Software Vault: The Gold Collection/Software Vault - The Gold Collection (American Databankers) (1993).ISO/cdr20/fedzone.zip/APPEND-L.TXT

Text File | 1993-01-21 | 6KB | 363 lines

                           Appendix L

                          IRS Form W-8:
                  Certificate of Foreign Status








































                         Page L - 1 of 6

                                                The Federal Zone:


Reader's Notes:























































                         Page L - 2 of 6

                                                       Appendix L


























































                         Page L - 3 of 6

                                                The Federal Zone:


























































                         Page L - 4 of 6

                                                       Appendix L


                 ASSEVERATION OF FOREIGN STATUS

                      [Substitute W-8 Form]

This document  replaces/supersedes any/all  previous declarations
of status  by John  Q. Doe  and it  is to be used as my NOTICE OF
RESCISSION OF  ANY PREVIOUS  SIGNATURE AND ANY POWER OF ATTORNEY,
ab initio,  as it relates to any previous W-4, W-8, W-9, etc., as
well as Federal and State information forms or presentments.

California State/Republic )
                          )                ASSEVERATION OF STATUS
County of Marin           )


I, John Q. Doe, state, of Right, my Status as follows:

1.   That I am of lawful age and that I am competent to make this
     Asseveration of Status;

2.   That I  am  a  non-immigrant,  non-naturalized,  nonresident
     alien, non-taxpayer,  natural born  free American, Sovereign
     man and  an inhabitant  of a geographical area in a State of
     the American Union known as the California Republic;

3.   That I  am an American and nonresident alien with respect to
     the "United  States" (i.e.,  the District of Columbia, Guam,
     American Samoa, Virgin Islands, Commonwealth of Puerto Rico,
     etc.) with  no income effectively connected with a "trade or
     business" (26 U.S.C. 7701(a)(26)) within the "United States"
     (Government);

4.   That I  have never  knowingly,  willingly,  voluntarily  and
     intentionally  inhabited  the  state  of  the  forum  (Forum
     Contractus in Latin);

5.   That I  have never  been involved  in any  taxable "trade or
     business" activity  under 27  Code  of  Federal  Regulations
     (CFR) pursuant  to commerce in Alcohol, Tobacco Products and
     Firearms, State or Federal;

6.   That this Asseveration is to be used in lieu of Form W-8, as
     suggested by  that Form W-8, specifically:  "Use Form W-8 or
     a  substitute   form  containing   a  substantially  similar
     statement to  tell the  payor ... that you are a nonresident
     alien individual,  foreign entity,  or exempt foreign person
     not subject to certain U.S. information return, reporting or
     backup withholding rules."

The following information is given in lieu of a Form W-8:

     Name:          John Q. Doe
     Location:      c/o P. O. Box [xx]
                    San Rafael, California Republic


                         Page L - 5 of 6

                                                The Federal Zone:


     Please note:   I  do not  voluntarily use ZIP codes or other
     forms of  Federal Identification,  e.g., "CA",  "TX",  "FL",
     etc., because  I do  not  reside  inside  Government  (U.S.)
     Territory or any of its Federal Territories.

     U.S. taxpayer identification number:  not applicable

     See Form  W-8:  "... foreign persons [sic] are not generally
     required to  have a U.S. taxpayer identification number, nor
     are they  subject to  any backup withholding because they do
     not furnish  such a number to a payer or broker."  [Emphasis
     added for purposes of notification.]

     You are  hereby ordered  to purge  the "Social  Security  or
     Taxpayer I.D.  Number" as shown on Your "Payer's Request for
     Taxpayer Identification Number" form, if any.

     Check the appropriate space(s) with an "X":

     (   )     For Interest  Payments, I  am not a "U.S. citizen"
               or "U.S. resident";  AND

     (   )     For Broker  Transactions or Barter Exchanges, I am
               an exempt foreign Sovereign man.


THIS ASSEVERATION  OF STATUS  IS  TO  NOTIFY  PAYERS,  MIDDLEMEN,
BROKERS, AND  BARTER EXCHANGES NOT TO WITHHOLD OR REPORT PAYMENTS
OF INTEREST, BROKER TRANSACTIONS, OR BARTER EXCHANGES.

The W-8  accompanying this  ASSEVERATION OF STATUS should not and
cannot be attached to this ASSEVERATION OF STATUS but is enclosed
for information purposes only.


NUNC PRO  TUNC, this _____ day of __________, 19____ Anno Domini,
for June 21, 1948 (date of birth),

with explicit reservation all of my unalienable rights
and  without prejudice to any of my unalienable rights,



I, ______________________________________________________________
   (signature)

   ______________________________________________________________
   (printed name)


state that the foregoing is true in substance and in fact, to the
best of  my knowledge  and belief, and is made in good faith, and
that this asseveration could be used as evidence, and that I have
personal knowledge of the facts stated herein.


                         Page L - 6 of 6