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Form w-9 Fay. 12-20141 Pape 4
<br />Part 11, Certification
<br />To esUb6gr to the wht>ftak" epeM that you ere a U.S. person, of resident din.
<br />sign Form W-9. You may be requested to sips by the withholding agent even H
<br />Items 1, 4, or 5 below Indicate otarwlee.
<br />For a job►t account, any line person whose TIN Is shown in Part I should sips
<br />(when ngdn4. In do me at a d bogarded entity, the person Identified on ins 1
<br />must sign. Exempt payees. ass,& mptpayee code eerier.
<br />4lgnobura requirements. Complete the artificadan as Indicated In Items 1
<br />through 5 below.
<br />1. Interest, dividend, and bwtsr uAlveme accounts opened before 1984
<br />and bmMr a000urds considered eadve during 1ti63. You must On your
<br />correct TN. but you do not have to sign the fxr5firetbn.
<br />2. InW*K dhvWvrtd, broker, and barter esaMnge aoaounts opened after
<br />12a and broker amounts eafuldered hnative dw tg 1914. You must sign the
<br />certification or badarp witdroidkg will appy. N you are a A*W to backup
<br />witdtcidkng and You are merely providMp your cotrect TIN to the requester. You
<br />must cross out Item 2 In the certlSrurMon bion signktp the form.
<br />L Real estate transactions. You Must sign the cardlic:atfon. You may hose out
<br />Bern 2 of the ardflwtlon.
<br />4. Other payments. You must give your ttorrsct TIN, but you do not have to sign
<br />the card iatlen unless you haws been nodal that you have previously given an
<br />Incorrect TIN. "Dour pWmw tor" linckrde payments made in Bre cam of the
<br />rsquate's us& or business to rents, royalties, goods [other them bila far
<br />merchandise), medial and health an servioes OxMiling payments to
<br />corporations). payrnents to a sattimmW f paymentcard end third party bansa s, payments to
<br />cwUM fishing boat waw members and fisherman. end Won proceeds paid to
<br />attarnsya Oncluding ItaYmems to corporal!").
<br />S, Htortpsge interest paid by you, aaWaltion or eberulmmeM of aeaurad
<br />preperty, um IlWan of debt, qualified hditn program payawrifa (ceder
<br />station 629J. M& CovardeU BBA, Archer MBA Or NSA aonhlbutions or
<br />dletribubmw do not hffw toand You mat give your correct TIN, but you
<br />What Name and Number To Give the Requester
<br />For "type of account:
<br />Ola name and BSN oh
<br />1. Indh4dual
<br />The kKvvtdual
<br />2. Two or mon Intbvid nle point
<br />The actual owner of the account or,
<br />IMCCMM14
<br />If earnbktad f mit the first
<br />kndlvkhW on tuns account'
<br />3. Cus%dlsn account of a minor
<br />The minor
<br />Wnilorm Ml1 to Mkwrs Acq
<br />4. s. The usual maable savings
<br />The grantor-tr alse
<br />trust {grarrtar le also trustsej
<br />b. SO -called refuel eecatrtt that !e
<br />The eehml awns?
<br />not a legal or wand trust under
<br />state law
<br />S. Bob Proprietorship or disregarded
<br />The Owner
<br />erudty owned by an Individual
<br />& Grantor trust filing under OptlrnuY
<br />The grarw
<br />Form 1069 FIBng Method 1 Pte
<br />4 WIOM "CON 1AT1 4MM
<br />For this type of Possum
<br />gin nano and IIIIN at
<br />7. Disntparded ernhy not owned by an
<br />The owner
<br />lndMdud
<br />6 A velli trust. estate, or pension trust
<br />Legal amny
<br />4. Corporation or LLC slatting
<br />Ths corporation
<br />twpcm* status on Fpm all= or
<br />Form 2553
<br />10. Association, dub, reiplous,
<br />The orgenhadon
<br />exal ta4le or other tax -
<br />11. PwbmzW or muliinamber LLC
<br />The pertnerahip
<br />12. A bfokar ar reghtered nominee
<br />The broker or nominee
<br />13. Account Wlh the Department of
<br />The public entity
<br />Agricuftme In the mane of a pubic
<br />entity Ouch as a aide or local
<br />govert moo, school dhbkt, ar
<br />peiscro that receives egmiwtkual
<br />pmgnm paNments
<br />14. Grantor trust OM trtdsr the Form
<br />Tha trust
<br />1041 FEBng Method orthe Options!
<br />Foran 1099 Fling Method 2 (ore
<br />Regulations seadon VOI-4(bM
<br />' yip brat rd ride sea acme o11da person whm rudm you hrnhh. 0 orb aro person on a
<br />loins a=ast las an 5W, dot parson's rxv dm = t be fumtethed
<br />'G:CNterMkoftplenaandfu *m InanWWftUK
<br />'Yau must show your kxhk W n in and flea m&y"eviler your balrna or DBAno= an
<br />me •&retinae weaklisrogmaed array' nsnhs ane. You mey vee aehor yen 5M or El id you
<br />Irra one}. burl 1st IRS rtroursaa yw m fowl yohrliBN.
<br />' Lhl neral end drde the tares of the beep. atet. or Pralen MOL too not Mnbh the TIN of the
<br />prsorhel rsproomm rive or mates unless do WO array neon k not dtsgrahted Intro seehahrt
<br />ttllej Aso sea 6prhet n*o ferparbwahbs on pope 2.
<br />-!late. QMrdor also must prarlde a Form w -a to duper at busL
<br />Note. Una name Is dreled whm mors then ona name le Bated. the number wll be
<br />Waned to be ttul of the first nems listed.
<br />Setxtrfa Your Tax Records from Identity Theft
<br />identty theft occurs when sarneane toes your personal intomatlon such se your
<br />none, SSN, or other Iden&VM lnfm oWn, without yarn pawAsdon, to commit
<br />Fraud or other wkruam An ider ft thM1 may use your SON to get a job or may 4M a
<br />tax rstum using your SM to receive a reforrd.
<br />To reduce yam risk:
<br />• Protect your SSN.
<br />• Ensure your employer Is protsedrg yore SSI, and
<br />• He careful when chooft a tax preparer.
<br />It your tax records are affected by Identity Nteft and you receive a notice from
<br />No IHS. respond right away to She nutrfhe and phare number prkaed an fire IRS
<br />notim erkher.
<br />If your tax records ere mot cumertty affected by Identity"but you think you
<br />are at risk dare to a foal or IMet purse or Valet. quesftaW s credit card acdit
<br />or creditrepert, contact the IRS kkn* Theft Ho&o at l4GO 6082490 or oubndt
<br />Fong 14039.
<br />For more Wormetlon, see PublaUm 4635. Www Theft Prevanlhon and Vktim
<br />Assistance.
<br />Vktirm or kiertily theft who are expede cine economic harm ora syalern
<br />problem, or an sseking help In reeoluing tax problems Net have not been readvad
<br />through normal denude. may be algble for Taxpayer Advocate service {TAS)
<br />enhance. You an reach TAS by calling Ira TAS toll-1ne case kdaka Arra at
<br />1.877 7TT-4TTe orTrYAUD 14KG 429.4056.
<br />Prefect yowoW from snapidam emote es ptdddng srheaae. Phishkhg M the
<br />creation and use of small est wabehse desigrad to mknlo (aphknate bushels
<br />smalls and wabdias. The most common act M sending an small to a user tahey
<br />dakrrinp to los an satebldtsd ktplltkneta entefpfiae Ms an attempt to scam Ira user
<br />bit nmarhderlrtg pxlvals INdrmallm Nat will be used for identity twit.
<br />Tia IRS does not I Ili I aordsats with taxpayers via aaugs. Also. the IRB does
<br />not requ at personal detailed kdarmallon Nwugh smell or ask texpeyers for to
<br />PIN numbers. passworft or skr4 r secret emu Www atlont for their wed! card.
<br />harder, or other 8ranciel accurits.
<br />It you recent an unsolicited em fl aWmirng to be hon the FA kw*wd this
<br />or � M property 10 Nto u T ansury Inspector You may dw �General for Tax IRS
<br />Admi nium mk hatiafiong0.
<br />MOTA) at 14100466 4W. You an forward suspicious entailsto the Federal
<br />Trade Cortndaeton at spemOucs gav or contact them at www.ffapov/ Waft or
<br />1-8774DTHEF T {14177.4382395).
<br />Visit IRS.gov to Mem mese about WW" daft and how to reduce your risk.
<br />Privacy Act Notice
<br />Section 0104 of the ktana) Reverse Code requires you to provide your correct
<br />TIN to persons pnebeAng federal agene" who ars required to fie kh mnaton
<br />returns with h the IRS to report blerest, dividends, or certain other Income paid to
<br />you; mwtpape lrer you pit the acquisition or WwWww ant of seared
<br />puoperty; the cenceAatbn of debt; or aw*fh dons you made to an IRA, Ardor
<br />MSA, or HSA. The person collecting this form toes the kdomation an rte tam to
<br />fila I Mile.
<br />1t- a returns with the IRS, the ]eprbtngfa tenaaefof Justice for cm and rnsdon. Routine �
<br />of this ktfanatlaer Include glvltp fi to line
<br />a krkhd litigation and to dues, wbae, the t]M rM of CdzrM L and US.
<br />carrsrrortwset0scnd fa use b their turas. 'the
<br />h0orowdlonelaamsybodselosad to War Countries under a treaty. to federal and
<br />amts ngiviWas toto 1 r dv6 and wdakW knee, or to fedeni law enforownmt and
<br />kgeBgertee aperneMs to combat lemorism. You must protide yourrTlN wbWw or
<br />not you era requited to fie a tax rokarL Linder section 9405. payee must goneniy
<br />withhold a percentage of mxable iron#, dividend, and certain other payna tt to
<br />a payee who does mol give it TIN to the payer. Certain pwaBMs may also appy for
<br />p vAdktp false or fraudulent kdom uftL
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