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orm W-9 Request for Taxpayer Give form to the
<br />IRev. January 20021 Identification Number and Certification requester. Do not
<br />DeparVn ent of the treasvy Send LO the IR$.
<br />InlMnal Revenue Service '
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<br />^ Exempt from backup
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<br />Atldress (number, street, and apt. or suite no.)
<br />Requester's name and atldress (optional)
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<br />!5 City, stale. and ZIP code
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<br />u List account number(s) here (optional)
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<br /> Tax a' er Identification Number (TIN)
<br />Enter your TIN in We appropriate box. For individuals, this is your social security number (SSNI~ Social sewnry number
<br />However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on
<br />page 2. For other entities, it is your employer iden[ifcauon number (EIN). If you do not have a number.
<br />see How to get a TIN on page 2. or
<br />Note: 1/ [he account is in more than one name, see the chart on page 7 (or guidelines on whose number Employer idamificaVon number
<br />to enter. ~ ~ ,~
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this form is my coned taxpayer identification number (or I am waiting for a number to be issued to me), and
<br />2. I am no[ subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have no[ been notified by the Internal
<br />Revenue Service (IRS) that l am wbject to backup withholding as a rewlt of a failure to report all interest or dividends, or (c) the IRS has
<br />notified me that I am no longer subject [o backup withholding, and
<br />3. 1 am a U.S. person (including a U.S. resident alien).
<br />Certification instructions. Vou must cross out item 2 above if you have been notifed 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 Vansactions, item 2 does not apply.
<br />For mortgage interest paitl, acquisition or abandonment of secured property, cancellation of dab[, contributions [o an intlivitlual retirement
<br />arrangement (IRA), antl generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
<br />provitle your coned iIN. (See the instructions on page 2.)
<br />Sign Signature of
<br />Here U.S. person - _ __ Date -
<br />Purpose of Form
<br />A person who is required to file an information
<br />return with the IRS must get your coned
<br />taxpayer itlenti(ca[ion number (TIN) to report, for
<br />example, income paitl to you, real estate
<br />Vansactions, mortgage interest you paid,
<br />acquisition or abandonment of securetl property.
<br />cancellation of deb[, or contributions you made
<br />[o an IRA.
<br />Use Form W-9 only if you are a U.S. person
<br />(including a resident alien). to give your coned
<br />TIN to the person requesting it ([he requester)
<br />and, when applicable, to:
<br />1. Certify the TIN you are giving is correct for
<br />you are wailing for a number [o be issuetl),
<br />2. Gerrity you are no[ subject to backup
<br />withholding, or
<br />3. Claim exemption from backup withholtling if
<br />you are a U.S.~exempt payee.
<br />IT you are a foreign person, use the
<br />appropriate Form W-6. See Pub. 515,
<br />Withholtling of Tax on Nonresident Aliens and
<br />Foreign Entities.
<br />Note: Ir a requester gives you a (orm other than
<br />Form W-9 [o request your TIN, you must use the
<br />requester"s Porm if it is substantially similar to this
<br />Form W-9.
<br />What is backup withholding? Persons making
<br />certain payments to you must under certain
<br />contlitions withhold and pay to the IRS 30 % of
<br />such payments after December 31. 2001 (29%
<br />after December 31, 2003). This is calletl "backup
<br />wnhhgiding.' Payments [hat may 6e subject to
<br />backup withholdiny iriclutle interesT; dividends.
<br />broker and barter exchange Vansactions, rents,
<br />royalties, nonemployee pay, and certain
<br />payments from fshing boat operators. Real
<br />estate transactions are not subject [o backup
<br />withholding.
<br />You will no[ be subject to backup withholding
<br />on payments you receive if you give me
<br />requester your correct TIN, make the proper
<br />certifications, and report all your taxable interest
<br />antl tlivitlends on your tax return.
<br />Payments you receive vn71 be subject to
<br />backup withholding i/:
<br />t. You do no[ furnish your TIN [o [he
<br />requester, or
<br />2. You do no[ certify your TIN when required
<br />(see the Part II instructions on page 2 for
<br />details), or
<br />3. The IRS tells the requester [ha[ you
<br />furnishetl an incorrect TIN, or
<br />4. The IRS tells you that you are subject to
<br />backup withholtling because you did not report
<br />all your interest and dividends on your [ax return
<br />(for reportable interest and dividends only), or
<br />5. You tlo not certify to the requester that you
<br />are not subject to backup withholding under 4
<br />above {for reportable interest and dividentl
<br />accounts opened after 1983 only).
<br />Certain payees antl payments are exempt
<br />from backup wthholding. See the instructions on
<br />page 2 and [he separate Inswdions for the
<br />Requester of Form W-9.
<br />Penalties
<br />Failure to fumish TIN. It you tail Co furnish your
<br />correct TIN to a requester, you are subject to a
<br />penalty of E50 for each such failure unless your
<br />failure is due to reasonable cause and not to
<br />willful neglect.
<br />Civil penalty for false information wiN respect
<br />to withholding. If you make a false statement
<br />with no reasonable basis that results in no
<br />backup withholding, you are subject to a 8500
<br />penalty.
<br />Criminal penalty for falsifying information.
<br />Willfully falsifying certifcations or affrmatlons
<br />may subject you to criminal penalties including
<br />foes antl/or imprisonment.
<br />Misuse of TINS. If the requester discloses or
<br />uses TINS in violation of Federal law, the
<br />requester may be Subject to civil dntl criminal
<br />penalties.
<br />Cat. No. 10231X Form W-g IRev. 1-2002)
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