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orm ~J°ad~ <br />ifev..Woverra:a 1999) <br />eeomrmerrc oP iM Trernu <br />Imenm~oii ~Selviee- <br />Name~(If ajoim~ <br />m <br />a <br />`a <br />r <br />a <br />m <br />m <br />ii <br />Business name, if diner <br />Check zppropriarE box: <br />Address inumber, street antl apt or suds no.) . <br />crcy, cram, and nP mde <br />~~~5~ ~P ~i~y~ <br />you changed your name. sae Speosre lrseuczmns on page <br />1--- <br />ham above. (Ses S¢asine Insttuedoes an page 2a <br />lndivitluaVSoie <br />Enter your 71N in the appropriate box. Far <br />individuals, this is your snclal. security number <br />(SSN-, However, if you a2 a r~dertt affen OR a <br />sole pmpdemr, see the instrucvrns an page 2. <br />Far other entdles, i[ is your employer <br />ideridfi~tior, num6ar {E1NJ. If you da War have a <br />number, see Hoter m get a TW an pace 2. <br />Notes !f the accauM is in mot than one name, <br />see. the chart on page 2 for guidet6tes on whose <br />nran6er [o enter: ~ - <br />Under perraides of perjury, 1 ce#Y drat <br />Saeial secrtrrty mm~eer <br />OR <br />£re~layer idendficatian nrmmer <br />GSv~ fc+rato ~ igye <br />r~ttest~: fao ~~~ <br />J ~~ <br />Requesmrs name and address (oadanal) <br />!1a a¢ount number(s) ham (optrart~l ! <br />For Fayees Exempt From Backup <br />'dlPot,°,hWdeng {Ses the insttuatgn5 <br />en page 2) <br />7. The mrm6ar snawn on iha tram is my correct taxpayer idendhcidon rtumtrer (or 1 am waidrtg for a numherta tre Fssued to rrreJ, aced <br />2 1 am War subject to hadwp withholding txrause; (a~ 1 am exempt from backup widthokfing, ar ~- I have not tram notified by the tritemal, <br />Reeerate Srsvica (IRS) that ! am subject to traclarp withholding as a result of a failure to report ail iritaresi ar dividends, or 1~ the IRS has <br />notified me that 1 am no kmger atbjed to hadtup withhofdtng. ~ . <br />. Ycr Hurst cuss cut i~it 2 above if yriu have l~~netified i3y the 1}ZS Ctaryvu are aatarlYly v'~ ra hadaip <br />wid~l2cWmc he,--„~ ace true r-~ed to r~ssc au ini~ and ort ;c+er Tas r-^ n. F~ tFi ?a2,: fiai~. troll 2 a~ tall arty. <br />Far mortgage iatem5t paid, acgrtisidtar er abandonment of seared property, tarv~~+~n of detrt contrtbudarts to an individual redremerrt <br />arrangement (IRA), and generally, paymeras other than interest and d'widentls, you are not requvr(d m sign the Cetdficadan, Dut you must <br />provide your correct TIN. (Sea the irrstrttcdons do page 2.J ~ - <br />i5ign <br />Here ~ Sdarmture to <br />Purpose a6 Parma. A persrn wtta~ is <br />required to f7e an information redurt. with <br />the IRS must get your correct taxpayer <br />idertdtipdon numtrer (T1N- iq report, f~ <br />- ~~t:xamaie, ihcasne paid•iL.~yau, -mat esi.^.ar- <br />`-•1;.ans0~an5:-mortyage t~ ~rxrest yao-paid:: - <br />~acquisidan or abandonment d ~cvred <br />property, pnce0adon of debt, or <br />comribudons you~made to an IRti. <br />Use Fann W-B, if you are a,U.S. person <br />(mckrding a re<_ideta atienJ, to give your <br />carted TIN m the~persan requesting in (!he <br />requester) and, when applipbl!?, m: <br />1. Certify the TIN you are ghring is <br />cnmect (or you are waiting for a number Ta <br />he issued), - n <br />Z. Certify you are not subject za badtup <br />withholding, dr <br />3. Claim exemption from backup <br />wkhhalding ff you era an exempt payee. <br />If you era a foreign person, IRS prefers <br />you use a Fonn W-8 (prdficate of foreign <br />status). After Dectartber 31, 2000, fortign <br />persons mist use an appropriate Farm <br />rN-B- <br />Nate: 1f a regw3Ear gives you a fomr od:er <br />roan Form W-9 to request ;roar TiN, ~cu <br />must use the reque?-iG-r'i Porrtr if• it is <br />su(trandally simriar to this Form IAl-5. <br />. Vi/hat is haakktaP vredtirhoBd"mgY Persons <br />making certain paymerrts m yea must <br />withhqId and}pay to rite 1R5 31% of such <br />paym~tr under min cagditlans. 'this is <br />--~6a:c3-'badu:Q withholding." Paymer2s ~: <br />"~s'c Wray-be~scbjxt tab,.~;:r~. v..".a?;,^.ldiny <br />indude irrteresi,~ divddends, broker and <br />barter exchange transactions, reins: <br />royalties, ndnemployee pay, and certain <br />paymerRS ham fishing boat operators. Real <br />estate transactions are Hat subject to <br />backup withholding. <br />dyou give the requesteryour,tvmeci <br />TIN, make the proper cerdficaddns, and <br />report all your taxable interest and <br />dividends ort your taz retain, payments <br />you restive will not be subject to baGcup <br />urithhalding. Paymert[s you receive wr71 be <br />subject to hadcup withholding if: <br />7, You do no[ furnish your TIN to the <br />requester, ar - <br />2 Yau do not txrdfy yow TlN when <br />required (see the Part III instructions on <br />page 2 for details), or <br />3. The IRS tails the reaueser drat you <br />famished an incnmet-i 7JN, or <br />A. Tne IRS AIL you that you are subieC, <br />To haclrup wiihholdira bepusa you did not <br />report all your interes-and dividends an <br />year 2.: return (fer r2pa,-rable imenst and <br />dividends only}, cr <br />5. Yau do not cerdfii to the requester ~" -~~ <br />that you are Hat subject iq backup <br />vviddtoWing under 3 above (for reportable <br />irrteresk and dividend atcixtrrts aperred <br />~afier-1g83 e: dY1.. - ~ - -- - _ . -- <br />... Certain payees and'payrrients~are ~:.. .,. <br />exempt from backup withholding. See the <br />Part II instructions and the repaints <br />Instruo5®ets for ¢he Requester od Fawn <br />NU-9. <br />PeftaP~es <br />Faiiura to furradsh T7N. !f you fail to fumisn <br />your correct TiN ZQ a requester, you are <br />subject to a penalty of S50 for each such <br />falure unless your failure is due td <br />reasonable puce and rtat to vnllfirl neglect <br />Civil panalbp far false information wiUr <br />re=pest io withhdding. if you make a <br />false statement, no reasonabe basis <br />that results in no 6addtp withholding, you <br />are subject to a S-°QO perraibj. <br />Crirn6rai pematty for fa9sirying <br />information. Witlfully falsifying , <br />c.~rdficadons or atfimtations may subject <br />yolr ifl cxnfnal penalties indudina fines <br />and/cr imprisonment <br />ABisise ~ i+Ns. if the 2questa discieses <br />cr uses TiNs in vicladdn of Fsdeal law, lte <br />reque_~.er may he subjec rn csvii and. <br />ciminai penalties. <br />va Vo. id237r Fvrt t~-~ ;ReH. ~1'-34) <br />