|
Form w
<br /> Request for Taxpayer Give Form to the
<br /> (Rev.October 2018) Identification Number and Certification requester.Do not
<br /> Department of the Treasury send to the IRS.
<br /> Internal Revenue Service F Go to www.irs.gov/Formtif9 for instructions and the latest information.
<br /> 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
<br /> KIANA HOLDINGS II,LLC
<br /> 2 Business name/disregarded entity name,if different from above
<br /> se
<br /> 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one cf the 4 Exemptions(codes apply only to
<br /> co following seven boxes. certain entities,not individuals;see
<br /> instructions on page 3):
<br /> S 0 Individual/sole proprietor or 0 C Corporation 0 S Corporation 0 Partnership 0 Trust'estate
<br /> ei
<br /> Ir angle-member LLC Exempt payee code(if any)
<br /> ✓v ❑ Lmited liabilitycompany.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership) P
<br /> `8 , 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 /> LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code if any)
<br /> 'C another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that
<br /> a U is disregarded from the owner should check the appropriate box for the tax classification of its owner.
<br /> 0 Other(see instructions)► ifropaesnaccountsmanic,,clam*meus,
<br /> 5 Address(number,street,and apt or suite no.)See instructions. Requester's name and address(optional)
<br /> 3450 BIG BEAR DRIVE
<br /> 6 City,state,and ZIP code
<br /> SEDALIA,CO 80135
<br /> 7 List account number(sl 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 [social socurftYllonlbobr
<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 instructions for Part I,later,For other I — —
<br /> entities,it is your employer identification number(EIN).If you do not have a number,see How to 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 Employer identification number
<br /> Number To Give the Requester for guidelines on whose number to enter.
<br /> 8 3 - 4 2 4 5 9 4 2
<br /> Part 11 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 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 TTN.See the instructions for Part II,later.
<br /> Sin � / p
<br /> Here ups.person e• (jc(,> • t7rit} '4(7 u Date► I Z 24)Z C'
<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. proceeds)
<br /> Future developments.For the latest information about developments •Form 1099-8(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.gov/FarmW9. •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 MN)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
<br /> (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident
<br /> amount reportable on an information return.Examples of information alien),to provide your correct TIN.
<br /> returns include,but are not limited to,the following. If 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 /> Gat.No.10231X Form W-9(Rev.10-2018)
<br />
|