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Fomn Ws9 <br />lRs+r. tMcamber20,A1 <br />I�Aew+� $i vlee� <br />on your <br />rs <br />Request for Taxpayer owa, Form to the <br />Identification Number and Certification requester, Do not <br />send to the IRs. <br />s Check appropriate box for federal tax atasaMeatkr4 check only one of the fokwhg seven boxes: 4 Ibr.m dons (odes apply omyto <br />er not Tdduale[3 mr or [3 C Caporwion [3 S Corpw.W- [3 Farmwoop ❑ Trustledsta bsvuctlm on pop 31: <br />e ; res <br />LLC <br />❑ Limited rablwy company. Enter the tax elaseMestlon (a.0 eorporw1m, S.S corporation, Pmpartnarthipl s E70 Pt Pay" code a only) <br />Note. For a etnplrmembw LLC cut b dbreparded, do mol cheek LiC; chat! the appropriate box b tlta ins above for Examptkn from FATCA reporting <br />tha tax cmeeiflcdion of the sknpb�rramtmer corner. cods P am <br />❑ Other (aft knstnucam)► POOMrnhWMM"^ •!crud <br />apt. or <br />U <br />Enter your 11N In the appropriate box. The TIN provided must match the name given on One 1 to avoid <br />backup withholding. For IndivWuals, this is generally your social security number (83N). However, for a <br />resident alkK4 sale propriatm or disregarded entity. see the Pert I Instructions on page 3. For other <br />antitias, R is your employer identification number (SIN). It you do not have a number, sea How to get a <br />17M an page 3, or <br />Note. If the account Is In more than one name, sea the instructions for Ina 1 and the chart an page 4 for <br />guldellnes on whose number to enter. r <br />new <br />Linder penalles of perjury. I certify that <br />- <br />1. The member 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. l am not subject to backup wititlloklttg because: (a) I am exempt from backup withholding, or (b) I have not bean notified by the Internal Revenue <br />Service (IRS) that I am subject to backup withholding as a result of a lalure to report all interest or dividends. or (c) the IRS has notified me that I turf <br />no longer subject to backup withhokfing; and <br />3. 1 am a U.S, chizen or other U.S. person (defined below): and <br />4. The FATCA code(s) entered an this form (if any) Indicating that I am exempt from FATCA reporting Is tarot!. <br />Cerd§catlan bu t uc ims. You must cross out item 2 above If you have been ratified by the IRS that you are currently subject to backup wilhhokling <br />because you have Waled to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mwgapa <br />Interest paid, acquisition or abandarunant of secured property. canceliaeon of debt. conbibutfans to an Individual re,irement wrwWmwd (IRA}, and <br />generefly, peymants other than Interest and dhddenris, you are not ragL lmd to sign the fin, but you must provide your corset TN. Sae the <br />Instnscdons on page 3. <br />at8n awksh" of <br />Here I U.B,penen► Dab ► <br />General Instructions <br />Section ref rercaa are to the tntprra, Aweare Cada urdme otbowiee noted. <br />Ftebm deWNeprrnenta. lnfanmatlan about devalopmnamds affecting Form W-9 (tach <br />as Iegwdlon arrested after wa release f4 le at www kspov/M9. <br />Purpose of Fora! <br />An individual or entity loam W-9 n mpAster) who Is n gndred to Idle an 1Mamatlon <br />return with the IRs mud obtain your>ro i r taxpayer Mian number MR <br />which may be your modal Wearily marmWrr {�M. kndlvtdual taxpayer idenHfiostlon <br />nuedrar (MhL &kp*m taxpayer kiwAca*m nrarbwr (A7 ft eremployer <br />Idendficedan number (814. to report an an Wornatkn rahmn the amotrd paid to <br />you, or other amount repodeble on an Wamtalion w1un. Examples of Inkmration <br />ratu mra km*We, but we not limited to. the fallowing: <br />• Form 1098 -INT Ontereat awned or ps" <br />Form 10911-M (dvideods. kmduding thole from docks or mutual funds) <br />• Fmrn 1099 MISC (various types of krcama, prizes. awards, or wm p of <br />• Form log" (stack or mutual fund Saba mrd certain othertrantaWo►ec by <br />brokers) <br />• Form, M—S (peoeeeda from raft osis traetaecum* <br />• Form 1094-K (mercharrt cad and third party network urn eacdorr) <br />• Form IM (home marlp" kstarmt1.1090-E (student loan kdwaat).1098•T <br />• Form 1025-C (canceled dsbtj <br />• Farr! IOWA {occp"den or abmrdarmwt of secued property} <br />Use Form W-9 oily g you ars n U.S. person f nduding a resident eller), to <br />provide your correct TIN. <br />11 you do not return Form W-9 to rhe requestat with a 7A your nVht be KWect <br />to bwAip wit tk fro See What & becimp wfthbc *W an pope 2. <br />By SIWJV the file&W lam, you: <br />to1 t o the TIN you are gk ft Is correct (or you are wetting for a number <br />be bwjlKL <br />2. CW* tlmt you are not subject to badarp widt4dirp, or <br />3. Claim exemption frmn backup wkMxgdft i( you ere it U.S. exempt paym if <br />apptmbla, you are rdw ar*ft duet ae a UA person, your atocable share of <br />any parMeeshlp bx me tram a US. trade or bxakmen Is not subject to the <br />wkhhd&v taxon foreign penmen' share at a fach* wmectad incemeend <br />4. Cw* that FATCA eode(e} en&WW an wiz term Of arryj kmdading fled you are <br />exempt fmmn the FATCA reperting, Is tamest. See What b FATCA reporting? an <br />papa 2 kr Wraw kdarmdbn. <br />Cd. NO. lo2S1X Foran v%9 F.W. 12 30141 <br />