b'MISCELLANEOUS FORMS| | | | XXXI-9 W9 W4 3921 3922I-9 W9 W4APEX I-9TFP 10251 APEX LW9TFP 5311 APEX W-421 TFP 102021 Employment Eligibility VerificationUSCIS Form Request for TaxpayerGive Form to the FormEmployees Withholding Certicate OMB No. 1545-0074Department of Homeland Security Form I-9W-9 Identication Number and Certication requester. Do notFo W-4 Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.U.S. Citizenship and Immigration ServicesOMB No. 1615-0047(Rev. October 2018) Go to www.irs.gov/FormW9 for instructions and the latest information. send to the IRS. (Rev. December 2020)Give Form W-4 to your employer. 2021Expires 10/31/2022 Department of the Treasury Department of the Treasury Your withholding is subject to review by the IRS.Internal Revenue ServiceInternal Revenue Service 1Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. (a)First name and middle initial Last name (b)Social security numberStep 1: uSriTnAgR cTo HmEpRleEti:o Rne oafd t hiniss tfrourcmti.o Enms pcaloryeefursl a rbee lfioarbel ec foomr pelrertoirnsginth iths ef ocromm. Tplheeti oinns otrfu tchtiiso nfosr mm.u st be available, either in paper or electronicaly y,2Business name/disregarded entity name, if different from above EnterAddressnameonyour social securitydANTI-DISCRIMINATION NOTICE: It is illegal to discriminate against work-authorized individuals. Employers CANNOT specify which document(s) an l because the3 following seven boxes.one of the 4Exemptions (codes apply only toPersonalCity or town, state, and ZIP code Does foryour to name match go to documentation presented has a future expiration date may also constitute illegal discrimination.card? not,ensure youtheget employee may present to establish employment authorization and identity. The refusal to hire or continue to employ an individua certain entities, not individuals; seeInformation creditatIf 800-772-1213contact on page 3. See Specic Instructions instructions on page 3): SSAyour earnings,or Section 1. Employee Information and Attestation (Employees must complete and sign Section 1 of Form I-9 no laterIndividual/sole proprietor or C Corporation S Corporation Partnership Trust/estate (c)Single or Married ling separately www.ssa.gov.than the first day of employment, but not before accepting a job offer.) Middle Initial Other Last Names Used (if any) single-member LLC P=Partnership)Exempt payee code (if any) Married ling jointly or Qualifying widow(er)Print or type. Last Name (Family Name) First Name (Given Name) Head of household (Check only if youre unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)Note: Exemption from FATCA reportingAddress (Street Number and Name) Apt. Number City or Town State ZIP Code another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that code (if any) Complete Steps 24 ONLY if they apply to you; otherwise, skipwww.irs.gov/W4App to Step 5. See page , and privacy.2 for more information on each step, who can claim exemption from withholding, when to use the estimator at Other (see instructions)(Applies to accounts maintained outside the U.S.)Date of Birth (mm/dd/yyyy)U.S. Social Security NumberEmployee\'s E-mail Address Employee\'s Telephone Number 5Address (number, street, and apt. or suite no.) See instructions. Requesters name and address (optional) Step 2: jointly and your spouse- - 6City, state, and ZIP code Multiple JobsComplete this step if you (1) hold more than one job at a time, orearned from all of these jobs.(2) are married also works. The correct amount of withholding depends on incomeI am aware that federal law provides for imprisonment and/or fines for false statements or use of false documents in 7List account number(s) here (optional) or SpouseDo Use the estimator atof the following.www.irs.gov/W4App for most accurate withholding for this step (and Steps 34); oronly oneconnection with the completion of this form.Works (a)I attest, under penalty of perjury, that I am (check one of the following boxes): (b)Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or1. A citizen of the United States Part I Taxpayer Identication Number (TIN) Social security number (c)If there are only two jobs total, you may check this box. Do th . . . . . Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoidis accurate for jobs with similar pay; otherwise, more tax thane same on Form W-4 for the other job. This option necessary may be withheld 2. A noncitizen national of the United States (See instructions) backup withholding. For individuals, this is generally your social security number (SSN). However, for a 3. A lawful permanent resident (Alien Registration Number/USCIS Number): resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other How to get aor TIP: To be accurate, submit a 2021 Form W-4 for all other jobs. or.If you (or your spouse) have self-employment TIN, later. income, including as an independent contractor, use the estimatSome aliens may write "N/A" in the expiration date field.(expiration date, if applicable, mm/dd/yyyy):(See instructions) QR Code - Section 1Number To Give the Requester for guidelines on whose number to enter.Complete Steps 34(b) on Form W-4 for only ONE of these jobs.or the highest paying job.) Leave those steps blank for the other jobs. (Your withholding will 4. An alien authorized to workuntilNote: If the account is in more than one name, see the instructions for line 1. Also see What Name andEmployer identication numberbe most accurate if you complete Steps 34(b) on the Form W-4 fAliens authorized to work must provide only one of the following document numbers to complete Form I-9: Do Not Write In This Space Part II Certication Step 3: An Alien Registration Number/USCIS Number OR Form I-94 Admission Number OR Foreign Passport Number.1. Alien Registration Number/USCIS Number: Under penalties of perjury, I certify that:and ClaimMultiply the number of qualifying children under age 17 by $2,000 $OR he Internal RevenueDependents2. Form I-94 Admission Number: Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) theMultiply the number of other dependents by $500. . . .$OR no longer subject to backup withholding; and3. Foreign Passport Number: 4.The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Add the amounts above and enter the total here . . . . . . . . . . . . . 3 $Country of Issuance: Certication instructions.For mortgage interest paid, withholding becauseStep 4(a) thisincomejobs). If you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. (optional):Otheryear that wont(not have fromwithholding, you enter want the tax amount withheld of for other other income income here. you This expectmaySignature of Employee Today\'s Date (mm/dd/yyyy) acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirementprovide your correct TIN. See the instructions for Part II, later.arrangement (IRA), and generally, paymentsOther include interest, dividends, and retirement income . . . . . . . . . . . . 4(a)$SignAdjustmentsPreparer and/or Translator Certification (check one):Here Signature ofDate(b)Deductions. If you expect to claim deductions other than the standard deductionU.S. personI did not use a preparer or translator.A preparer(s) and/or translator(s) assisted the employee in completing Section 1. General Instructions Form 1099-DIV (dividends, including those from stocks or mutual and want to reduce your . withholding, use . . . . the Deductions Worksheet on page 3 and . . . . . . . . . . . . 4(b)$(Fields below must be completed and signed when preparers and/or translators assist an employee in completing Section 1.) funds) enter the result here I attest, under penalty of perjury, that I have assisted in the completion of Section 1 of this form and that to the best of mySection references are to the Internal Revenue Code unless otherwiseForm 1099-MISC (various types of income, prizes, awards, or gross (c)Extra withholding. Enter any additional tax you want withheld each pay period. 4(c)$knowledge the information is true and correct. noted. proceeds)Signature of Preparer or Translator Today\'s Date (mm/dd/yyyy) Future developments. For the latest information about developmentsForm 1099-B (stock or mutual fund sales and certain otherrelated to Form W-9 and its instructions, such as legislation enactedtransactions by brokers)after they were published, go to www.irs.gov/FormW9. Form 1099-S (proceeds from real estate transactions) Step 5:lete.Last Name (Family Name) First Name (Given Name) Purpose of Form Form 1099-K (merchant card and third party network transactions) Sign State ZIP Code information return with the IRS must obtain your correct taxpayer Form 1098 (home mortgage interest), 1098-E (student loan interest), Here Employees signature (This form is not valid unless you sign it.) Date Address (Street Number and Name) City or Town 1098-T (tuition)Form 1099-C (canceled debt)Form 1099-A (acquisition or abandonment of secured property) Employers name and addressFirst date of (EIN), to report on an information return the amount paid to you, or otherUse Form W-9 only if you are a U.S. person (including a resident Employersemployment number (EIN)amount reportable on an information return. Examples of informationalien), to provide your correct TIN.Onlyreturns include, but are not limited to, the following.If you do not return Form W-9 to the requester with a TIN, you might What is backupwithholding, be subject to backup withholding. See Employer Completes Next Page Form 1099-INT (interest earned or paid) later. For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q FormW-4(2021) Cat. No. 10231X5311 FormW-9(Rev. 10-2018)F Form I-910/21/2019 Page 1 of 3orm I-9 10/21/20193921 3922TFP 3921A TFP 3922A VOID CORRECTEDTRANSFERORS name, street address, city or town, state or province,1 Date option granted OMB No. 1545-2129country, and ZIP or foreign postal code Exercise of an Form 3921 Incentive Stock 2 Date option exercised Option Under (Rev. October 2017) Section 422(b) (Rev. September 2016)TRANSFERORS TIN EMPLOYEES TIN 3 Exercise price per share 4 Fair market value per shareCopy Aon exercise date For EMPLOYEES name $ $ Internal Revenue 5 No. of shares transferred Service CenterFile with Form 1096.Street address (including apt. no.) 6 If other than TRANSFEROR, name, address, and TIN ofFor Privacy Act and Paperwork corporation whose stock is being transferred Reduction Act City or town, state or province, country, and ZIP or foreign postal code current version of I-9 EMPLOYMENT ELIGIBILITY VERIFICATIONNotice, see thethe GeneralInstructions for Account number (see instructions) Certain Information (Rev. October 2017) Returns.(Rev. 9-2016)Form3921 Department of the Treasury - Internal Revenue Service The Department of Homeland Security: Requires employers to use this form to document Do Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page VOID CORRECTED OMB No. 1545-2129 Exercise of anthat each new employee (both citizens and noncitizens) hired after November 6, 1986, is TRANSFERORS name, street address, city or town, state or province,1 Date option grantedcountry, and ZIP or foreign postal code 2 Date option exercised Form 3921 Incentive Stock(Rev. September 2016) authorized to work in the United States. This form must be completed no later than the Option Under (Rev. October 2017) Section 422(b)TRANSFERORS TIN EMPLOYEES TIN 3 Exercise price per share 4 Fair market value per shareCopy A time of hire, which is the actual beginning of employment. Both employer and employee on exercise date For EMPLOYEES name $ 5 No. of shares transferred $ Internal Revenueare required to fill in information to complete an I-9 form.Service CenterFile with Form 1096.Street address (including apt. no.) 6 If other than TRANSFEROR, name, address, and TIN ofFor Privacy Act and Paperwork corporation whose stock is being transferred Reduction Act City or town, state or province, country, and ZIP or foreign postal code Notice, see the current version ofthe GeneralAccount number (see instructions) Instructions for (Rev. 9-2016) W9 PAYERS REQUEST FOR TAXPAYER IDENTIFICATION NUMBERCertain InformationReturns. Form3921(Rev. October 2017) Department of the Treasury - Internal Revenue ServiceDo Not Cut or Separate Forms on This PageDo Not Cut or Separate Forms on This Page VOID CORRECTED OMB No. 1545-2129 Form W9 is used by payers required to file information returns (for exampleincome TRANSFERORS name, street address, city or town, state or province,1 Date option grantedcountry, and ZIP or foreign postal code 2 Date option exercised Form 3921 Exercise of an(Rev. September 2016) paid, real estate transactions, mortgage interest, acquisition or abandonment of secured Incentive Stock Option Under TRANSFERORS TIN EMPLOYEES TIN 3 Exercise price per share (Rev. October 2017) Section 422(b) property, cancellation of debt, or contributions made to an IRA) with the IRS to get the 4 Fair market value per shareCopy Aon exercise date For EMPLOYEES name $ 5 No. of shares transferred $ Internal Revenuepayees correct Taxpayer Identification Number (TIN). Payees use Form W9 to give their Service CenterFile with Form 1096.Street address (including apt. no.) 6 If other than TRANSFEROR, name, address, and TIN ofFor Privacy Act andcorrect TIN to the person requesting it and, when applicable to: Paperwork corporation whose stock is being transferred Reduction Act Notice, see the City or town, state or province, country, and ZIP or foreign postal code current version ofthe GeneralAccount number (see instructions) Instructions for(Rev. 9-2016) 1. Certify the TIN given is correct, Certain InformationReturns.Form3921(Rev. October 2017) Department of the Treasury - Internal Revenue ServiceRequired envelope Apex DW19/s, SW19 or TFP 22221 or 22222, 11111 2. Certify payee is not subject to backup withholding, or 3. Claim exemption from backup withholding. For more information on backup withholding MISCELLANEOUS FORMS and requirements, obtain IRS Pub. 1679 A Guide to Backup Withholding, or Pub. 1281 Backup Withholding on Missing and Incorrect TINs.APEXTFP W4 EMPLOYEES WITHHOLDING ALLOWANCE CERTIFICATEDESCRIPTIONI-910251I-9 Laser1 page equals 1 form (20 Sheets per form/50 per pack) Employers are required to furnish W4 Certificates to all new employees. This form LW95311W9 Laser1 page equals 1 form incorporates IRS instructions to employees for filing exemption allowances.W-421102021W4 Laser 2021 1 page equals 1 form (2 Sheets per form/50 per pack) 3921 EXERCISE OF STOCK FORMSW-422102022W4 Laser 20221 page equals 1 form (2 Sheets per form/50 per pack) Every corporation which in any calendar year transfers to any employee a share of stock 3921A503921A3921 Laser Copy A1 page equals 3 forms pursuant to that employees exercise on an incentive stock option described in section 3921B503921B3921 Laser Copy B1 page equals 3 forms 422(b) must, for that calendar year, file Form 3921 for each transfer made during the year.3921C503921C3921 Laser Copy C1 Page Equals 3 Forms 3922 TRANSFER OF STOCK FORMS3921D503921D3921 Laser Copy D1 Page Equals 3 Forms Every corporation which in any calendar year records, or has by its agent recorded, a transfer of the legal title 3922A503922A3922 Laser Copy A1 Page Equals 3 Forms of a share of stock acquired by the employee pursuant to the employees exercise of an option granted under 3922b503922B3922 Laser Copy B1 Page Equals 3 Forms an employee stock purchase plan and described in section 423(c) (where the exercise price is less than 100% 3922C503922C3922 Laser Copy C1 Page Equals 3 Forms of the value of the stock on the date of grant, or is not fixed or determinable on the date of grant), must, for that calendar year, file Form 3922 for each transfer made during the year.55'