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For, W-9 Request for Taxpayer Give Folin to the
<br />(Rev. December 2014) Identification Number and Certification requester. Do not
<br />Department of the Treasury send to the IRS.
<br />Internal Revenue Service
<br />1 Name (as shown on your Income tax return). Name is required on this line; do not leave this line blank.
<br />2 Business name/disregarded entity name,
<br />3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to
<br />❑Individual/sole proprietor or C Corporation S oration Partnership Trustlestate certain entities, not individuals; see
<br />❑ orPora ❑ Corporation ❑ P ❑ instructions on page 3):
<br />single -member LLC Exempt payee code (d any)
<br />❑ I-Imited liability company. Enter the tax classification (C -C corporation, S -S corporation, Pmpartnership) >
<br />Note. For a single -member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for Exemption from FATCA reporting
<br />the tax classification of the single -member owner. code (d any)
<br />❑ Other (see Instructions) ► PAW" e*wwu=m4xu4rdcuWW do U.84
<br />and apt. or suite no.)
<br />name
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I social security number
<br />backup -1For individuals, this is generally your social security number (SSN). However, fora
<br />resident alienien,, sole sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
<br />entities, it is your employer identification number (EIN). if you do not have a number, see Now to get a
<br />TTN 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 F&r p -coyer identification number
<br />guidelines on whose number to enter. I I I ITT]
<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 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 l 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 (if 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 amangement (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 />vrasr I Signature of
<br />Here U.S. person ► Date ►
<br />General Instructions
<br />Section references are to the internal Revenue Code unless otherwise noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release it) is at www.irs.gov/Av9.
<br />Purpose of Form
<br />An Individual or entity (Form W-9 requester) who is required to file an information
<br />return with the IRS must obtain your correct taxpayer identification number (TIM
<br />which may be your social security number (SSM, Individual taxpayer Identification
<br />number (MM, adoption taxpayer identification number WnM, or employer
<br />Identification number (EIN), to report an an Information return the amount paid to
<br />you, or other amount reportable on an information return. Examples of information
<br />returns Include, but are not limited to, the following:
<br />• Form 1099 -INT ¢nterest earned or paid)
<br />• Form 1099 -DN (dividends, Including those from stocks or mutual funds)
<br />• Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds)
<br />• Form 1099-B (stock or mutual fund sates and certain other transactlons by
<br />brokers)
<br />• Form 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 (home mortgage Interest), 1098-E (student loan interest), 1098-T
<br />(tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only If you are a U.S. person (including a resident alien), to
<br />provide your correct TIN.
<br />Ifyou do not return Form W-9 to the requester with a 71N, you might be subject
<br />to backup withholding. See What is backup withholding? on page 2.
<br />By signing the filled -out form, you:
<br />1. Certify that the TIN you are giving Is correct (or you are waiting for a number
<br />to be Issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
<br />appOcable, you are also certifying that as a U.S, person, your allocable share of
<br />any partnership income from a U.S, trade or business Is not subject to the
<br />withholding tax on foreign partners' share of effectively connected Income, and
<br />4. Certify that FATCA code(s) entered on this form (if any) indicating that you are
<br />exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
<br />page 2 for further Information.
<br />Cat. No. 10231X Forth irilf-9 (Rev. 12-2014)
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