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Form Wr-9 Request for Taxpayer Give Form to the
<br /> (Rev,DbcemDepartment
<br /> a 20u Identification Number and Certification ►end to the
<br /> Do not
<br /> oaperanent of tine Trrawry send to fire IRS.
<br /> Internal Revenue Service
<br /> 1 Name(as shown on your Income tax return).Name is reguilred on this line;do not leave this line thank
<br /> N 2 Business name/disregarded entity name.If different from above
<br /> 3 Climic appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to
<br /> Individual/sole proprietor a certain entities,not Individuals;see
<br /> n proprt ❑ C Corporation ❑ S Co poration ❑ Psrt,erahp ❑Trust/estate
<br /> mcingto-mamber Instructions on page 3):
<br /> EJ UmHed liability company.
<br /> pany,Enter the tax classification(CzC corporation,S=S corporation,P=parfnerahlp)► Exempt payee code(d arty)
<br /> Note.For a single member LLC that is dlaregarded,do not check Lt C;check the appropriate box in tie line above for Exemption from FATCA reporting
<br /> _ the tax ciamtrrcation of the single-member owner. code rd any)
<br /> d " ❑Other(see instructions)> OAO&r tc srca nn n.r atra catvd Ur US,) -
<br /> b Address(number,street,and apt or suite no.) Requestees name and address(optional)
<br /> 6 City,state,and ZiP code A
<br /> 7 list account number(s)here(optlonati
<br /> MOM Taxpayer Identification Number(TIN)
<br /> Enter your TIN In the appropriate box.The-nN provided must match the name given on line 1 to avoid Social securtty number
<br /> backup withholding.For Individuals,this is generally your social security number(SSN).However,for a
<br /> resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other 111 -
<br /> entities,it Is your employer Identification number(EIN).if you do not have a number,see Now to get a r
<br /> ] I i J
<br /> TIN on page 3. or
<br /> Note.it the account is In more than one name,see the Instructions for line 1 and the chart on page 4 for Employer fderWflimeon number
<br /> guldeiines on whose number to enter,
<br /> M
<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 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 Intemal 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 langer 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(rf any)indicating that I am exempt from FATCA reporting Is correct.
<br /> Certlficatlon Instructions.You must cross out item 2 above If you have been notified by the IRS that you are currently subject to backup withholding
<br /> because you have failed to report ail interest and dividends on your tax mtum.For real estate transactions,item 2 does not apply.For mortgage
<br /> Interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an Individual retirement arrangement(IRA),and
<br /> generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.Seer the
<br /> Instructions on page 3,
<br /> Sign Signature of
<br /> Here us,person► oat.►
<br /> Genera! Instructions •Form 1098(hone mortgage interest),1M-E(student loan interest),1098-T
<br /> (tuition)
<br /> Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt)
<br /> Future developments.In!ormetion about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property)
<br /> as legislation enacted after we reisase it)is at www.irs.gov/fk9.
<br /> Use Form Wg only If you are a U.S.parses(Including s resident alien),to
<br /> Purpose of Form provide your correct TiN.
<br /> An I.rx"ual or entity(Form W9 requester)who Is required to file an information tf you do not return Form W-9 to the requester with a TIN,you might be subject
<br /> ratum with the IRS must obtain your correct taxpayer Identification number(TIN) to backup whhhoidfng.See What is backup wkhhofding?on page 2.
<br /> which milry be your social security number(SSN),Incilvidual taxpayer Identification By signing the tilled-out form,you:
<br /> number(MM,adoption taxpayer Identification number(ATIN),or employer 1.Certify that the TiN you are giving Is correct(or you are waiting for a number
<br /> Identification number(EIM,to report on an information return the amount paid to
<br /> you,or other amount reportable on an Information retum.Examp!es of Information to be Issued),
<br /> ratums Include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or
<br /> •Form imo-INT(Interest earned or paid) 3.Claim exemption from backup withholding H you are a U.S.exempt payee.if
<br /> •Form 1099 ON(dividends,Including those ham stocks er mutual fords) rtPP"ble,you are also certifying that as a U.S.person,your also—ble,share of
<br /> any partnership inconw from a U.S.trade or lou31ne LS Is not subject to the
<br /> •Form 1099-MISC(various types of Income,prtzes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected Income,and
<br /> •Form 1099-B(stock or mutual fund sales and certain other transactions try 4.Certify that FATCA codes)entered on this form(tt any)indicating that YOU are
<br /> brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on
<br /> •Form IOH-S(proceeds from real estate transactions) page 2 for further information.
<br /> •Form 1000-K(mormhant card and third party network transactions)
<br /> Cat.No.10231X Forth W-9(Rev.12-2014)
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