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Dallas, TX
April 21, 2016

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Form W-*

(Rev. August ****)

Department of the Treasury

Internal Revenue Service

Application for IRS Individual

Taxpayer Identification Number

For use by individuals who are not U.S. citizens or permanent residents.

See instructions.

OMB No. 1545-0074

An IRS individual taxpayer identification number (ITIN) is for federal tax purposes only. Before you begin:

• Do not submit this form if you have, or are eligible to get, a U.S. social security number (SSN).

• Getting an ITIN does not change your immigration status or your right to work in the United States and does not make you eligible for the earned income credit. FOR IRS USE ONLY

Reason you are submitting Form W-7. Read the instructions for the box you check. Caution: If you check box b, c, d, e, f, or g, you must file a tax return with Form W-7 unless you meet one of the exceptions (see instructions). a Nonresident alien required to get ITIN to claim tax treaty benefit b Nonresident alien filing a U.S. tax return

c U.S. resident alien (based on days present in the United States) filing a U.S. tax return d Dependent of U.S. citizen/resident alien

e Spouse of U.S. citizen/resident alien } Enter name and SSN/ITIN of U.S. citizen/resident alien (see instructions) f Nonresident alien student, professor, or researcher filing a U.S. tax return or claiming an exception g Dependent/spouse of a nonresident alien holding a U.S. visa h Other (see instructions)

Additional information for a and f: Enter treaty country and treaty article number Name

(see instructions)

1a First name Middle name Last name

Name at birth if

different . .

1b First name Middle name Last name


mailing address

2 Street address, apartment number, or rural route number. If you have a P.O. box, see separate instructions. City or town, state or province, and country. Include ZIP code or postal code where appropriate. Foreign (non-

U.S.) address

(if different from


(see instructions)

3 Street address, apartment number, or rural route number. Do not use a P.O. box number. City or town, state or province, and country. Include ZIP code or postal code where appropriate. Birth


4 Date of birth (month / day / year) Country of birth City and state or province (optional) 5 Male Female



6a Country(ies) of citizenship 6b Foreign tax I.D. number (if any) 6c Type of U.S. visa (if any), number, and expiration date 6d Identification document(s) submitted (see instructions) Passport Driver’s license/State I.D. USCIS documentation Other

Issued by: No.: Exp. date: / /

Date of entry into the

United States

(MM/DD/YYYY) / /

6e Have you previously received a Internal Revenue Service Number (IRSN) or employer identification number (EIN)? No/Do not know. Skip line 6f.

Yes. Complete line 6f. If more than one, list on a sheet and attach to this form (see instructions). 6f Enter: IRSN or EIN and

Name under which it was issued

6g Name of college/university or company (see instructions) City and state Length of stay



Keep a copy for

your records.

Under penalties of perjury, I (applicant/delegate/acceptance agent) declare that I have examined this application, including accompanying documentation and statements, and to the best of my knowledge and belief, it is true, correct, and complete. I authorize the IRS to disclose to my acceptance agent returns or return information necessary to resolve matters regarding the assignment of my IRS individual taxpayer identification number (ITIN), including any previously assigned taxpayer identifying number.

Signature of applicant (if delegate, see instructions) Name of delegate, if applicable (type or print)

Date (month / day / year)

/ /

Phone number

Delegate’s relationship

to applicant

Parent Court-appointed guardian

Power of Attorney




Signature Date (month / day / year)

/ /



Name and title (type or print) Name of company EIN PTIN Office Code

For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 10229L Form W-7 (Rev. 8-2013)

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