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<br /> W-9 Request for Taxpayer Give Form to the
<br /> thee.November 201'. Identification Number and Certification requester.Do not
<br /> Department or the Treasure send to the IRS.
<br /> internal rievenuti Service ►Go to www.irs.gov/ForrnW9 for instructions and the latest information.
<br /> 1 Nan e las shown on your income tat return).Name is required on this lure,do net leave this line blank.
<br /> 2 Business name/ regarded entity name,it different from above
<br /> Ic le - +0! I.L�
<br /> c.:i; 3 Chectailtippropriate box for federal tax classificatioralelN,person whose name is entered on lure 1.Check only one rd the 4 Exemptions races apply only to
<br /> °o' lultuwnrg seveui hex's, certain entities,not individuals:see
<br /> a
<br /> instructions on page 31
<br /> q InewhakiVsole propncter,n El Curpm-Abort1:1S Corporation El Par tner,hip ❑ husl•��statr
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<br /> 0F+(enter Davao code rit any)
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<br /> �'u ❑ I unctt•<7 It nbrlity company Litter the tax classification(C--C corporation.S.S corporation,P-'Partnership)►
<br /> o` ;? Note:Check the appropriate.box in the line above for the tax classification of the single,-member owner. Do not check Exemption front FATCA reporting
<br /> c N LI.C it the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
<br /> i e another t t C that is not disregarded front the owner for U S federal tax purposes.Otherwise.a snrglo-rnetnber LLC that code 6t anY)
<br /> n FE° is disregarded from the owner should check the appropriate bet(for the tax classification of its ownx,
<br /> g ❑ Other(see instructions)or-
<br /> a
<br /> t 5 dress(number.street and apt or suite no.
<br /> ).u mstnuctions. Requester's name and address(optiR
<br /> rn 4 r 0 o L t:
<br /> 6 City,state,and ZIP code
<br /> 1+Oft_(I cc 1 0 C) ?-i23,3 FEB 0 5 2018
<br /> 7 List account nurnbea(s)here(optional)
<br /> Division of Reclamation,
<br /> Part I Taxpayer Identification Number(TIN) Mining&Safety
<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 withhotdrng.For individuals,this is generally your social security number(SSN).However,for a III j ( I 1 t I
<br /> resident alien,sold proprietor,or disregarded entity,see the instructions for Part I,later.For other l
<br /> entities,it is your employer identnccation number(EIN),If you do not have a number,see How to yet a I I -L, t._, _,J -L I L r
<br /> TIN, 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 I
<br /> Number To Give the Requester for guidelines on whose number to enter.
<br /> Part II Certification '
<br /> Under penalties of perjury,I certify that:
<br /> 1.The number s'rown on this form is my correct taxpayer identification number(or I am waiting for a number to he issued to me):and - .-
<br /> 2.I 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 I ant
<br /> no longer subject to backup withholding;and
<br /> 3.I ant a U.S.citizen or other U.S.poison(defined below);and
<br /> 4.The FAT CA code(s)entered on this funs(if any)indreating that I am exempt front FATCA reporting is con eet.
<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 because
<br /> you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid.
<br /> acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),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 instructions for Part li,later.
<br /> ..>
<br /> Sign Signature of -" " y
<br /> Here U.S.person► - ✓�
<br /> oats 10. „ c..y ,.
<br /> General Instructions •Form 1099-DIV(dividends,including those from stocks or mutual
<br /> funds)
<br /> Section references are to the Internal Revenue Code unless otherwise
<br /> •Form 1099-MISC(various types of income,prizes,awards,or grossrioted.
<br /> proceeds)
<br /> Future developments. For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other
<br /> related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
<br /> after they were published,go to www.rrs.gov/Form 64/9
<br /> •Form 1099-S(proceeds from real estate transactions)
<br /> Purpose of Form •Form 109J-K(merchant card and third party network transactions)
<br /> An individual or entity(Form W-9 r equester)who is required to file an
<br /> •Form 1093(honk)mortgage interest), 10`98-F (studtrrrt loan.interest).
<br /> information return with the IRS must obtain your correct taxpayer 10984(tu+hon)
<br /> identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
<br /> (SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property)
<br /> taxpayer identification number(ATIN),or employer identification number
<br /> (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you area U.S.person(including a resident
<br /> amount reportable on an information return Examples of infornnation alien),to provide your correct TIN.
<br /> returns include.but are not limited to,the following. If you do not return Form 14/-9 to the requester with a TIN,you might
<br /> •Form 1099-INT(interest carried or paid) be subject to backup withholding See What is bacsup withholding,
<br /> later.
<br /> Cat,No.10231X Form W-9(Ret,11.2017)
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