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)
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