ࡱ> CEBe  bjbj@@ 4"-f"-f^^8  !`  $i$'b   ,,,R , ,,:X,M8 oLR t  0 !R''', D !'^ i:  Compensation paid to a nonresident alien for services performed entirely outside of the United States is considered to be foreign source income; therefore, no U.S. tax withholding is required. If the service is performed both within and outside the U.S., the total amount of the compensation must be prorated based on the total amount paid and total time associated with the performance of the service. This exclusion from gross income is applicable to both dependent compensation (i.e., employee wages) and independent compensation (i.e., independent contractor fees). INSTRUCTIONS: Individual Providing the Service: Complete the following information and provide the completed form to your ߲о Representative ߲о Representative: Attach the completed form to the request for payment (e.g., AP Voucher). ________________________________________________________________________ I, {Name}, certify that I am not a U.S. Citizen or permanent resident alien, and all {or the specified portion} of the services I performed for ߲о were performed in {country}. {Name} {Mailing Address} {Email Address} {Full or Prorated Amount/Currency} _______________________________________________ Signature _______________________________________________ Date     Controllers Office 5400 College Station Brunswick Maine 04011-8445 Tel 207.725.3787 Fax 207.725.3920 Form Revised 09/12/19 (LT) DL ? @ A P Q r u # 5 6 7 8 9 ־ִrִִh9=hDX5OJQJ^Jh9=OJQJ^Jh9=h9=5OJQJ^Jhq{h9=5OJQJ^Jhq{hDX5OJQJ^JhDXOJQJ^Jhu1OJQJ^JhDXhDX6OJQJ^JhDXhDXOJQJ^Jh OJQJhQNOJQJjh OJQJU*@ A Q 8 9 B C J \  !gdK  !gdDX & F !h^hgdDX $ !a$gd9=$ & F !h^ha$gd9= $ !a$gdDX !   % ) 7 A B C J K S Z \ ] j l m ~ q`Vh9=OJQJ^J!hchKB*OJQJ^JphDr!hchq{B*OJQJ^JphDr!hch9=B*OJQJ^JphDrhKB*OJQJ^JphOh},S/B@B@h-B@֨d@!P ~_ >}, ! j! |X!घtI HG@6c/:$qB@B@uB@e%B@Z(6Z >}, ! j! 5Z >},X]Y9999xUK)2} paPɃBRB@Q#p˗~u_xn.;(  \߼q_?=:O|"UZF!wY fɽW=4q`:OKq+o;* ..~ú,UUvA\TZ: $smOݶ~ܢMtW#4KQQ X -Y;T| bjw`~f˃pN=VY_];#ԨdV_ڂ3߼z79 o/Di>ѳ<ϯ%% VըGoǷ=63i@@u͏7I…_]ǟVݓ}ـT7VMRL4,\!Wfطg(h8G)R1$5QXmKkԂl6aFAt6mBv(Q6x`}u "ZJ|/(&9lۆ3## MJ»X=xLؐ 'X,nzfI sRh zP#): )Îa:TRr("F1[I1 $4C4FxtFQ 20zW֧3h矐|DHP_/+O5+" ~Nuͼ}Whf cGknvܮzCd4Q_Q,S#~hWdzHOd1kKW^l԰LIjqF`)R[gW IrPS;W|[L-Q ZLqWl\Na]Wu {Ŧ#/O.blbmcþ!@fqOc(CV:ؚo|+왧5ߟe!F ¤zFDԽoL};N=iXI ?SL[޻C9-ěOAUpnXZk[?zvbIɰI /gHԲǓ:7<ƻ@t14MZz!㇟3μ|lFFn} ҋ#!P?0~@kgyw1/\΋E井xG20#L^~t"SEԧp76nԄBߟNڧO2 L:fpzw򢼦.RrI:8g[Zņ r׾,M^<:6]4}+jT}+Lput\hA׹ H VYށ5Fvd8ak 0n.}&O>*\̽~(x27^k`>IM*vs Gӹgbc'K}E aGOѝYuf4X!<(Dh N)DJ7Uc8Hl#Ռ *aHM@oz8cؕ$PvXW'a4=(́#A +z]<|^:Y0) I;\1Rѱbиsh~_^sMTVV@ë]?<'1`?- |F n 7${܈ פ0hC2Rˬ@סN%T4~ݲ6'/^U5/^mNxÑ)&KȀ;pX[[;-L 4Gԓhey 1>J*Ix^;q %hCZߥHUBcACTCA9D_oM)xZ9>~PU脱"1 4;ӡp#9r?Ow;zvBEu곡JNuLHI2 a*2XaGIM$aKFI Y08u틔MwӦʩڜܶL:"xnRˍYGsm#k9/<˫F y "u43,Go DZg(dL猡m)gg2ZdQ؝zth̲ (wYLvfdf(?єBGj?Rz`N2*2 D^b"0fh&IJ8%ݱ1Dj@_3PdGjب`jkH]e΁OfEUMW0@UH^&rMU{DQ>>z"&53L+@v ƂpSqn}KVC&2hV, o%XQ d," 't?2(Y"bi=uFjOf8ssWŴO?C1=b1#(~R~2,CpS]R#bj8ĠfYފSߕ5ʧ ;͕@8>nmf DpnT(qձG!ZL8zQl WG6 ,?ҢB^ѐG׋Q!kd?M>c|;F{tSG(YӘ6y77 UE-X8Έu=gH Cy3W6F`b\rkoC.{d,1+ɛNB]TI侁eZ[Z<"L$8#+B)1@j4%Ze;y5iDj2'ۦ7)U`:36&S82if\ RplgD/(wW^b(I3͔F46k4zL:&(Üd{5̍v̚9E2ݏ#;I~WwFMҫ/]V(|Tt!J.x⇈V' ɋKSéۨr7\c{jLڀYU-C&ì0&Vi#k[5_iVo龍ˍH!ZR%9kHe>QP)w=FܐVBFyF" ʵ8tιCI'RFqL;y<"մ J2Ck[\IpI k"Yҍk^ 7w:}%UBˠ5vMœ3vE>w ai=]zy#"ͤ >oH,H0(J- ϳ H>sDi.ưn~߱5J^xYgU.kt\*;,ON&n(Ky-KUG/MT{R"m hCF#Uu)nүSCSGD.`~Etbڱ%E4kĆ/v4HP)3"=G5@ I'kWi^ycB;pi"`5"z(0h(Eq+6 IQhs)0H<`>=[;y=!fM}7eާ$m3ƣ) _iPeLQջ hS^WR 𠓷p !5F^gk2 `ڒ4Arftn']%l[ k.h&*2 dRP5YBdFƈwۥ6"JO@Mc=x1=j¯.D@)^٪-<&) b9dD6,dl`Q1S^8Q[XH2D9C$HwX#5>D @LTpO0]~_YRmsAu"V0w|'Fo8;48JDBRpR))Q?>[xMnBF^Q~),L8DvğR-; ':qGda,1s=pk&嚷x,PR.2ҤGӡFgO]Wt ZQۥ?5 $D|`PgJL:͗LuuL!$x&&ZYJ~O{`іB%: v$dT ZrSM5@ޮ*2X~-_,U&UcL"X|Ua23ab?$8M;:W7jv9[i-T#[;2m^ m˖hqbk3,eIP2-mݬi/ QFƲ!=K!Zd0†[bwIhF6fFlSzfι8y/9Xc0X~1< Vj+{7eI ʹ$2-k4@UX y:I6ZFR G1ToT 955L$p2 {22JWپ@w:<@_$FF9{7BL@ Rtb$͑-j|+!W`1>iRLLFG^$알3G`=뚯2yZf9 .gF!R1zՑBgȩCDqL !3!"GEC@jt8&zv]^3XDBE@( ! 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