UC Santa Barbara                                Attachment 5150 C
  Policies                                              
  Issuing Unit:  Administrative Services          Date: September 1, 1982
  
  
  
             UNIVERSITY OF CALIFORNIA, SANTA BARBARA
                        Accounting Office
                                
      CERTIFICATION OF TAX EXEMPTION FOR PERSONAL SERVICES
                                
                                               File No.  225-50
                                                       or    260-50
  
  This is to certify that I am a citizen of_____________________and a
  resident of____________________; that I entered the United States on
  __________________; that I am performing personal services at the 
  University of California, Santa Barbara, during the period 
  from____________to_____________; that I will be in the United States 
  for a period or periods not exceeding ________days during the tax 
  year____________; and that total compensation received by me for such 
  personal services will not exceed  $____________.
  .
  
  Because of this certification I claim excemption from United States
  withholding tax in accordance with Article__________of the Income Tax
  Convention between the United States and
                                                                .
  
  I declare under the penalties of perjury that this statement, to the best
  of my knowledge and belief, is true and correct.
  
            Signature
            Name
            Foreign Address
  
            Local Address
  
            Taxpayer Identification Number
            Date
  
                      PRIVACY NOTIFICATION
                                
  STATE
  
  The State of California Information Practices Act of 1977 (effective July
  1, 1978) requires the University to provide the following information to
  individuals who are asked to supply personal information about
  themselves:
  
  The principal purpose for requesting this information on this form is to
  report payments for income tax purposes to Federal and State governments,
  as applicable.  University policy and State and Fedeeral statutes
  authorize the maintenance of this information.
  
  Furnishing all information requested on this form is mandatory - failure
  to provide such information will delay or may even prevent the payment
  for which this form is being filled out.  Information furnished on this
  form is used by University departments for nonpayroll payments, and may
  be transmitted to the State and Federal governments as required by law.
  Individuals have the right to access to this record as it pertains to
  themselves.  Campus Accounting Officers are responsible for maintaining
  the information contained on this form.
  
  FEDERAL
  
  Pursuant to the Federal Privacy Act of 1974, you are hereby notified that
  disclosure of your social security number is mandatory.  Disclosure of
  the social security number is required pursuant to Sections 6011 and 6051
  of Subtitle F of the Internal Revenue Code and pursuant to Regulation 4,
  Section 4041256, Code of Federal Regulations, under Section 218, Title II
  of the Social Security Act, as amended.  The social security number is
  used to verify your identity.  The principal uses of the number shall be
  to report payments and income taxes withheld to Federal and State
  governments.
  7/82

For questions or comments regarding the format of the above information, please contact webcontact@ucsbuxa.ucsb.edu.

Last Modified By: HMW, 5/21/97

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