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SEC Filings

S-4/A
RENAISSANCE MEDIA GROUP LLC filed this Form S-4/A on 08/06/1998
Entire Document
 
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                                PAYORS' NAMES:
                          RENAISSANCE MEDIA GROUP LLC
                       RENAISSANCE MEDIA (LOUISIANA) LLC
                       RENAISSANCE MEDIA (TENNESSEE) LLC
                     RENAISSANCE MEDIA CAPITAL CORPORATION

- --------------------------------------------------------------------------------
       SUBSTITUTE             Name (if joint names, list first and circle the
                              name of the person or entity whose number you
        FORM W-9              enter in Part 1 below.  See instructions if your
                              name has changed.)
                           _____________________________________________________
 
     Department of            Address
     the Treasury
                           _____________________________________________________

    Internal Revenue          City, State and ZIP Code
       Service
                           _____________________________________________________

                              Part 1 - PLEASE PROVIDE YOUR     Social Security
                              ------                           Number or TIN
                              TAXPAYER IDENTIFICATION NUMBER   
                              ("TIN") IN THE BOX AT RIGHT
                              AND CERTIFY BY SIGNING AND
                              DATING BELOW
                           _____________________________________________________
                              Part 2 - Check the box if you are NOT subject to
                              ------
                              backup withholding under the provisions of section
                              3408(a)(1)(C) of the Internal Revenue Code because
                              (1) you have not been notified that you are
                              subject to backup withholding as a result of
                              failure to report all interest or dividends or (2)
                              the Internal Revenue Service has notified you that
                              you are no longer subject to backup withholding.

                                                                            [_]

________________________________________________________________________________
                              CERTIFICATION--UNDER THE              Part 3 -
                              PENALTIES OF PERJURY, I               ------
                              CERTIFY THAT THE INFORMATION          AWAITING 
                              PROVIDED ON THIS FORM IS TRUE,        TIN
                              CORRECT AND COMPLETE.
                                                                            [_]
                              Signature: ________ Date: ______
                             
================================================================================


Note:  FAILURE TO COMPLETE AND RETURN THIS FORM MAY RESULT IN BACKUP WITHHOLDING
       OF 31% OF ANY PAYMENTS MADE TO YOU PURSUANT TO THE EXCHANGE OFFER.


YOU MUST COMPLETE THE FOLLOWING CERTIFICATE IF YOU CHECKED THE BOX IN PART 3 OF
                              SUBSTITUTE FORM W-9


            CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER

I certify under penalties of perjury that a Taxpayer Identification Number has
not been issued to me, and either (a) I have mailed or delivered an application
to receive a Taxpayer Identification Number to the appropriate Internal Revenue
Service Center or Social Security Administrative Office or (b) I intend to mail
or deliver an application in the near future. I understand that if I do not
provide a Taxpayer Identification Number by the time of the exchange, 31 percent
of all reportable payments made to me thereafter will be withheld until I
provide a number.



_________________________________________________    ___________________________
             Signature                                       Date

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