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Request for Taxpayer
<br /> (Rev.NovemberForm �7) Identification Number and Certification rreiqu ste oo of
<br /> Department of the Treasury send to the IRS.
<br /> Internal Revenue Service ►Go to www.lrs.Qov/FormW9 for instructions and the latest information.
<br /> 1 Name(as shown on your income tax return).Name is required on this Ana:do not leave this line blank.
<br /> State of Colorado
<br /> 2 Business name/disrogarded entity name,it different from above
<br /> Department of Natural Resources
<br /> m 3 Check appropriate box for federal tax classification of the person whose name Is entered on Nne 1.Check only one of the 4 Exemptions(codes apply only to
<br /> CD following seven boxes, certain entities,not individuals:see
<br /> Instructions on page 3):
<br /> p ❑ indMdual/sole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate
<br /> c c single-member LLC Exempt payee code(it any) 1
<br /> ,v 1B ❑ Umiled liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)No
<br /> p J Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
<br /> 1? LLC It the LLC Is classified as a single-member t.LC that is disregarded from the owner unless the owner of the LLC Is of any)
<br /> another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that
<br /> code Is dlsragarded from the owner should check the appropriate box for the tax classification of its owner.
<br /> y ✓ Other(we instructions)► Government MAUW=CUM nUWLWW WV*ftUs.J
<br /> 6 Address(number,street,and apt.or suite no.)See Instructions. Requester's came and address(options!)
<br /> 1313 Sherman Street,Room 423
<br /> 6 City,state,and ZiP coda
<br /> Denver,CO 80203
<br /> 7 Ust account number(s)hero(optional)
<br /> Taxpayer Identification Number MN)
<br /> Enter your TIN In the appropriate box.The TIN provided must match the name given on line 1 to avoid social saeurNy number
<br /> backup withholding.For i ,duals,this is generally your social security number ISSN).However,for aFM -
<br /> 77N, � —
<br /> resident alien,sole proprietor,or disregarded entity,see the instructions for Part 1,later.For otherentities,it is your employer identification number(EIN).if you do not have a number,see Now to get a
<br /> later. or
<br /> Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer ldentifcation number
<br /> Number To Give the Requester for guidelines on whose number to enter.
<br /> 8 4 — 0 6 4 4 7 3F91
<br /> Certification
<br /> Under penalties of perjury,I certify that:
<br /> 1.The number shown on this form is my correct taxpayer Identification number(or 1 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 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 /> 3.1 am a U.S.citizen or other U.S.person(defined below);and
<br /> 4.The 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 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 11,later.
<br /> Sign U.S.p rs of / O 19/13-
<br /> Here u.s.person► Dots►
<br /> General Instructiong •Form 1099-DN(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 /> proceeds)
<br /> Futrelated
<br /> developments.For the latest information about developments e Form 1099-B(stock or mutual fund sales and certain other
<br /> teded to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
<br /> after they were published,go to www.irs.gov1FormW9. •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 required to file an •Form 1098(home mortgage interest),1098-E(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.amount reportable on an information return.Examples of Information
<br /> returns Include,but are not limited to,the following. 1/you do not 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.10231X Form W-9(Rev,11-2017)
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