Form

(Rev. October 2018)

W-9 Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
Department of the Treasury send to the IRS.
Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the latest information.
1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

See Specific Instructions on page 3.

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
following seven boxes. certain entities, not individuals; see
instructions on page 3):
Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate
single-member LLC Exempt payee code (if any)
Print or type.

✔ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
code (if any)
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Other (see instructions) (Applies to accounts maintained outside the U.S.)

5 Address (number, street, and apt. or suite no.) See instructions. Requester’s name and address (optional)

6 City, state, and ZIP code

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 Social security number
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. or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer identification number
Number To Give the Requester for guidelines on whose number to enter.
–

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 Signature of
Here U.S. person Date
02/08/2022

General Instructions • Form 1099-DIV (dividends, including those from stocks or mutual
funds)
Section references are to the Internal Revenue Code unless otherwise • Form 1099-MISC (various types of income, prizes, awards, or gross
noted. proceeds)
Future developments. For the latest information about developments • Form 1099-B (stock or mutual fund sales and certain other
related to Form W-9 and its instructions, such as legislation enacted transactions by brokers)
after they were published, go to www.irs.gov/FormW9.
• Form 1099-S (proceeds from real estate transactions)
Purpose of Form • Form 1099-K (merchant card and third party network transactions)
An individual or entity (Form W-9 requester) who is required to file an • Form 1098 (home mortgage interest), 1098-E (student loan interest),
information return with the IRS must obtain your correct taxpayer 1098-T (tuition)
identification number (TIN) which may be your social security number • Form 1099-C (canceled debt)
(SSN), individual taxpayer identification number (ITIN), adoption
• Form 1099-A (acquisition or abandonment of secured property)
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other Use Form W-9 only if you are a U.S. person (including a resident
amount reportable on an information return. Examples of information alien), to provide your correct TIN.
returns include, but are not limited to, the following. If you do not return Form W-9 to the requester with a TIN, you might
• Form 1099-INT (interest earned or paid) be subject to backup withholding. See What is backup withholding,
later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)

Form W-9 (Rev. 10-2018)
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. If applicable, you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income, and
4. 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).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax under section 1446 on any foreign partners’ share of effectively
connected taxable income from such business. Further, in certain cases
where a Form W-9 has not been received, the rules under section 1446
require a partnership to presume that a partner is a foreign person, and
pay the section 1446 withholding tax. Therefore, if you are a U.S. person
that is a partner in a partnership conducting a trade or business in the
United States, provide Form W-9 to the partnership to establish your
U.S. status and avoid section 1446 withholding on your share of
partnership income.
In the cases below, the following person must give Form W-9 to the
partnership for purposes of establishing its U.S. status and avoiding
withholding on its allocable share of net income from the partnership
conducting a trade or business in the United States.
• In the case of a disregarded entity with a U.S. owner, the U.S. owner
of the disregarded entity and not the 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 trust; and
• In the case of a U.S. trust (other than a grantor trust), the U.S. trust
(other than a grantor trust) and not the beneficiaries of the trust.
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, do not use
Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign
Entities).
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.
Page 2
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 his or her 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 his or her 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 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 under 4 above (for reportable interest and dividend
accounts opened after 1983 only).
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.
Also see Special rules for partnerships, earlier.
What is FATCA Reporting?
The Foreign Account Tax Compliance Act (FATCA) requires a
participating foreign financial institution to report all United States
account holders that are specified United States 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 no
longer are 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.
Form W-9 (Rev. 10-2018) Page 3

Criminal penalty for falsifying information. Willfully falsifying IF the entity/person on line 1 is THEN check the box for . . .
certifications or affirmations may subject you to criminal penalties a(n) . . .
including fines and/or imprisonment.
Misuse of TINs. If the requester discloses or uses TINs in violation of • Corporation Corporation
federal law, the requester may be subject to civil and criminal penalties. • Individual Individual/sole proprietor or single-
• Sole proprietorship, or member LLC
Specific Instructions • Single-member limited liability
company (LLC) owned by an
Line 1 individual and disregarded for U.S.
You must enter one of the following on this line; do not leave this line federal tax purposes.
blank. The name should match the name on your tax return.
• LLC treated as a partnership for Limited liability company and enter
If this Form W-9 is for a joint account (other than an account U.S. federal tax purposes, the appropriate tax classification.
maintained by a foreign financial institution (FFI)), list first, and then • LLC that has filed Form 8832 or (P= Partnership; C= C corporation;
circle, the name of the person or entity whose number you entered in 2553 to be taxed as a corporation, or S= S corporation)
Part I of Form W-9. If you are providing Form W-9 to an FFI to document or
a joint account, each holder of the account that is a U.S. person must
provide a Form W-9. • LLC that is disregarded as an
entity separate from its owner but
a. Individual. Generally, enter the name shown on your tax return. If the owner is another LLC that is
you have changed your last name without informing the Social Security not disregarded for U.S. federal tax
Administration (SSA) of the name change, enter your first name, the last purposes.
name as shown on your social security card, and your new last name.
Note: ITIN applicant: Enter your individual name as it was entered on • Partnership Partnership
your Form W-7 application, line 1a. This should also be the same as the • Trust/estate Trust/estate
name you entered on the Form 1040/1040A/1040EZ you filed with your
application. Line 4, Exemptions
b. Sole proprietor or single-member LLC. Enter your individual If you are exempt from backup withholding and/or FATCA reporting,
name as shown on your 1040/1040A/1040EZ on line 1. You may enter enter in the appropriate space on line 4 any code(s) that may apply to
your business, trade, or “doing business as” (DBA) name on line 2. you.
c. Partnership, LLC that is not a single-member LLC, C Exempt payee code.
corporation, or S corporation. Enter the entity's name as shown on the • Generally, individuals (including sole proprietors) are not exempt from
entity's tax return on line 1 and any business, trade, or DBA name on backup withholding.
line 2. • Except as provided below, corporations are exempt from backup
d. Other entities. Enter your name as shown on required U.S. federal withholding for certain payments, including interest and dividends.
tax documents on line 1. This name should match the name shown on the • Corporations are not exempt from backup withholding for payments
charter or other legal document creating the entity. You may enter any made in settlement of payment card or third party network transactions.
business, trade, or DBA name on line 2.
• Corporations are not exempt from backup withholding with respect to
e. Disregarded entity. For U.S. federal tax purposes, an entity that is attorneys’ fees or gross proceeds paid to attorneys, and corporations
disregarded as an entity separate from its owner is treated as a that provide medical or health care services are not exempt with respect
“disregarded entity.” See Regulations section 301.7701-2(c)(2)(iii). Enter to payments reportable on Form 1099-MISC.
the owner's name on line 1. The name of the entity entered on line 1
should never be a disregarded entity. The name on line 1 should be the The following codes identify payees that are exempt from backup
name shown on the income tax return on which the income should be withholding. Enter the appropriate code in the space in line 4.
reported. For example, if a foreign LLC that is treated as a disregarded 1—An organization exempt from tax under section 501(a), any IRA, or
entity for U.S. federal tax purposes has a single owner that is a U.S. a custodial account under section 403(b)(7) if the account satisfies the
person, the U.S. owner's name is required to be provided on line 1. If requirements of section 401(f)(2)
the direct owner of the entity is also a disregarded entity, enter the first 2—The United States or any of its agencies or instrumentalities
owner that is not disregarded for federal tax purposes. Enter the
disregarded entity's name on line 2, “Business name/disregarded entity 3—A state, the District of Columbia, a U.S. commonwealth or
name.” If the owner of the disregarded entity is a foreign person, the possession, or any of their political subdivisions or instrumentalities
owner must complete an appropriate Form W-8 instead of a Form W-9. 4—A foreign government or any of its political subdivisions, agencies,
This is the case even if the foreign person has a U.S. TIN. or instrumentalities
Line 2 5—A corporation
6—A dealer in securities or commodities required to register in the
If you have a business name, trade name, DBA name, or disregarded
United States, the District of Columbia, or a U.S. commonwealth or
entity name, you may enter it on line 2.
possession
Line 3 7—A futures commission merchant registered with the Commodity
Check the appropriate box on line 3 for the U.S. federal tax Futures Trading Commission
classification of the person whose name is entered on line 1. Check only 8—A real estate investment trust
one box on line 3. 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
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
Form W-9 (Rev. 10-2018)
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 Exempt payees 1 through 4
patronage dividends
Payments over $600 required to be Generally, exempt payees
reported and direct sales over 1 through 52
$5,0001
Payments made in settlement of Exempt payees 1 through 4
payment card or third party network
transactions
1 If you are a single-member LLC that is disregarded as an entity
See Form 1099-MISC, Miscellaneous Income, 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) written or printed 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
possession, 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)
Page 4
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, write 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
individual taxpayer identification number (ITIN). Enter it in the social
security number box. 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.
separate from its owner, enter the owner’s SSN (or EIN, if the owner has
one). Do not enter the disregarded entity’s EIN. 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 1-800-772-1213.
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/Businesses and
clicking on Employer Identification Number (EIN) under Starting a
Business. 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 SS-4 mailed to you within 10
business days.
If you are asked to complete Form W-9 but do not have a TIN, apply
for a TIN and write “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, generally you will 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.
Caution: A disregarded U.S. entity that has a foreign owner must use
the appropriate Form W-8.
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.
Form W-9 (Rev. 10-2018) Page 5

1. Interest, dividend, and barter exchange accounts opened For this type of account: Give name and EIN of:
before 1984 and broker accounts considered active during 1983.
14. Account with the Department of The public entity
You must give your correct TIN, but you do not have to sign the
Agriculture in the name of a public
certification.
entity (such as a state or local
2. Interest, dividend, broker, and barter exchange accounts government, school district, or
opened after 1983 and broker accounts considered inactive during prison) that receives agricultural
1983. You must sign the certification or backup withholding will apply. If program payments
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 15. Grantor trust filing under the Form The trust
certification before signing the form. 1041 Filing Method or the Optional
Form 1099 Filing Method 2 (see
3. Real estate transactions. You must sign the certification. You may
Regulations section 1.671-4(b)(2)(i)(B))
cross out item 2 of the certification.
4. Other payments. You must give your correct TIN, but you do not 1
List first and circle the name of the person whose number you furnish.
have to sign the certification unless you have been notified that you If only one person on a joint account has an SSN, that person’s number
have previously given an incorrect TIN. “Other payments” include must be furnished.
payments made in the course of the requester’s trade or business for 2
Circle the minor’s name and furnish the minor’s SSN.
rents, royalties, goods (other than bills for merchandise), medical and
3
health care services (including payments to corporations), payments to You must show your individual name and you may also enter your
a nonemployee for services, payments made in settlement of payment business or DBA name on the “Business name/disregarded entity”
card and third party network transactions, payments to certain fishing name line. You may use either your SSN or EIN (if you have one), but the
boat crew members and fishermen, and gross proceeds paid to IRS encourages you to use your SSN.
attorneys (including payments to corporations). 4
List first and circle the name of the trust, estate, or pension trust. (Do
5. Mortgage interest paid by you, acquisition or abandonment of not furnish the TIN of the personal representative or trustee unless the
secured property, cancellation of debt, qualified tuition program legal entity itself is not designated in the account title.) Also see Special
payments (under section 529), ABLE accounts (under section 529A), rules for partnerships, earlier.
IRA, Coverdell ESA, Archer MSA or HSA contributions or *Note: The grantor also must provide a Form W-9 to trustee of trust.
distributions, and pension distributions. You must give your correct
Note: If no name is circled when more than one name is listed, the
TIN, but you do not have to sign the certification.
number will be considered to be that of the first name listed.
What Name and Number To Give the Requester Secure Your Tax Records From Identity Theft
For this type of account: Give name and SSN of:
Identity theft occurs when someone uses your personal information
1. Individual The individual such as your name, SSN, or other identifying information, without your
2. Two or more individuals (joint The actual owner of the account or, if permission, to commit fraud or other crimes. An identity thief may use
account) other than an account combined funds, the first individual on your SSN to get a job or may file a tax return using your SSN to receive
maintained by an FFI the account
1 a refund.
3. Two or more U.S. persons Each holder of the account To reduce your risk:
(joint account maintained by an FFI) • Protect your SSN,
4. Custodial account of a minor The minor
2
• Ensure your employer is protecting your SSN, and
(Uniform Gift to Minors Act) • Be careful when choosing a tax preparer.
1
5. a. The usual revocable savings trust The grantor-trustee If your tax records are affected by identity theft and you receive a
(grantor is also trustee)
1 notice from the IRS, respond right away to the name and phone number
b. So-called trust account that is not The actual owner printed on the IRS notice or letter.
a legal or valid trust under state law
If your tax records are not currently affected by identity theft but you
6. Sole proprietorship or disregarded 3
The owner think you are at risk due to a lost or stolen purse or wallet, questionable
entity owned by an individual credit card activity or credit report, contact the IRS Identity Theft Hotline
7. Grantor trust filing under Optional The grantor* at 1-800-908-4490 or submit Form 14039.
Form 1099 Filing Method 1 (see For more information, see Pub. 5027, Identity Theft Information for
Regulations section 1.671-4(b)(2)(i) Taxpayers.
(A)) Victims of identity theft who are experiencing economic harm or a
For this type of account: Give name and EIN of: systemic problem, or are seeking help in resolving tax problems that
8. Disregarded entity not owned by an The owner have not been resolved through normal channels, may be eligible for
individual Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
9. A valid trust, estate, or pension trust Legal entity
4 calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
1-800-829-4059.
10. Corporation or LLC electing The corporation Protect yourself from suspicious emails or phishing schemes.
corporate status on Form 8832 or Phishing is the creation and use of email and websites designed to
Form 2553 mimic legitimate business emails and websites. The most common act
11. Association, club, religious, The organization is sending an email to a user falsely claiming to be an established
charitable, educational, or other tax- legitimate enterprise in an attempt to scam the user into surrendering
exempt organization private information that will be used for identity theft.

12. Partnership or multi-member LLC The partnership

13. A broker or registered nominee The broker or nominee
Form W-9 (Rev. 10-2018)
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 1-800-366-4484. 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.
Visit www.irs.gov/IdentityTheft to learn more about identity theft and
how to reduce your risk.
Page 6
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 possessions for use in
administering their laws. The information also may 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, payers
must generally withhold a percentage of taxable interest, dividend, and
certain other payments to a payee who does not give a TIN to the payer.
Certain penalties may also apply for providing false or fraudulent
information.
 Rev. 8/16
Massachusetts
Form ST-4 Department of
Sales Tax Resale Certificate Revenue

Name of purchaser Account ID number or Federal ID number

VZNARY SOLUTIONS LLC 87-4808701
Address
67 Forest St, Ste 270 #815
City/Town State Zip
Marlborough MA 01752
Type of business in which purchaser is engaged:
Amazon Dropshipping
Type of tangible personal property or service being purchased (be as specific as possible):

Name of vendor from whom tangible personal property or services are being purchased:

Address City/Town State Zip

I hereby certify that I hold a valid Massachusetts Vendor’s Registration, issued by the Commissioner of Revenue, pursuant to Massachusetts General
Laws, Chapter 64H, section 7, and that I am in the business of selling the kind of tangible personal property or services being purchased under this
certificate, and that I intend to sell such property or services in the regular course of my business.
Signed under the penalties of perjury.
Signature of purchaser Title Date

Check applicable box: Single purchase certificate Blanket certificate

Notice to Vendors Notice to Purchasers

1. Massachusetts General Laws assume that all gross receipts of a
vendor from the sale of tangible personal property and services are
from sales subject to tax, unless the contrary is established. The bur-
den of proving that a sale of tangible personal property or service by
any vendor is not a retail sale is placed upon the vendor unless he/she
accepts from the purchaser a certificate declaring that the property or
service is purchased for resale.
2. A resale certificate relieves the vendor from the burden of proof only
if it is taken in good faith from a purchaser who is engaged in the busi-
ness of selling tangible property or services and who holds a valid
Massachusetts sales tax registration.
3. The good faith of the vendor will be questioned if he/she has knowl-
edge of facts which give rise to a reasonable inference that the pur-
chaser does not intend to resell the property or services. For example,
knowledge that a purchaser of particular merchandise is not engaged
in the business of selling the kind of merchandise or service he/she is
purchasing under this certificate would constitute grounds to question
the good faith of the vendor.
4. The vendor must make sure that the certificate is filled out properly
and signed before accepting it.
5. The vendor must retain this certificate as part of his/her permanent
tax records.
If you have any questions about the acceptance or use of this certif-
icate, please contact: Massachusetts Department of Revenue, Cus-
tomer Service Bureau, PO Box 7010, Boston, MA 02204, or call
(617) 887-MDOR or toll-free, in-state 1-800-392-6089.
1. This certificate is to be used when the purchaser intends to resell
the tangible personal property or service in the regular course of busi-
ness. Manufacturers claiming an exempt use of the materials, tools
and fuel which will be used in the manufacture, processing or conver-
sion of tangible personal property should use Form ST-12, Exempt
Use Certificate. Tax-exempt organizations making purchases for other
than resale are to use Form ST-5, Exempt Purchaser Certificate.
2. The purchaser must hold a valid Massachusetts vendor registration.
If you need to apply for a registration, go to mass.gov/dor and click on
MassTaxConnect to complete an online application for registration.
3. This certificate must be signed by and bear the name and address
of the purchaser and his/her Account ID number or Federal Identifica-
tion number. This certificate must also indicate the type of tangible per-
sonal property purchased and resold by the purchaser.
4. If a purchaser who gives a certificate makes any use of the property
other than retention, demonstration or display while holding it for sale
in the regular course of business, such property will be subject to the
Massachusetts sales or use tax, as of the time the property is first
used by him/her.
5. If you are engaged in a service activity, and are unsure as to the el-
igibility of the tangible personal property being purchased for resale,
see the regulation on Service Enterprises, 830 CMR 64H.1.1.
6. For further information about the use of resale certificates, see the
regulation on Resale and Exempt Use Certificates, 830 CMR 64H.8.1.
Warning: Willful misuse of this certificate may result in criminal
tax evasion sanctions of up to one year in prison and $10,000
($50,000 for corporations) in fines.

This form is approved by the Commissioner of Revenue and may be reproduced.

A private agreement between the members/owners
of the LLC, and it details the ownership, rights, and
responsibilities of the LLC members.
 LIMITED LIABILITY COMPANY
OPERATING AGREEMENT OF
VZNARY SOLUTIONS LLC

This agreement is made effective on the ________ day of _________________, ___________

among the member(s) and the company.

1. Formation. A limited liability company (LLC) of the above name has been formed
under the laws of the State of Massachusetts by filing Articles of Organization (or similar
organizing document) with the Secretary of State (or other appropriate office) on
02/03/2022. The purpose of the business shall be to carry on any activity which is lawful
under the jurisdiction in which it operates. The LLC may operate under a fictitious name
or names as long as the LLC is in compliance with applicable fictitious name registration
laws. The term of the LLC shall be perpetual or until dissolved as provided by law or by
vote of the member(s) as provided in this agreement. Upon dissolution the remaining
members shall have the power to continue the operation of the LLC as long as necessary
and allowable under state law until the winding up of the affairs of the business has been
completed.

2. Members. The name and address of each initial limited liability company member is:

ABDUL JAVED
67 FOREST ST, STE 270 #815
MARLBOROUGH , MA 01752

3. Contributions. The capital contribution of each limited liability company member in

exchange for their LLC ownership is:

LLC Capital
Name
Ownership Contribution

ABDUL JAVED 100% $_____________

NOTE: The capital contribution may be in the form of cash (or cash equivalents), labor or
services (past or future), or property/equipment/assets other than cash. Regardless of the
type of capital contribution, it should be expressed above in a dollar equivalent value that
is agreed upon by all limited liability company members. Additionally, there may be
accounting/tax ramifications for individuals contributing capital other than cash.

4. Profit and Loss. The profits and losses of the limited liability company shall be
distributed amongst the members in proportion with the ownership of each member by
default, but this may be changed at any time upon a unanimous vote of the members.

5. Distributions. The limited liability company shall have the power to make
distributions to its members in such amounts and at such intervals as a majority of the
members deem appropriate according to law.

6. Management. The limited liability company shall be managed by all LLC members.
Any member may bind the LLC in all matters in the ordinary course of LLC business. In
the event of a dispute between members, final determination shall be made with a vote by
the members, votes being proportioned according to capital contributions.
7. Registered Agent. For receipt of official legal and tax correspondence from the State
of Massachusetts, the registered agent of the limited liability company (sometimes known
as a resident agent, statutory agent, agent for service of process, or delivery of service
address) shall be maintained in accordance with the requirements of the State of
Massachusetts.

8. Assets. The assets of the limited liability company shall be registered in the legal name
of the LLC and not in the names of the individual members, unless approved by a majority
vote of the members.

9. Records and Accounting. The limited liability company shall keep an accurate
accounting of its affairs using any method of accounting allowed by law. All members
shall have a right to inspect the records during normal business hours. The members shall
have the power to hire such accountants as they deem necessary or desirable.

10. Banking. The members of the limited liability company shall be authorized to set up
bank accounts as in their sole discretion are deemed necessary and are authorized to
execute any banking resolutions provided by the institution in which the accounts are
being set up, or by adopting their own resolution.

11. Taxes. The limited liability company shall file such tax returns as required by law.
The LLC shall elect to be taxed as a majority of the members decide is in their best
interests. The "tax matters partner," as required by the Internal Revenue Code, shall be
appointed by unanimous consent of the members.

12. Separate Entity. The limited liability company is a legal entity separate from its
members. No member shall have any separate liability for any debts, obligations, or
liability of the LLC except as provided in this agreement.

13. Indemnity and Exculpation. The limited liability company shall indemnify and hold
harmless its members, managers, employees, officers, and agents to the fullest extent
allowed by law for acts or omissions done as part of their duties to or for the LLC.
Indemnification shall include all liabilities, expenses, attorney and accountant fees, and
other costs reasonably expended. No member shall be liable to the LLC for acts done in
good faith.

14. Meetings. The members shall have no obligation to hold annual or any other
meeting, but may hold such meetings if they deem them necessary or desirable.

15. Amendment of this Agreement. This agreement may not be amended except in
writing signed by all of the members.

16. Conflict of Interest. No member shall be involved with any business or undertaking
which competes with the interests of the limited liability company except upon agreement
in writing by all of the members.

17. Deadlock. In the event that the members cannot come to an agreement on any
matter the members agree to submit the issue to mediation to be paid for by the limited
liability company. In the event the mediation is unsuccessful, they agree to seek
arbitration under the rules of the American Arbitration Association.
18. Dissociation of a Member. A member shall have the right to discontinue
membership upon giving thirty days notice. A member shall cease to have the right to
membership upon death, court-ordered incapacity, bankruptcy or expulsion. The limited
liability company shall have the right to buy the interest of any dissociated member at fair
market value.

19. Dissolution. The limited liability company shall dissolve upon the unanimous consent
of all the members or upon any event requiring dissolution under state law. In the event
of the death, bankruptcy, permanent incapacity, or withdrawal of a member the
remaining members may elect to dissolve or to continue the operation of the LLC.

20. General Provisions. This agreement is intended to represent the entire agreement
between the parties. In the event that any party of this agreement is held to be contrary
to law or unenforceable, said party shall be considered amended to comply with the law
and such holding shall not affect the enforceability of other terms of this agreement. This
agreement shall be binding upon the heirs, successors, and assigns of the members.

IN WITNESS whereof, the members of the limited liability company sign this
agreement and adopt it as their operating agreement this ______ day of
______________, ______.

ABDUL JAVED , MEMBER

A set of formal documents filed with the Secretary of
State to legally document the creation of a new
business entity.
 MA SOC Filing Number: 202200360920 Date: 2/3/2022 9:55:00 AM

The Commonwealth of Massachusetts Minimum Fee: $500.00

William Francis Galvin
Secretary of the Commonwealth, Corporations Division
One Ashburton Place, 17th floor
Boston, MA 02108-1512
Telephone: (617) 727-9640

Certificate of Organization
(General Laws, Chapter )

Identification Number: 001560298

1. The exact name of the limited liability company is: VZNARY SOLUTIONS LLC

2a. Location of its principal office:

No. and Street: 67 FOREST ST, STE 270 #815
City or Town: MARLBOROUGH State: MA Zip: 01752 Country: USA

2b. Street address of the office in the Commonwealth at which the records will be maintained:

No. and Street: 67 FOREST ST, STE 270 #815

City or Town: MARLBOROUGH State: MA Zip: 01752 Country: USA

3. The general character of business, and if the limited liability company is organized to render professional
service, the service to be rendered:
AMAZON FBA

4. The latest date of dissolution, if specified:

5. Name and address of the Resident Agent:

Name: LEGALINC CORPORATE SERVICES INC.
No. and Street: 1900 WEST PARK DRIVE
SUITE 280B
City or Town: WESTBOROUGH State: MA Zip: 01581 Country: USA

I, WESLEY DOLAN OBO LEGALINC CORPORATE SERVICES INC. resident agent of the above limited liability
company, consent to my appointment as the resident agent of the above limited liability company pursuant
to G. L. Chapter 156C Section 12.

6. The name and business address of each manager, if any:

Title Individual Name Address (no PO Box)

First, Middle, Last, Suffix Address, City or Town, State, Zip Code

7. The name and business address of the person(s) in addition to the manager(s), authorized to execute
documents to be filed with the Corporations Division, and at least one person shall be named if there are no
managers.

Title Individual Name Address (no PO Box)

First, Middle, Last, Suffix Address, City or Town, State, Zip Code
SOC SIGNATORY ABDUL JAVED
67 FOREST ST, STE 270 #815
 MARLBOROUGH, MA 01752 USA

8. The name and business address of the person(s) authorized to execute, acknowledge, deliver and record
any recordable instrument purporting to affect an interest in real property:

Title Individual Name Address (no PO Box)

First, Middle, Last, Suffix Address, City or Town, State, Zip Code
REAL PROPERTY ABDUL JAVED 67 FOREST ST, STE 270 #815
MARLBOROUGH, MA 01752 USA

9. Additional matters:

SIGNED UNDER THE PENALTIES OF PERJURY, this 3 Day of February, 2022,

LOVETTE DOBSON
(The certificate must be signed by the person forming the LLC.)

© 2001 - 2022 Commonwealth of Massachusetts

All Rights Reserved
MA SOC Filing Number: 202200360920 Date: 2/3/2022 9:55:00 AM

THE COMMONWEALTH OF MASSACHUSETTS

I hereby certify that, upon examination of this document, duly submitted to me, it appears

that the provisions of the General Laws relative to corporations have been complied with,

and I hereby approve said articles; and the filing fee having been paid, said articles are

deemed to have been filed with me on:

February 03, 2022 09:55 AM

WILLIAM FRANCIS GALVIN

Secretary of the Commonwealth

A set of formal documents filed with the Secretary of
State to legally document the creation of a new
business entity.
 MA SOC Filing Number: 202200360920 Date: 2/3/2022 9:55:00 AM

The Commonwealth of Massachusetts Minimum Fee: $500.00

William Francis Galvin
Secretary of the Commonwealth, Corporations Division
One Ashburton Place, 17th floor
Boston, MA 02108-1512
Telephone: (617) 727-9640

Certificate of Organization
(General Laws, Chapter )

Identification Number: 001560298

1. The exact name of the limited liability company is: VZNARY SOLUTIONS LLC

2a. Location of its principal office:

No. and Street: 67 FOREST ST, STE 270 #815
City or Town: MARLBOROUGH State: MA Zip: 01752 Country: USA

2b. Street address of the office in the Commonwealth at which the records will be maintained:

No. and Street: 67 FOREST ST, STE 270 #815

City or Town: MARLBOROUGH State: MA Zip: 01752 Country: USA

3. The general character of business, and if the limited liability company is organized to render professional
service, the service to be rendered:
AMAZON FBA

4. The latest date of dissolution, if specified:

5. Name and address of the Resident Agent:

Name: LEGALINC CORPORATE SERVICES INC.
No. and Street: 1900 WEST PARK DRIVE
SUITE 280B
City or Town: WESTBOROUGH State: MA Zip: 01581 Country: USA

I, WESLEY DOLAN OBO LEGALINC CORPORATE SERVICES INC. resident agent of the above limited liability
company, consent to my appointment as the resident agent of the above limited liability company pursuant
to G. L. Chapter 156C Section 12.

6. The name and business address of each manager, if any:

Title Individual Name Address (no PO Box)

First, Middle, Last, Suffix Address, City or Town, State, Zip Code

7. The name and business address of the person(s) in addition to the manager(s), authorized to execute
documents to be filed with the Corporations Division, and at least one person shall be named if there are no
managers.

Title Individual Name Address (no PO Box)

First, Middle, Last, Suffix Address, City or Town, State, Zip Code
SOC SIGNATORY ABDUL JAVED
67 FOREST ST, STE 270 #815
 MARLBOROUGH, MA 01752 USA

8. The name and business address of the person(s) authorized to execute, acknowledge, deliver and record
any recordable instrument purporting to affect an interest in real property:

Title Individual Name Address (no PO Box)

First, Middle, Last, Suffix Address, City or Town, State, Zip Code
REAL PROPERTY ABDUL JAVED 67 FOREST ST, STE 270 #815
MARLBOROUGH, MA 01752 USA

9. Additional matters:

SIGNED UNDER THE PENALTIES OF PERJURY, this 3 Day of February, 2022,

LOVETTE DOBSON
(The certificate must be signed by the person forming the LLC.)

© 2001 - 2022 Commonwealth of Massachusetts

All Rights Reserved
MA SOC Filing Number: 202200360920 Date: 2/3/2022 9:55:00 AM

THE COMMONWEALTH OF MASSACHUSETTS

I hereby certify that, upon examination of this document, duly submitted to me, it appears

that the provisions of the General Laws relative to corporations have been complied with,

and I hereby approve said articles; and the filing fee having been paid, said articles are

deemed to have been filed with me on:

February 03, 2022 09:55 AM

WILLIAM FRANCIS GALVIN

Secretary of the Commonwealth

A document signed by the Organizer which identifies
the initial members of the Limited Liability Company.
 STATE of MASSACHUSETTS
STATEMENT and RESIGNATION of the ORGANIZER
A LIMITED LIABILITY COMPANY

The undersigned, the Organizer of VZNARY SOLUTIONS LLC, who signed and filed its
Articles of Organization (or similar organizing document) with the Massachusetts
Secretary of State (or other appropriate state office), appoints the following individuals to
serve as members of the limited liability company:

Name and address of each initial member:

ABDUL JAVED
67 FOREST ST, STE 270 #815
MARLBOROUGH, MA 01752

Additionally, the undersigned does hereby tender his/her resignation as Organizer for the
LLC, and from any and all involvement with, control of, or authority over the LLC, real or
perceived, effective immediately.

Dated: February 3rd, 2022

Lovette Dobson, Organizer

A nine-digit number that is assigned by the IRS and
used to identify taxpayers in a business entity.
 DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE
CINCINNATI OH 45999-0023

Date of this notice: 02-03-2022

Employer Identification Number:

87-4808701

Form: SS-4

Number of this notice: CP 575 G

VZNARY SOLUTIONS LLC
ABDUL JAVED SOLE MBR
1376 QUAKER ST For assistance you may call us at:
NORTHBRIDGE, MA 01534 1-800-829-4933

IF YOU WRITE, ATTACH THE

STUB AT THE END OF THIS NOTICE.

WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER

Thank you for applying for an Employer Identification Number (EIN). We assigned you
EIN 87-4808701. This EIN will identify you, your business accounts, tax returns, and
documents, even if you have no employees. Please keep this notice in your permanent
records.

Taxpayers request an EIN for their business. Some taxpayers receive CP575 notices when
another person has stolen their identity and are opening a business using their information.
If you did not apply for this EIN, please contact us at the phone number or address listed
on the top of this notice.

When filing tax documents, making payments, or replying to any related correspondence,
it is very important that you use your EIN and complete name and address exactly as shown
above. Any variation may cause a delay in processing, result in incorrect information in
your account, or even cause you to be assigned more than one EIN. If the information is
not correct as shown above, please make the correction using the attached tear-off stub
and return it to us.

A limited liability company (LLC) may file Form 8832, Entity Classification Election,
and elect to be classified as an association taxable as a corporation. If the LLC is
eligible to be treated as a corporation that meets certain tests and it will be electing S
corporation status, it must timely file Form 2553, Election by a Small Business
Corporation. The LLC will be treated as a corporation as of the effective date of the S
corporation election and does not need to file Form 8832.

To obtain tax forms and publications, including those referenced in this notice,
visit our Web site at www.irs.gov. If you do not have access to the Internet, call
1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office.
 (IRS USE ONLY) 575G 02-03-2022 VZNA O 9999999999 SS-4

IMPORTANT REMINDERS:

* Keep a copy of this notice in your permanent records. This notice is issued only
one time and the IRS will not be able to generate a duplicate copy for you. You
may give a copy of this document to anyone asking for proof of your EIN.

* Use this EIN and your name exactly as they appear at the top of this notice on all
your federal tax forms.

* Refer to this EIN on your tax-related correspondence and documents.

* Provide future officers of your organization with a copy of this notice.

Your name control associated with this EIN is VZNA. You will need to provide this
information along with your EIN, if you file your returns electronically.

Safeguard your EIN by referring to Publication 4557, Safeguarding Taxpayer

Data: A Guide for Your Business.

You can get any of the forms or publications mentioned in this letter by
visiting our website at www.irs.gov/forms-pubs or by calling 800-TAX-FORM
(800-829-3676).

If you have questions about your EIN, you can contact us at the phone number
or address listed at the top of this notice. If you write, please tear off the
stub at the bottom of this notice and include it with your letter.

Thank you for your cooperation.

Keep this part for your records. CP 575 G (Rev. 7-2007)

----------------------------------------------------------------------------------------------

Return this part with any correspondence

so we may identify your account. Please CP 575 G
correct any errors in your name or address.
9999999999

Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 02-03-2022
( ) - EMPLOYER IDENTIFICATION NUMBER: 87-4808701
_____________________ _________________ FORM: SS-4 NOBOD

INTERNAL REVENUE SERVICE VZNARY SOLUTIONS LLC

CINCINNATI OH 45999-0023 ABDUL JAVED SOLE MBR
1376 QUAKER ST
NORTHBRIDGE, MA 01534
 Rev. 8/16
Massachusetts
Form ST-4 Department of
Sales Tax Resale Certificate Revenue

Name of purchaser Account ID number or Federal ID number

VZNARY SOLUTIONS LLC 87-4808701
Address
67 Forest St, Ste 270 #815
City/Town State Zip
Marlborough MA 01752
Type of business in which purchaser is engaged:
Amazon Dropshipping
Type of tangible personal property or service being purchased (be as specific as possible):

Name of vendor from whom tangible personal property or services are being purchased:

Address City/Town State Zip

I hereby certify that I hold a valid Massachusetts Vendor’s Registration, issued by the Commissioner of Revenue, pursuant to Massachusetts General
Laws, Chapter 64H, section 7, and that I am in the business of selling the kind of tangible personal property or services being purchased under this
certificate, and that I intend to sell such property or services in the regular course of my business.
Signed under the penalties of perjury.
Signature of purchaser Title Date

Check applicable box: Single purchase certificate Blanket certificate

Notice to Vendors Notice to Purchasers

1. Massachusetts General Laws assume that all gross receipts of a
vendor from the sale of tangible personal property and services are
from sales subject to tax, unless the contrary is established. The bur-
den of proving that a sale of tangible personal property or service by
any vendor is not a retail sale is placed upon the vendor unless he/she
accepts from the purchaser a certificate declaring that the property or
service is purchased for resale.
2. A resale certificate relieves the vendor from the burden of proof only
if it is taken in good faith from a purchaser who is engaged in the busi-
ness of selling tangible property or services and who holds a valid
Massachusetts sales tax registration.
3. The good faith of the vendor will be questioned if he/she has knowl-
edge of facts which give rise to a reasonable inference that the pur-
chaser does not intend to resell the property or services. For example,
knowledge that a purchaser of particular merchandise is not engaged
in the business of selling the kind of merchandise or service he/she is
purchasing under this certificate would constitute grounds to question
the good faith of the vendor.
4. The vendor must make sure that the certificate is filled out properly
and signed before accepting it.
5. The vendor must retain this certificate as part of his/her permanent
tax records.
If you have any questions about the acceptance or use of this certif-
icate, please contact: Massachusetts Department of Revenue, Cus-
tomer Service Bureau, PO Box 7010, Boston, MA 02204, or call
(617) 887-MDOR or toll-free, in-state 1-800-392-6089.
1. This certificate is to be used when the purchaser intends to resell
the tangible personal property or service in the regular course of busi-
ness. Manufacturers claiming an exempt use of the materials, tools
and fuel which will be used in the manufacture, processing or conver-
sion of tangible personal property should use Form ST-12, Exempt
Use Certificate. Tax-exempt organizations making purchases for other
than resale are to use Form ST-5, Exempt Purchaser Certificate.
2. The purchaser must hold a valid Massachusetts vendor registration.
If you need to apply for a registration, go to mass.gov/dor and click on
MassTaxConnect to complete an online application for registration.
3. This certificate must be signed by and bear the name and address
of the purchaser and his/her Account ID number or Federal Identifica-
tion number. This certificate must also indicate the type of tangible per-
sonal property purchased and resold by the purchaser.
4. If a purchaser who gives a certificate makes any use of the property
other than retention, demonstration or display while holding it for sale
in the regular course of business, such property will be subject to the
Massachusetts sales or use tax, as of the time the property is first
used by him/her.
5. If you are engaged in a service activity, and are unsure as to the el-
igibility of the tangible personal property being purchased for resale,
see the regulation on Service Enterprises, 830 CMR 64H.1.1.
6. For further information about the use of resale certificates, see the
regulation on Resale and Exempt Use Certificates, 830 CMR 64H.8.1.
Warning: Willful misuse of this certificate may result in criminal
tax evasion sanctions of up to one year in prison and $10,000
($50,000 for corporations) in fines.

This form is approved by the Commissioner of Revenue and may be reproduced.