|
Form W®9 Request for Taxpayer Give form to the
<br /> (Rev.October 2007) Identification Number and Certification requester. Do not
<br /> Department of the Treasury send to the IRS.
<br /> Internal Revenue Service
<br /> Name(as shown on your income tax return)
<br /> CID
<br /> aBusiness name,if different from above
<br /> c
<br /> 0
<br /> a o Check appropriate box: Individual/Sole proprietor ❑ Corporation ❑ Partnership ❑ p Exem t
<br /> :. ❑ Limited liability company.Enter the tax classification(D=disregarded entity,C=corporation, P=partnership) D
<br /> L payee
<br /> o 2 ❑ Other(see instructions) ►
<br /> tic Address(number,street,and apt.or suite no.) Requester's name and address(optional)
<br /> a) City,state,and ZIP code
<br /> tCL
<br /> cu
<br /> aa) List account number(s)here(optional)
<br /> U)
<br /> 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 Social security number
<br /> backup withholding. For individuals,this is your social security number(SSN). However,for a resident 3JV V6 69 73
<br /> alien, sole proprietor, or disregarded entity,see the Part i instructions on page 3. For other entities, it is
<br /> your employer identification number(EIN). If you do not nave a number,see How to get a TIN on page 3. or
<br /> Note. If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number
<br /> number to enter.
<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 Internal
<br /> Revenue 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
<br /> notified me that I am no longer subject to backup withholding, and
<br /> 3. 1 am a U.S. citizen or other U.S. person(defined below).
<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
<br /> withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
<br /> For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
<br /> arrangement(IRA), and generally, payments other than interest and dividends,you are not required to sign the Certification, but you must
<br /> provide your correct TIN.See the instructs 7s on page 4.
<br /> Sign Signature o
<br /> Here U.S.person D Date D
<br /> General Instruc Ions Definition of a U.S. person. For federal tax purposes, you are
<br /> considered a U.S.person if you are:
<br /> Section references are to the Internal Revenue Code unless otherwise noted. o An individual who is a U.S. citizen or U.S. resident alien,
<br /> o A partnership, corporation, company, or association created or
<br /> Purpose of Form organized in the United States or under the laws of the United
<br /> A person who is required to file an information return with the States,
<br /> IRS must obtain your correct taxpayer identification nt.mper(TIN) o An estate(other than a foreign estate), or
<br /> to report, for example, income paid to you, real estate o A domestic trust(as defined in Regulations section
<br /> transactions, mortgage interest you paid, acquisition or 301.7701-7).
<br /> abandonment of secured property, cancellation of debt, or Special rules for partnerships.Partnerships that conduct a
<br /> contributions you made to an IRA. trade or business in the United States are generally required to
<br /> Use Form W-9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income
<br /> resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W-9
<br /> requesting it (the requester) and, when applicable, to:; has not been received, a partnership is required to presume that
<br /> 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
<br /> waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
<br /> 2. Certify that you are not subject to backup withhoidi;�g, or partnership conducting a trade or business in the United States,
<br /> provide Form W-9 to the partnership to establish your U.S.
<br /> 3. Claim exemption from backup withholding if you ara a U.S. status and avoid withholding on your share of partnership
<br /> exempt payee. If applicable, you are also certifying that es a income.
<br /> U.S. person,your allocable share of any partnership income from The person who gives Form W-9 to the partnership for
<br /> a U.S.trade or business is not subject to the withholc'ng tax on purposes of establishing its U.S. status and avoiding withholding
<br /> foreign partners' share of effectively connected incorr i,. on its allocable share of net income from the partnership
<br /> Note. If a requester gives you a form other than Form W-9 to conducting a trade or business in the United States is in the
<br /> request your TIN, you must use the requester's form if it is following cases:
<br /> substantially similar to this Form W-9. a The U.S. owner of a disregarded entity and not the entity,
<br /> Cat.No.10231X Form W-9 (Rev.10-2007)
<br />
|