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orm W-9 Request for Taxpayer Give form to the
<br />IRev. J anuary 2002) Identification Number and Certification requester. Do not
<br />Departm ent of me Treesray send to the IRS.
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<br /> Tax a- er Identification Number IN)
<br />Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN). Social security number
<br />However, far a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on
<br />page 2. For other entities, it is your employer itlentifcation number (EIN). If you do not have a number.
<br />see How to get a TIN on page 2. or
<br />Note: If [he account is in more than one name, see [he chart an page 2 for guidelines on whose number Employer idendficatlon number
<br />to enter. - ~ 1 ~ ~ ~ ~ ~ ~
<br />Untler penalties of perjury, I certify that:
<br />7. 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 not been notified by [he Internal
<br />Revenue Service (IRS) that I am subject to backup withholding as a result of a failure [o report all interest or dividends, or (c) the IRS has
<br />no[ifetl me that I am no longer subject to backup withholding, and
<br />3. I am a U.S. person (including a U.S. resident alien).
<br />Certification instructions. You 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 transactions, item 2 does not apply.
<br />for mortgage interest paid, acquisition or abandonment of secured property. cancellation of debt, contributions to an individual retirement
<br />arrangement (IRA), and generally, payments other than interest and dividends, you are not required [o sign [he Certifcation, but you must
<br />provide your coned TIN. (See the insvuctions on page 2.)
<br />sign I Signature of
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<br />Purpose of Form
<br />A person who is requiretl to Flle an information
<br />return with the IRS must get your caned
<br />taxpayer idendfcation number (TIN) [o report, for
<br />example, income paid to you, real estate
<br />Vansactions. mortgage mrerest you paitl.
<br />acquisition or abandonment of secured property.
<br />cancellation of tleht, or contribuuons you made
<br />to an IRA.
<br />Use Form W-9 only i/ you are a U.s. person
<br />(indutling a resitlent alien), to give your correct
<br />TIN to the person requesting it (the requester)
<br />antl, when applicable, to:
<br />1. Certify the TIN you are giving is correct (or
<br />you are waiting for a number to he issuedl.
<br />2. Certify you are not subject to backup
<br />withholding, or
<br />3. Claim exemption from backup withholtling if
<br />you are a U.S. exempt payee.
<br />If you are a foreign person, use the
<br />appropriate Form W-a. See Pub. 515,
<br />Wi[hholtling of Tax on Nonresident Aliens and
<br />Foreign Entities.
<br />Note: 11 a requester gives you a Iorm other than
<br />Form W-9 to request your TIN, you must use the
<br />requester's form it it is substantially SimUar to this
<br />Form W-9.
<br />What is backup withholding? Persons making
<br />certain payments to you must under certain
<br />conditions wkhholtl antl pay to the IRS 309e of
<br />such payments after December 31, 2001 (29%
<br />after December 31, 2003). This is calletl "backup
<br />wi[hhq~tling." Payments [ha[ may be subject to
<br />backup withholding ihdutle interasc-divitlentls,
<br />broker antl boner exchange vansactions. rents,
<br />royalties, nonemployee pay, and certain
<br />payments tram fshing boa[ operators. Real
<br />estate vansactions are not subject to backup
<br />withholding.
<br />You will not be subject to backup withholtling
<br />on payments you receive if you give the
<br />requester your correct TIN, make the proper
<br />certifcations, and report all your taxable interest
<br />antl tlivitlentls on your tax return.
<br />Payments you receive will be subject to
<br />backup withholding if:
<br />1. You tla not furnish your TIN to the
<br />requester, or
<br />2. Vou oo not certify your TIN when requiretl
<br />(see [he Part II instructions on page 2 for
<br />details), or
<br />3. The IRS tells the requester Ina[ you
<br />furnishetl an incorrect TIN. or
<br />4. The IRS tells you that you are subject to
<br />backup withholding because you did not report
<br />all your interest antl dividends on your tax return
<br />(for reportable interest and divitlentls only), or
<br />5. You tlc no[ certify to the requester that you
<br />are not subject co backup withholding under 4
<br />above (for reportable interest antl dividend
<br />accounts openetl after 1983 only).
<br />Certain payees and payments are exempt
<br />from backup withholding. See the instructions on
<br />page 2 and the separate Instructions for the
<br />Requester of Form W-9.
<br />Penalties
<br />Failure to famish TIN. If you fail to furnish your
<br />correct 71N tc a requester, you are subject to a
<br />penalty of s50 for each such failure unless your
<br />failure is due to reasonable cause antl not [o
<br />willful neglect.
<br />Civil penalty for false information with respect
<br />to withholding. If you make a false statement
<br />with no reasonable basis that results in no
<br />backup withholtling, you are subject to a 5500
<br />penalty.
<br />Criminal penalty for falsifying information.
<br />Willfully falsifying certifcations or affrmations
<br />may subject you to criminal penalties including
<br />fines antl/or imprisonment.
<br />Misuse of TINS. If me requester discloses or
<br />uses TINS in violation of Fetlerel law, the
<br />requester may be subject to civil and criminal
<br />penalties.
<br />Caf. No. 10231X Form W-g (Rev. 1-2002)
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