. See, for example, sections 6698, 6722, and 6724 for
penalties that may apply.
Line 4 Exemptions
If you are exempt from backup withholding and/or FATCA reporting,
enter in the appropriate space on line 4 any code(s) that may apply to
you.
Exempt payee code.
• Generally, individuals (including sole proprietors) are not exempt from
backup withholding.
• Except as provided below, corporations are exempt from backup
withholding for certain payments, including interest and dividends.
• Corporations are not exempt from backup withholding for payments
made in settlement of payment card or third-party network transactions.
• Corporations are not exempt from backup withholding with respect to
attorneys’ fees or gross proceeds paid to attorneys, and corporations
that provide medical or health care services are not exempt with respect
to payments reportable on Form 1099-MISC.
The following codes identify payees that are exempt from backup
withholding. Enter the appropriate code in the space on line 4.
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).
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Form W-9 (Rev. 3-2024) 	Page 4
2—The United States or any of its agencies or instrumentalities.
3—A state, the District of Columbia, a U.S. commonwealth or territory,
or any of their political subdivisions or instrumentalities.
4—A foreign government or any of its political subdivisions, agencies,
or instrumentalities.
5—A corporation.
6—A dealer in securities or commodities required to register in the
United States, the District of Columbia, or a U.S. commonwealth or
territory.
7—A futures commission merchant registered with the Commodity
Futures Trading Commission.
8—A real estate investment trust.
9—An entity registered at all times during the tax year under the
Investment Company Act of 1940.
10—A common trust fund operated by a bank under section 584(a).
11—A financial institution as defined under section 581.
12—A middleman known in the investment community as a nominee or
custodian.
13—A trust exempt from tax under section 664 or described in section
4947.
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
above, 1 through 13.
IF the payment is for . . . 	THEN the payment is exempt
for . . .
• Interest and dividend payments 	All exempt payees except
for 7.
• Broker transactions 	Exempt payees 1 through 4 and 6
through 11 and all C corporations.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
noncovered securities acquired
prior to 2012.
• Barter exchange transactions
and patronage dividends
Exempt payees 1 through 4.
• Payments over $600 required to
be reported and direct sales over
$5,0001
Generally, exempt payees
1 through 5.2
• Payments made in settlement of
payment card or third-party
network transactions
Exempt payees 1 through 4.
1 See Form 1099-MISC, Miscellaneous Information, and its instructions.
2 However, the following payments made to a corporation and
reportable on Form 1099-MISC are not exempt from backup
withholding: medical and health care payments, attorneys’ fees, gross
proceeds paid to an attorney reportable under section 6045(f), and
payments for services paid by a federal executive agency.
Exemption from FATCA reporting code. 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. Therefore, if
you are only submitting this form for an account you hold in the United
States, you may leave this field blank. Consult with the person
requesting this form if you are uncertain if the financial institution is
subject to these requirements. A requester may indicate that a code is
not required by providing you with a Form W-9 with “Not Applicable” (or
any similar indication) entered on the line for a FATCA exemption code.
A—An organization exempt from tax under section 501(a) or any
individual retirement plan as defined in section 7701(a)(37).
B—The United States or any of its agencies or instrumentalities.
C—A state, the District of Columbia, a U.S. commonwealth or
territory, or any of their political subdivisions or instrumentalities.
D—A corporation the stock of which is regularly traded on one or
more established securities markets, as described in Regulations
section 1.1472-1(c)(1)(i).
E—A corporation that is a member of the same expanded affiliated
group as a corporation described in Regulations section 1.1472-1(c)(1)(i).
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.
G—A real estate investment trust.
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.
I—A common trust fund as defined in section 584(a).
J—A bank as defined in section 581.
K—A broker.
L—A trust exempt from tax under section 664 or described in section
4947(a)(1).
M—A tax-exempt trust under a section 403(b) plan or section 457(g)
plan.
Note: You may wish to consult with the financial institution requesting
this form to determine whether the FATCA code and/or exempt payee
code should be completed.
Line 5
Enter your address (number, street, and apartment or suite number).
This is where the requester of this Form W-9 will mail your information
returns. If this address differs from the one the requester already has on
file, enter “NEW” at the top. If a new address is provided, there is still a
chance the old address will be used until the payor changes your
address in their records.
Line 6
Enter your city, state, and ZIP code.
Part I. Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. If you are a resident alien and
you do not have, and are not eligible to get, an SSN, your TIN is your
IRS ITIN. Enter it in the entry space for the Social security number. If you
do not have an ITIN, see How to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter either
your SSN or EIN.
If you are a single-member LLC that is disregarded as an entity
separate from its owner, enter the owner’s SSN (or EIN, if the owner has
one). If the LLC is classified as a corporation or partnership, enter the
entity’s EIN.
Note: See What Name and Number To Give the Requester, later, for
further clarification of name and TIN combinations.
How to get a TIN. If you do not have a TIN, apply for one immediately.
To apply for an SSN, get Form SS-5, Application for a Social Security
Card, from your local SSA office or get this form online at
www.SSA.gov. You may also get this form by calling 800-772-1213. Use
Form W-7, Application for IRS Individual Taxpayer Identification
Number, to apply for an ITIN, or Form SS-4, Application for Employer
Identification Number, to apply for an EIN. You can apply for an EIN
online by accessing the IRS website at www.irs.gov/EIN. Go to
www.irs.gov/Forms to view, download, or print Form W-7 and/or Form
SS-4. Or, you can go to www.irs.gov/OrderForms to place an order and
have Form W-7 and/or Form SS-4 mailed to you within 15 business
days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and enter “Applied For” in the space for the TIN, sign and date
the form, and give it to the requester. For interest and dividend
payments, and certain payments made with respect to readily tradable
instruments, you will generally have 60 days to get a TIN and give it to
the requester before you are subject to backup withholding on
payments. The 60-day rule does not apply to other types of payments.
You will be subject to backup withholding on all such payments until
you provide your TIN to the requester.
Note: Entering “Applied For” means that you have already applied for a
TIN or that you intend to apply for one soon. See also Establishing U.S.
status for purposes of chapter 3 and chapter 4 withholding, earlier, for
when you may instead be subject to withholding under chapter 3 or 4 of
the Code.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
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Form W-9 (Rev. 3-2024) 	Page 5
Part II. Certification
To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if item 1, 4, or 5 below indicates otherwise.
For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.
Signature requirements. Complete the certification as indicated in
items 1 through 5 below.
1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during 1983.
You must give your correct TIN, but you do not have to sign the
certification.
2. Interest, dividend, broker, and barter exchange accounts
opened after 1983 and broker accounts considered inactive during
1983. You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing
your correct TIN to the requester, you must cross out item 2 in the
certification before signing the form.
3. Real estate transactions. You must sign the certification. You may
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not
have to sign the certification unless you have been notified that you
have previously given an incorrect TIN. “Other payments” include
payments made in the course of the requester’s trade or business for
rents, royalties, goods (other than bills for merchandise), medical and
health care services (including payments to corporations), payments to
a nonemployee for services, payments made in settlement of payment
card and third-party network transactions, payments to certain fishing
boat crew members and fishermen, and gross proceeds paid to
attorneys (including payments to corporations).
5. Mortgage interest paid by you, acquisition or abandonment of
secured property, cancellation of debt, qualified tuition program
payments (under section 529), ABLE accounts (under section 529A),
IRA, Coverdell ESA, Archer MSA or HSA contributions or
distributions, and pension distributions. You must give your correct
TIN, but you do not have to sign the certification.
What Name and Number To Give the Requester
For this type of account: 	Give name and SSN of:
1. Individual 	The individual
2. Two or more individuals (joint account)
other than an account maintained by
an FFI
The actual owner of the account or,
if combined funds, the first individual
on the account1
3. Two or more U.S. persons
(joint account maintained by an FFI)
Each holder of the account
4. Custodial account of a minor
(Uniform Gift to Minors Act)
The minor 2
5. a. The usual revocable savings trust
(grantor is also trustee)
The grantor-trustee1
b. So-called trust account that is not
a legal or valid trust under state law
The actual owner
1
6. Sole proprietorship or disregarded
entity owned by an individual
The owner 3
7. Grantor trust filing under Optional
Filing Method 1 (see Regulations
section 1.671-4(b)(2)(i)(A))**
The grantor*
For this type of account: 	Give name and EIN of:
8. Disregarded entity not owned by an
individual
The owner
9. A valid trust, estate, or pension trust 	Legal entity4
10. Corporation or LLC electing corporate
status on Form 8832 or Form 2553
The corporation
11. Association, club, religious, charitable,
educational, or other tax-exempt
organization
The organization
12. Partnership or multi-member LLC 	The partnership
13. A broker or registered nominee 	The broker or nominee
14. Account with the Department of
Agriculture in the name of a public
entity (such as a state or local
government, school district, or prison)
that receives agricultural program
payments
The public entity
15. Grantor trust filing Form 1041 or
under the Optional Filing Method 2,
requiring Form 1099 (see Regulations
section 1.671-4(b)(2)(i)(B))**
The trust
1 List first and circle the name of the person whose number you furnish.
If only one person on a joint account has an SSN, that person’s number
must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name on line 1, and enter your business
or DBA name, if any, on line 2. You may use either your SSN or EIN (if
you have one), but the IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do
not furnish the TIN of the personal representative or trustee unless the
legal entity itself is not designated in the account title.)
* Note: The grantor must also provide a Form W-9 to the trustee of the
trust.
** For more information on optional filing methods for grantor trusts, see
the Instructions for Form 1041.
Note: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Secure Your Tax Records From Identity Theft
Identity theft occurs when someone uses your personal information,
such as your name, SSN, or other identifying information, without your
permission to commit fraud or other crimes. An identity thief may use
your SSN to get a job or may file a tax return using your SSN to receive
a refund.
To reduce your risk:
• Protect your SSN,
• Ensure your employer is protecting your SSN, and
• Be careful when choosing a tax return preparer.
If your tax records are affected by identity theft and you receive a
notice from the IRS, respond right away to the name and phone number
printed on the IRS notice or letter.
If your tax records are not currently affected by identity theft but you
think you are at risk due to a lost or stolen purse or wallet, questionable
credit card activity, or a questionable credit report, contact the IRS
Identity Theft Hotline at 800-908-4490 or submit Form 14039.
For more information, see Pub. 5027, Identity Theft Information for
Taxpayers.
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Form W-9 (Rev. 3-2024) 	Page 6
Victims of identity theft who are experiencing economic harm or a
systemic problem, or are seeking help in resolving tax problems that
have not been resolved through normal channels, may be eligible for
Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
calling the TAS toll-free case intake line at 877-777-4778 or TTY/TDD
800-829-4059.
Protect yourself from suspicious emails or phishing schemes.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites. The most common act
is sending an email to a user falsely claiming to be an established
legitimate enterprise in an attempt to scam the user into surrendering
private information that will be used for identity theft.
The IRS does not initiate contacts with taxpayers via emails. Also, the
IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
information for their credit card, bank, or other financial accounts.
If you receive an unsolicited email claiming to be from the IRS,
forward this message to phishing@irs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (TIGTA) at 800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@uce.gov or report them at www.ftc.gov/complaint. You can
contact the FTC at www.ftc.gov/idtheft or 877-IDTHEFT (877-438-4338).
If you have been the victim of identity theft, see www.IdentityTheft.gov
and Pub. 5027.
Go to www.irs.gov/IdentityTheft to learn more about identity theft and
how to reduce your risk.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your
correct TIN to persons (including federal agencies) who are required to
file information returns with the IRS to report interest, dividends, or
certain other income paid to you; mortgage interest you paid; the
acquisition or abandonment of secured property; the cancellation of
debt; or contributions you made to an IRA, Archer MSA, or HSA. The
person collecting this form uses the information on the form to file
information returns with the IRS, reporting the above information.
Routine uses of this information include giving it to the Department of
Justice for civil and criminal litigation and to cities, states, the District of
Columbia, and U.S. commonwealths and territories for use in
administering their laws. The information may also be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. You must provide your TIN whether or not
you are required to file a tax return. Under section 3406, payors must
generally withhold a percentage of taxable interest, dividends, and
certain other payments to a payee who does not give a TIN to the payor.
Certain penalties may also apply for providing false or fraudulent
information.
Case 4:16-cv-05544-HSG Document 257 Filed 08/07/26 Page 23 of 23