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Form W-9 Request for Taxpayer Give Form to the
<br /> De December Treasury
<br /> Identification Number and Certiflcation requester.Do not
<br /> DeparVnent oftheervice send to the IRS.
<br /> Intemal Revenue Service
<br /> 1 Name(as shown on your incoQ�e tax return).Name is required on this line;do not leave this line blank,
<br /> ni 2 Business name/disregarded entity name,If different from above
<br /> m
<br /> to
<br /> 3 Check appropriate box for federal tax classification;check only one of the following seven boxes 4 Exemptions(Codes apply only to
<br /> m ❑Indivldual/sole proprietor or ❑ C Corporation 0 S Corporation ❑ Partnership ❑Trust/estate
<br /> o
<br /> �n entftes.nokldivkkWs,See
<br /> ❑single-member LLC 3)
<br /> Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► Exempt payee code Of any)
<br /> t3 Note.For a single-membercheck LLC that Is disregarded,do riot check LLC; the appropriate box In the line above for Exemption from FATCA reporting
<br /> _ the tax classification of the single-member owner. code(If�Y)
<br /> rLc
<br /> ❑other(see Instructions)► r vow,m a=mm nr awd Wow.aM u sJ
<br /> 5 Address(number,street,and apt.or suite no.) Requester's name and address(optionaQ
<br /> C 4 5 no )c j a\ \r - 1 23, -3
<br /> 6 City,state,and ZIP code
<br /> 7 List account number(s)here(optional)
<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 I social securfty number
<br /> backup withholding.For individuals,this is entity,your social security number(SSN).However,for a FM _
<br /> m —
<br /> resident alien,sole proprietor,or disregardedd entity,see the Part 1 instructions on page 3.For ocher
<br /> entities,it is your employer Identification number(EIN).If you do not have a number,see Now to get a
<br /> TIN on page 3. or
<br /> Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer identification number
<br /> guidelines on whose 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 waking 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 Revenue
<br /> Service(IRS)that I am subject to backup withholding as a result of a failure to report all Interest or dividends,or(c)the IRS has notified me that I am
<br /> no longer subject to backup withholding;and
<br /> 3. 1 am a U.S.citizen or other U.S.person(defined below);and
<br /> 4.The FATCA code(s)entered on this form(f any)indicating that I am exempt from FATCA reporting is correct.
<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 withholding
<br /> because you have failed to report all Interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage
<br /> Interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and
<br /> generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the
<br /> instructions on page 3.
<br /> Sign signature� I
<br /> Here U.S.person►• _ --r �`� Date► % �'
<br /> •Form 109a(home mortgage interest),1098-E(student ban Interest),logs-T
<br /> General Instruct 4S
<br /> (tunlon)
<br /> Section references are to the Intemal Revenue Code unless otherwise noted. .Form 1099-C(canceled debt)
<br /> Future developments.Information about developments affeding Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
<br /> as legislation enacted after we release it)Is at www.lrs.gov/fw9.
<br /> Use Form W-9 only If you are a U.S.person(including a resident allen),to
<br /> Purpose of Form provide your correct TIN.
<br /> An Individual or entity(Form W 9 requester)who is required to file an Information If you do not return Fann W 9 to the requester with a TIN,you might be sub/eat
<br /> return with the IRS must obtain your correct taxpayer Identification number(TIN) to backup withholding.See What is backup withhokAng9 on page 2.
<br /> which may be your social security number(SSN),individual taxpayer Identification By signing the filled-out form,you:
<br /> number(RIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving Identification number(E1N),to report on an Information return the amount paid to to be Certify
<br /> y g ng is correct(or you are waking for a number
<br /> you,or other amount reportable on an Information return.Examples of information eM'
<br /> returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or
<br /> •Fort 10994NT pnterest earned or pairs 3.Claim exemption from backup withholding N you are a U.S.exempt payee.If
<br /> •Form 1099-DN(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your akocable share of
<br /> partnership Income from a U.S.trade or business Is not to the
<br /> •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign ppwtners'share of effectively connected come,and
<br /> •Font 1099-6(Stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form Of any)Indicating that you are
<br /> brokers) exempt from the FATCA reporting,is correct.See What Is FATCA reporting?on
<br /> •Form 1099-S(proceeds from real estate transactions) page 2 for further information.
<br /> •Form 1099-K(merchant card and third party network transactions)
<br /> Cat.No,10231X Form W-9(Rev.12.2014)
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