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Farm W09 Request for Taxpayer Give form to the
<br /> (Rev.November 2005) Identiftcation Number and Certiftatlon requester. Do not
<br /> Department of the Treasury send to the IRS.
<br /> internal Revenue Seance
<br /> N Name(as shown on your income tax return)
<br /> m
<br /> w
<br /> ca
<br /> a Business name,if different from above
<br /> Ci
<br /> o Individual/ -_ ❑ Exempt from backup
<br /> Check appropriate box: ❑ Sole proprietor ❑ Corporation ❑ Partnership ❑ Other ► ................ withholding
<br /> 3
<br /> c
<br /> Address(number,street,and apt,or suite no.) Requester's name and address(optionaq
<br /> c
<br /> City,state,and ZIP code
<br /> m
<br /> Ust accout numbers)here(optional)
<br /> m
<br /> W
<br /> • Taxpayer Identification Number IN
<br /> Enter your TIN in the appropriate box.The TIN provided must match the name given on Line 1 to avoid Social security number
<br /> backup withholding, For individuals,this is your social security number(SSN). However,for a resident
<br /> alien, sole proprietor,or disregarded entity, see the Part I instructions on page 3. For other entities,it is
<br /> your employer identification number(EIN). If you do not have a number,see Haw to get a TIN on page 3. or
<br /> Note.If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number
<br /> number to enter.
<br /> • Certification
<br /> Under penalties of perjury, I certify that:
<br /> 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and
<br /> 2. 1 am not subject to backup withholding because: (a)I am exempt from backup withholding, or(b)I have not been notified by the Internal
<br /> Revenue Service(IRS)that 1 am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has
<br /> notified me that I am no longer subject to backup withholding, and
<br /> 3. 1 am a U.S. person(including a U.S.resident alien).
<br /> Certification Instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
<br /> withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
<br /> For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt,contributions to an individual retirement
<br /> arrangement(IRA),and generally.payments other than interest and dividends, you are not required to sign the Certification, but you must
<br /> provide your correct TIN.(See the instructions on page 4.)
<br /> Sign Signature of
<br /> Here I U.S.person ► Date ►
<br /> Purpose of Form •An individual who is a citizen or resident of the United
<br /> A person who is required to file an information return with the States,
<br /> IRS, must obtain your correct taxpayer identification number 9 A partnership, corporation, company, or association
<br /> (TIN)to report, for example, income paid to you, real estate created or organized in the United States or under the laws
<br /> transactions, mortgage interest you paid, acquisition or of the United States, or
<br /> abandonment of secured property, cancellation of debt, or a Any estate(other than a foreign estate) or trust. See
<br /> contributions you made to an IRA Regulations sections 301.7701-6(a) and 7(a) for additional
<br /> U.S. person. Use Form W-9 only if you are a U.S. person information.
<br /> (including a resident alien), to provide your correct TIN to the Special rules for partnerships. Partnerships that conduct a
<br /> person requesting it(the requester) and, when applicable, to: trade or business in the United States are generally required
<br /> 1. Certify that the TIN you are giving is correct(or you are to pay a withholding tax on any foreign partners' share of
<br /> waiting for a number to be issued), income from such business. Further, in certain cases where a
<br /> 2. Certify that you are not subject to backup withholding, or Form W-9 has not been received, a partnership is required to
<br /> 3. Claim exemption from backup withholding if you are a presume that a partner is a foreign person, and pay the
<br /> U.S. exempt payee. withholding tax. Therefore, if you are a U.S. person that is a
<br /> partner in a partnership conducting a trade or business in the
<br /> In 3 above, if applicable, you are also certifying that as a United States, provide Form W-9 to the partnership to
<br /> U.S. person, your allocable share of any partnership income establish your U.S. status and avoid withholding on your
<br /> from a U.S. trade or business is not subject to the share of partnership income.
<br /> withholding tax on foreign partners' share of effectively
<br /> connected income. The person who gives Form W-9 to the partnership for
<br /> Note. If a requester gives you a form other than Form W-9 to purposes of establishing its U.S. status and avoiding
<br /> withholding on its allocable share of net income from the
<br /> request your TIN, you must use the requester's form if it is
<br /> substantially similar this Form W-9. partnership conducting a trade or business in the United
<br /> States is in the following cases:
<br /> For federal tax purposes,you are considered a person if you a The U.S. owner of a disregarded entity and not the entity,
<br /> are:
<br /> Cat.No.10231X Form -9 (Rev.11-2005)
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