Name as shown on tax return:
If different from above
Under penalties of perjury, I certify that:
- 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
- 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
- I am a U.S. citizen or other U.S. person.
- The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Digital Signature:
Date:
Name as Shown on Tax Return
Enter the name as shown on your IRS tax return for the Tax ID number entered at registration.
Primary Name on Winning Certificates
Per IRS guidelines, the primary name on winning certificates must be the "name as shown on tax return".
Additional Name(s) on Winning Certificates
If the county permits it, use this field to enter any additional name(s) to be printed on your winning certificates.
If the county has assigned you a Bidder Number in the past, enter it here.
If you have been assigned a number from the Department of Assessment and Taxation, enter it here.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.
Subject to backup withholding
As specified by the Internal Revenue Service (IRS), entities making specific payments to you must, under certain conditions, withhold 24% of such payments to be paid to the IRS. These mandatory payments are known as "backup withholding." Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, non-employee pay, 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 Tax Identification Number (TIN), make the proper certifications, and report all of your taxable interest and dividends on your tax return.
Payments you receive will be subject to backup withholding IF:
You do not furnish your TIN to the requester,
You do not certify your TIN when required,
The IRS tells the requester that you furnished an incorrect TIN,
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
You do not certify to the requester that you are not subject to backup withholding (for reportable interest and dividend accounts opened after 1983).
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt from backup withholding
Individuals (including sole proprietors) are not exempt from backp withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Exempt payee code
Individuals (including sole proprietors) are not exempt from backup withholding. Corporations are exempt from backup withholding for certain payments, such as interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
FATCA reporting code
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.
Realauction recommends that you consult a qualified tax accountant or visit the IRS website for additional information.
Address
The address entered here will be used for all redemption payments and official correspondence.