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<br /> Turn, 9
<br /> Request for Taxpayer Give Form to the
<br /> (Rev.November 2017) Identification Number and Certification requester.Do not
<br /> Depa'tment ut the Treasury send to the IRS.
<br /> Internal Revenue Se'vrce ►Go to www.irs.gov/FormW9 for instructions and the latest information.
<br /> 1 Name(as shown on your mean a tax return) Name is required on th line,do not leave this line blank
<br /> 2 Business name/dr arded entity name,if if ererrt from above
<br /> ea oto P i'vl i r v c LLL.
<br /> a3 Check` ropnate box for federal tax classification of the rsun whose name is entered on lune 1 Cher,k only one of the 4 Exemptions(codes apply only to
<br /> or m following seven boxes. certain entities.riot individuals,see
<br /> a instructions on page 3)
<br /> ,S �I Innliv,dual/solo proprietor or ❑ C Cor put at un ❑s Con par ation ❑ Partner ship ❑ Trust/estate
<br /> Sc /ssingle-member t I C Exempt payee code(if any'
<br /> no
<br /> Z.'-1 ❑ Limited liability company Enter the tax classification(C=C corporation,S-S corporation,P=Partnership)►
<br /> p 2 Note:Check the appropriate box in the line above for the lax classification of the single-member owner. Do not check Exemption tram FA1CA reporting
<br /> E. w LLC it the LLC is classified as a single-member I t C that is disregarded fr,ni the owner unless the owner of the LLC is
<br /> 'aC o another LLC that is not disregarded boor the owner for U.S.federal tax purposes.Otherwise.a single-member LLC that code UI any)
<br /> :: is disregarded from the owner should check the appropriate box for the tax classification of its owner.
<br /> u ❑ Other(see instructions)►
<br /> d
<br /> a 5 dress(number street and apt or suite no. See instructions. Requester s name and address(optional)
<br /> to P ):,, 9
<br /> CD
<br /> La-v�-€-
<br /> 6 City,state,and ZIP rode
<br /> rril �0 81233_ --
<br /> 7 List account numbers)here(optional)
<br /> Part I Taxpayer Identification Number(TIN)
<br /> Enter your TIN in the appropriate box The TIN provided must match the name given on line 1 to avoid 1-Social security number
<br /> backup withholding.For individuals,this is generally your social security number(SSN).t fowever,for a
<br /> resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later For other
<br />
<br />
<br /> Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number
<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 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.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 am
<br /> no longer subject to backup withholding;and
<br /> 3.I am a U.S.citizen or other ll.S.person(defined below);and
<br /> 4. rhe 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 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 0 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 II.later.
<br /> - rSign signature of ,,) -'`J -
<br /> i
<br /> ;/� %" f �—
<br /> Here U.S,person Date N. i- 0./s
<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 •Form 1099-MISC(various types of income,prizes,awards,or gross
<br /> noted.
<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 Irish uctions,such as legislation enacted transactions by brokers)
<br /> after they were published,go to www.irs gov/FormW9 •Form 1099-S(proceeds from real estate transactions)
<br /> Purpose of Form •Form 1099-K(merchant card and third Daity network transactions)
<br /> An individual or entity(Form W-9 requester)who is required to file an •Form 1098(borne mortgage interest), 1098E(student loan interest),
<br /> information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
<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 Use Form W-9 only if you are a U.S.person(including a resident
<br /> (EIN).to report on an information return the amount paid to you,or other alien),to provide your correct TIN.
<br /> amount reportable on an information return.Examples of information
<br /> returns include,but are not limited to,the following. If you do riot return Form W-9 to the requester with a TIN,you might
<br /> •Form 1099 INT(interest earned or paid) be subject to backup withholding See What is backup withholding.
<br /> later
<br /> Cat No.10731X Form W-9(Rev.11-2017)
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