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State of Florida <br />Chief Financial Officer <br />Department of Financial Services <br />Bureau of Accounting <br />200 East Gaines Street <br />Tallahassee, FL 32399-0354 <br />Telephone: (850) 413-5519 Fax:(850) 413-5550 <br />Substitute Form W-9 <br />In order to comply with Internal Revenue Service (IRS) regulations, we require Taxpayer Identification information <br />that will be used to determine whether you will receive a Form 1099 for payment(s) made to you by an agency of the <br />State of Florida, and whether payments are subject to Federal withholding. The information provided below must <br />match the information that you provide to the IRS for income tax reporting. Federal law requires the State of Florida <br />to take backup withholding from certain future payments if you fail to provide the information requested. <br />Taxpayer Identification Number (FEIN): 59-6000674 <br />IRS Name: COUNTY OF INDIAN RIVER <br />Address: 1801 27TH STREET <br />VERO BEACH, FL <br />32960-0000 <br />Attention Of: FINANCE DEPARTMENT <br />Business Designation: Government Entity <br />Certification Statement: <br />Under penalties of perjury, I certify that: <br />1. The number shown on this form is my correct taxpayer information AND <br />2. 1 am not subject to backup withholding because: <br />(a) I am exempt from backup withholding or <br />(b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup <br />withholding as a result of failure to report all interest or dividends, or <br />(c) the IRS has notified me that I am no longer subject to backup withholding AND <br />3. 1 am a U.S. citizen or other U.S. person (including U.S. resident alien) <br />Preparer's Name: ELISSA NAGY <br />Preparer's Title: FINANCE DIRECTOR <br />Phone:7722261570 Ext: 1570 <br />Email: ENAGY@clerk.indian-river.org <br />Date Submitted: 07/02/2018 <br />Date printed from the State of Florida Substitute Form W-9 Website: 07/02/2018 <br />