I,,,,,, W-9 Request for Taxpayer Give Form to the
<br /> ,1;,•t, Nubemt»u '01. Identification Number and Certification requester.Do not
<br /> Pr panni,rl„.the I r;ash:\ send to the IRS.
<br /> iiiternai hrsenue Surw,' ►Go to www.irs.gov/ForrnW9 for instructions and the latest information.
<br /> 1 Name as shown nn soar u''nair lax return) Nate'IS reguirod on this Ian,do not leave this fine blank
<br /> 2 husu1€55 naintter4'oyarded entity name it different hum above• --
<br /> rt3
<br /> an Checkepprupnak•kit,leu federal lax,Iassdu•atrun As.persrxr whuxi'name is rnb'n',i till 1111.•1,(:110:1(only one„1 the 4 F xompti s is trodes apply only to
<br /> 0(NJ
<br /> tilt wuut salon I,,x certain entities,not rndivuival5,see
<br /> a instructions on page 31
<br /> c`t ;El InditiduaU•ob•p '•
<br /> ,pnn' 111El.,t cCos potation tiConpur.itinn El Partner;hip U Irtr;t'',',tai,•
<br /> m ' stoule-mrme'r tI I('
<br /> ao
<br /> x. nip!nnyne r 04,lit any)
<br /> lis}rd ❑ t mond Ii ihrbty company t tier the tax,Jassificatwn(c tl corporation,S.S rnrpwabun,P i'artnershipl►
<br /> p wNote:C.ht'(.k the apprupn�it'b.us in the Into above;for the tax classification of the sin tlu-mentber owner On not check t-xi ii phut trust AI('A reportux)
<br /> S C I t C it the I t( it.(:Ltssitted p',a single mt'ntbet LIC that is disrt'ctardott from the owner unless the c'om'a ut the t t l:is
<br /> a
<br /> another l I C'that is not dist-garded from the owner for It S.ferieral tax purposes Otherwise.a style-milliner Lt c that cu`''i''Jny)
<br /> Is(isr.'yardert front Chi owner should check the appropriate box for the tax rlassrhratx n of its owner
<br /> an ❑ Oilier IS'-`1`ui\ir LI(:It'itsl►
<br /> to 5 Address trio itIher aren't Joni apt or state no 1 See instructions.
<br /> l)equesh'r'S mai lie and address opt r'
<br /> m -1 I 1i
<br /> (I) i. r.
<br /> -
<br /> 6 Cary state,and ZIP i o,ie
<br /> ' FEB 0 5 2018
<br /> 7 I ist'n
<br /> Clut'l r'unh•r
<br /> d•e•'Si • t•lob honat) _
<br /> Division of Reclamation,
<br /> Part I Taxpayer Identification Number(TIN) f4linfny&Safety
<br /> Enter your 1IN un fete appropriate box The TIN provided must march the name given on line 1 to avoid Social security number
<br /> backup withholding, F of individuals this is generally your social serail ity number (SSN) However,for aI I 1`1 I I 1
<br /> resident alio,.sole proprietor or disregarded utility,sec the instructions for Part I.later, F or other -f -1 i
<br /> entities,it is your employer identrficatrun number (LIN).If you do not have a number,see Ilow to get a 1 I _L L_. 1 � h 1
<br /> IIN later or
<br /> Note:If the account is in more than one name,see the Instructions for line 1,Also see What Name and I Employer identification number
<br /> Number To Give the Requester for guidelines on whose number to enter. —'
<br />
<br /> Part II Certification
<br /> Under penalties of perjury,I certify that
<br /> 1.The nulnbet s'towtr on this form is my correct taxpayer identification number(or I ant waiting for a number to he issued to ice).and
<br /> 2 I am not subject to backup withholding because:(a)I ant exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
<br /> Service(IHS)that lam subject to backup withholding as a result of a failure to report all interest or dividends,01 Ici the IRS has notified me that I am
<br /> no longer subject to backup withholding;and
<br /> 3 I ani a U.S.citizen or other II,S.person(defined below);and
<br /> 4. the FAICA code(s)entered on this form(if any)indicating that I and exempt from FAICA 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 wvthhuldrnu because
<br /> you have failed to report all interest and dividends on your tax return.For real estate transactions,stent 2 does not apply.For mortgage interest paid.
<br /> acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement IIRA),and,generally.payments
<br /> other than interest and dividends.you are not required to sign the certification,but you must provide your correct TIN.See the instrutttons tor Part II,later,
<br /> Sign Signature of '
<br /> Here u.s.peison► "" "- ---- Date► •
<br /> General Instructions •Font 1099 DIV(dividends.Including those front stocks or mutual
<br /> funds)
<br /> Section references are to the Internal Revenue Code hitless otherwise
<br /> •Form 1099-MISC(various types of income.pt rae'.awards,or gross
<br /> noted.
<br /> proceeds)
<br /> Future developments For the latest information about developments •Form 1099-B(stock or mutual fund salt's and certain other
<br /> related to Form W-9 and its instructions,such as legislation enacted
<br /> after they were published,cut to www.irs getv/FormWJ transactions by brokers)
<br /> •Form 1099-S(proceeds from real estate transactions)
<br /> Purpose of Form •Emet 1093-K(merchant card and thud party network transactions)
<br /> An uidn'idual or entity(Poon W 9 requester)who is required to file an •Foran 1098(home mortgage unh'rt'at), 1098-L (stridert Ivan Interest)
<br /> reformation return with the IRS must obtain your correct taxpayer 1098-1 (tuition)
<br /> identification number(I IN)which may be your social security number •Furst 109-3-C(canceled debt)
<br /> (SSN).individual taxpayer identification number(11IN),adoption •Form 1099-A(acquisition or abandonment of secured propertyi
<br /> taxpayer identification number(ATIN),or employer identification number Use Furan W-9 only if you are a U.S person(including a resider!
<br /> (LIN) to report on an information return the amount paid to you,or other
<br /> amount reportable on an information return Examples of informationalien) ht piuwde your correct TIN.
<br /> retorts include.but ate not limited to.the following. It you do nut return Forret W-9 to the requester with a TIN, you might
<br /> •Form 1099-INT(interest earned or pard} be subject to backup withholding See What is bacnup withholding,
<br /> later
<br /> cat No 111:331X Iono W-9,Fir,. 11-:0111
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