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Foam W-9 Request for Taxpayer Give Form to the
<br /> (Re,, November2017) Identification Number and Certification requester.Do not
<br /> Deoartrient of the Treasuri Send to the IRS.
<br /> Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest information.
<br /> 1 Nam_ li
<br /> e(as shown or,your income tax rreetujm)�Nyamme is requited on this line,doo not leare this line blank
<br /> 2 Business name/disregarded entity rat e,ff cifferent from above
<br /> O 3 Check appropriate box for federal Li.<Jassrficahon of the parson who=e naine is eni on line 1 Check only one of We 4 Exemptions(codes apply only to
<br /> mfollow ng seven boxe> certain entities,no'individuals see
<br /> a instructions on page 3)
<br /> p ❑ Indl�Idnal„oIe prnpn;tnr or ❑ C Corporation ❑ S Cori ❑ Partnership irustlestate
<br /> w ,angle-member LLC Exsmpt pave=code(f any)
<br /> T0 Limited liability company Enter tf-e tax class,5ca'on(C=C ccrporat on,S=S corporation P-Partnarship)►
<br /> U tit
<br /> p 2 Note:Check the appropriate box in;he line above for the tax classification of the single-member owner Do not check Exbmi from FATCA reportirg
<br /> y LLC if the LLC Is cla sif ed as a s ngle-member LLC that is disregarded from the owner unless the owner of the LLC Is
<br /> .5 another LLC that is not disregarded from the ovrner for U S federal fat purposes Otherwise a single-member LLC that code i,f any',
<br /> a Is disregarded from the owner she-dd chec'&the appropriate box for the tax class fication of its owner. RCCF
<br /> -
<br /> ❑ Other(see instructions)► _ °-
<br /> 5 Address(✓umber,street,and apt or suite ro See,nstrucUons Requaster's name and address(optional)
<br /> E
<br /> CO
<br /> 6 City state,and ZIP code
<br /> .JeSAc-
<br /> 7 List account r Umbor(s)here( ptwnal) -. &.7a a
<br /> Taxpayer Identification Number(TIN)
<br /> Enter your TIN In the appropriate box.The TIN provided must match the name given on I'ne 1 to avoid Social security number
<br /> backup withholding For individuals,this is generally your soc al security number(SSN) However fora -m -
<br /> res dent alien,sole proprietor,or disregslded entity,see the ins'-ructions for Part I later. For other FM entities,it Is your employer identification number(EIN) If you do not have a number,see Flow ro get a
<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
<br /> Number To Gwe the Requester for guidelines on whose number to enter i
<br /> N P5 �, 34�� 1
<br /> Certification
<br /> Under penalties of perjury. I cer;lfy that
<br /> 1 The number srown on this form Is my correct taxpayer identification number(or I am waiting for a number to be issued to me).and
<br /> 2 1 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 tc report all interest or dividend.,or(c)the IRS has notified me that I am
<br /> no longer subject to backup withholding,and
<br /> 3 1 am a U S citizen or other U.S.person(defined oelow).and
<br /> 4 The FATCA codes)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 faded to report all interest and d wdends 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 divide p s, ou are not ryuired to sign the certification,but you must provide your correct TIN See the instructions for Part 11,later.
<br /> Sign Signature of I
<br /> Here U.S.person► Ah ff Date► 1' V
<br /> •Form 1099-DIV(div Bends,including those from stocks or mutual
<br /> General Instru4iifunds)
<br /> Section references are to the V.rnal Revenue Code unless otherwise
<br /> •Form 1099-MISC(various types of income prizes,awards,or gross
<br /> noted. proceeds)
<br /> Future developments.For the Istest 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 irs govlFormW9
<br /> •Form 1099-S(proceeds from real estate transactions)
<br /> Purpose of Form •Form 1099-K(merchant card and third party network transactions)
<br /> An Individual or entity(Form W-9 requester)who is requ red to file an •Form 1098(home mortgage interest),1098-E(stide it 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 I,ITIN) adoption •Form 1099-A(acquisition or abandonment of secured property'
<br /> taxpayer Identification number(ATIM,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 nformation return Examples cf Information
<br /> returns Include,but are not limited to the following It you do not return Form W-9 to the requester with a TIN you might
<br /> •Form 1099-INT(interest earned or paid) be sub;ec!to backup withholding See What Is backup withholding,
<br /> later
<br /> Cat No 109-,lX Form W-g(Rev 1 t-9017)
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