2021-03-09_REVISION - M2001046 (17)

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SeIler's Certification of Nonforeign Status Section 1445 of the Internal Revenue Code provides that a transferee(buyer)of a U.S. real property interest must withhold tax if the transferor(seller) is a foreign person. For U.S. tax put poses(including§1445), the owner of a disregarded entity(which has legal title to a U.S. real property interest under local law) will be the transferor of the property and riot the disregarded entity. To inform the transferee that withholding of tax is not required upon the transfer of the U.S. real property interest by ("transferor") ,the undersigned hereby certified the following(if transferor is an entity, on behalf of the transferor): A. INDIVIDUAL TRANSFEROR(S) 1. I am not a nonresident alien for purposes of United States income taxation, 2. My U.S. taxpayer identification number(social security number) is , and 3. My home address is: B. CORPORATION,PARTNERSHIP,TRUST,OR ESTATE TRANSFEROR(S) 1. Transferor is not a foreign corporation,foreign partnership, foreign trust,or foreign estate (as those terms are defined in the U.S. Internal Revenue Code and Treasury Department Regulations); 2. Transferor is not a disregarded entity as defined in §1.1445-2(b)(2)(iii); 3. Transferor's U.S.taxpayer identification number is ; and 4. Transf is office address is IL. C. The transferor understands that this certificate may be disclosed to the Internal Revenue Service, that any false statement contained in this certificate may be punished by fine or imprisonment or both, that transferee is relying on this certificate in determining whether withholding is required,and that transferee may face liabilities if any statement in this certificate is false. D. Transferor hereby indemnifies transferee from any liability or cost which transferee may incur as a result of(1) the Seller's failure to pay any U.S. Federal income tax which such transferor is required to pay under applicable U.S. law,or(2)any false or misleading statement contained in this certification. Under penalties of perjury I declare that I have examined this certification and to the best of my knowledge and belief it is true,correct and complete(and,for an entity transferor,I further declare that I have the authority to sign this document on behalf of transferor. OWENS BROS.CONCRETE CO.,A COLORADO CORPORATION Dat 20011 �� Signa printed nam Title(if signed on behalf of an entity transferor) Remised 111104 Page 54 of 126