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2017-06-22_GENERAL DOCUMENTS - M2006017
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2017-06-22_GENERAL DOCUMENTS - M2006017
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Last modified
8/17/2017 11:42:00 AM
Creation date
8/17/2017 11:32:07 AM
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DRMS Permit Index
Permit No
M2006017
IBM Index Class Name
General Documents
Doc Date
6/22/2017
Doc Name
Correspondence
From
Premier Silica LLC
To
DRMS
Email Name
BJC
Media Type
D
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No
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Farm W-9 <br />MDV. December 2014) <br />Depetnnant of the Treewry <br />Internal Revenue Service <br />4 <br />Request for Taxpayer <br />Identification Number and Certification <br />I Name (es stlown on your Income tax return]. Name Is n <br />INDUSTRIAL SANDS HOLDING COMPANY <br />2 Business nameldtsrmarded entity name. N different fro <br />PIONEER SANDS LLC <br />not leave oft <br />M 70 D a Oil <br />Give Form to the <br />requester. Do not <br />send to the IRS. <br />3 Cheek appropriate box for federal tax clualHation; dmck only one of the loilowhp seven boxes: 4 Exemptions (codes apply only to <br />❑ irrdivfdto dsol* proprietor or 0/ C Carporatlon ❑ 5 Corporation ❑ Partnership ❑ TnWiestate COrtairn enUda, not Individuals see <br />sinple•member LLC an page 3)' <br />❑ Urnited liability company. Enter the tax classiscation (CaC corporetio,. S&S corporation, wpwtnesNp) ► Exempt payee code M WA <br />Note. For a slrgle-member LLC that Is dW@prded, do not ctrack LLC; check the appropriate box In the line above for Exemption from FATCA reporting <br />Um tax classlficzN of the sh Wmembw owner. code of No <br />❑ ottaer (see instructions) P. 14a►. u•®,e 06OW a. aur <br />is Address tnumba , street, and apt. or suite no.) <br />5205 N. O'CONNOR BLVD., SUITE 200 <br />IRVING, TX 75039 <br />T list account nunbKW here <br />Enter your TIN in the appropriate box. The TIN provided must match the name given on One 1 to avoid I social eocuty rermber <br />backup en,solwithholding. For Indivfetor, r ls,alis this is generally your social security number (SSM. However,orother fora <br />resident men, note proprietor, or disregarded enilty, ace the Pert ! instructions on page 3. For other <br />entitles, it Is your employer kientification number (EIN). If you do not have a number. we Now fo pet a <br />TIN on page 3. or <br />Nota. If the account is in more than one mune, see the InstrWk ms for One 1 and the chart on page 4 for I Empleyef Idantlflcatian number <br />guidelines on whose number to enter. <br /> <br />Under penalties of perMy, I codify that: <br />1. The number shown an this form is my cornea taxpayer Identificatton number jot I tort walling 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 QRS) 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 withholdhV. and <br />3. 1 am it U.S. citizen or other U.S. person (dented below); and <br />4. The FATCA code(s) ordered on this forth (it any) Indicating that I am exempt from FATCA reporting is correct <br />Certification Instructions. You must Moss 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, Ilam 2 does riot apply. For mortgage <br />Interact paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and <br />generally. payments other and divider you are 90 required to sign the cedificadon, but you must provide your correct TIN. See the <br />Instructions on page 3. J / <br />Sign Signature of I <br />Here U.S.parsonio ykU'—!:t0Cate. <br />General Instruct) cls • Foam 1098 (horn. mortgage Interest), toga -E (student Inn interest), 1098-T <br />tuition) <br />Section references arra to the Internet Revenue Code unless otherwise noted. a Form 1099-C (canceled debt) <br />Futuro developments. Information ebmd developments afree ft Form W-9 (such . Form 1099-A *qulsition or abandonment of sacued property) <br />as legislation enacted after we release N) Is at www.rrsgvv1iw9. <br />Purpose of Form provide �w correct TI u era a U S person {Irrcluding a resident din), to <br />An Individual or entity (Form W-9 request&) who is required to We an Information <br />feint with the IRS must obtain your correct taxpayer identification number (TIM <br />which may be your social security number (SSN), kublldural taxpayer Identification <br />number {ITIN}. adoption taxpayer Identification number "N). or employe <br />identlliallm number (pit}, to repot on an Information return the amount paid to <br />you, or other amount reportable on an InEartnadon return Examples of Information <br />returm k clrrde, but aro not limited to. the following: <br />• Form 1099-1NT {Merest named or paid) <br />• Form IM -01V (dividends, Including those from stocks or mutual funds) <br />• Form 1099-MISC (vatious types of Income, prtms, awards, or gross proceeds) <br />• Form 1099-B (stock or mutual fund oaks and certain other trensac8ona by <br />brokers) <br />■ Foran 1099-5 {proceeds from real estate transactions) <br />• Forts 1099-K (merchant card cad third party nelwartr transact onsj <br />M you do not return Fahr! W-9 to tree requester with a TIN, you rn"t be sub/ect <br />IQ backup wAhhokft. Seo Whet Is backup wfHdrafabrp7 on page 2. <br />By signhg Ura filed -out tome, you: <br />1. Certify that the TIN you are 91vhg Is cored (or you arra waiting for a number <br />to be Issued). <br />2 Certily that you are not subiW to backup withholding, or <br />3. Claim exemption from backup willgioldln9 9you are a U.S. exempt pays*. It <br />spplloable you arra also anifylng fiat as a U.S. person, your allocable share of <br />any pannersNp Im:ame from a U.S. Veda or business Is not subject to the <br />withholding lax on foreign partners' sham of oflectively connected Income, and <br />4. Certify that FATCA cods(s) entered on this fern (N any) fndlrafinp that you ars <br />exempt from Um FATCA roporft. Is correct. See What k FATCA repodirV? on <br />page 2 for Wher hfommft n. <br />Cat. No. 10231X Farm W-91Rev. 12-20141 <br />
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