Okaloosa County BOCC — September 6, 2016 — Mott MacDonald W-9
Mott MacDonald W-9 in the September 6, 2016 Okaloosa County BOCC meeting materials. Preserved county-portal original with machine-generated OCR reading text.
Preserved among the September 6, 2016 Okaloosa County Board of County Commissioners meeting materials (IQM2 meeting 1349). The date shown is the verified meeting context, not an independently established creation date for every attachment. The download catalog used July 25, 2016; the meeting date was corrected using the agenda/minutes heading and matching source filename.
Original publication
Mott MacDonald W-9
Date
September 6, 2016
Publisher
Okaloosa County Board of County Commissioners
Where to find it
1
Reference collection
Okaloosa County Board of County Commissioners (IQM2 public portal)
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Mott MacDonald W-9 — extracted reading text
Machine-extracted OCR text · Review label: Known limitations
W-9
Form
(Rev. December 2014)
Department of the Treasury
Internal Revenue Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Mott MacDonald Consultants, Inc.
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
Mott MacDonald Florida, LLC (59-1294824)
[ individual/sole proprietor or C Corporation
single-member LLC
the tax classification of the single-member owner.
D Other (see instructions) »
Print or type
3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
D S Corporation
|:| Limited liability company. Enter the tax classification (C=C corporation, S=8 corporation, P=partnership) »
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
4 Exemptions (codes apply only to
certain entities, not individuals; see
instructions on page 3):
Exempt payee code (if any) 5
[:] Partnership I:\ Trust/estate
Exemption from FATCA reporting
code (if any)
{Appies to accounts mainlained outside the U.S )
5 Address (number, street, and apt. or suite no.)
111 Wood Avenue South
Reguester's name and address (optional)
6 City, state, and ZIP code
Iselin, NJ 08830
See Specific Instructions on page 2.
7 tist account number(s) here (optional)
Taxpayer ldentification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1to avoid | Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a f
resiclent alien, sole proprietor, or disregarded entity, see the Part | instructions on page 3. For other - -
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a - -
TIN on page 3.
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for | Empoyer identification number |
guidelines on whose number to enter.
or
212 -1 3|5|6[|6|2|2)|3
IZd Certification
Under penalties of perjury, | certify that:
1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and
2. | am not subject to backup withholding because: (a) | am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue
Service (IRS) that | 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 | am
no longer subject to backup withholding; and
3. | 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 | 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 on page 3.
Sign Signature of //’??
Here U.S. person > | ,/>9? g llite it
Date > J/’ 3 6
General Instructions
Section references are to the Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such
as legislation enacted afer we release it) is at www.irs.gov/fwg.
Purpose of Form
An individual or entity (Form W-9 requester) whao is required to file an information
return with the IRS must obtain your correct taxpa
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Citation & reuse
Okaloosa County Board of County Commissioners. “Okaloosa County BOCC — September 6, 2016 — Mott MacDonald W-9.” September 6, 2016. Mott MacDonald W-9. Crypt of Echoes evidence ID LED-2026-a80a25fcd4914406ac54a7165d17ef32. https://cryptofechoes.com/evidence/LED-2026-a80a25fcd4914406ac54a7165d17ef32. Accessed [date].
Catalogue citation: Okaloosa County Board of County Commissioners, Mott MacDonald W-9, meeting materials for September 6, 2016. https://okaloosacountyfl.iqm2.com/Citizens/FileOpen.aspx?Type=4&ID=12452&MeetingID=1349
Preserved county public-record source. Third-party attachments may retain their original rights.