AO 215(08/18)ADMINISTRATIVE OFFICE OF THE UNITED STATES COURTSRequest to Determine Foreign Vendor Tax PaymentsFor any questions regarding the taxability of your foreign vendor payment, please contact the PaymentManagement Branch by phone at 202-502-4829 or via email at taxcompliance@ao.uscourts.gov . All Fields outlined inred are required.Payee Name:Vendor Code:Amount to be paid (In Dollars):Principal:Interest (if applicable):Type of Payment (select one):Restitution; Unclaimed Funds;Registry Funds; Criminal Bond; Contract;Criminal Justice Act (Attorney);Criminal Justice Act (Services Other than Counsel); or Other (Explain):If a service contract or CJA vendor, will the service be performed in the United States?Funding Information:Fiscal YearFundBudget OrgCost OrgObject CodeObligation:NumberTypeItem LineAccounting LineProposed Payment Method:Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com AO 215(08/18)ADMINISTRATIVE OFFICE OF THE UNITED STATES COURTSRequest to Determine Foreign Vendor Tax Payments If payment is to be made via international wire transfer, provide the following Bank information as applicable:Legal Name on Account:Account Holders Address:Receiving BankSWIFT Routing # or SWIFTBIC:Bank Name:Bank Address:Bank Account Number:IBAN, BSB (Australia) or CLABE (Mexico):Sort Code:Domestic United States Intermediary Bank (If applicable)ABA Routing # or SWIFTBIC:Bank Name:Bank Address:Bank Account Number:International Intermediary Bank (If applicable)SWIFT Bank Identifier Code (SWIFTBIC):Bank Name:Bank Address:Bank Account Number:IBAN, BSB (Australia) or CLABE (Mexico):Sort Code:Name of RequesterCourt Unit/FPDOPage 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com