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arm ~°'ad
<br />(Fev..Navembar 1994)
<br />R~~~~ ~Ir g~y~
<br />Givae faaam ~ tkte`
<br />~ ~~ ~~~
<br />Name pF ajoint aceeum or you changed year name. ~e spedne !ns°.tutdlons on page Z.)
<br />a / ~ t ~ 1 _ -
<br />_ 1-
<br />Business name. it dinemst from aoava. (See Spati'~c I~ w,,,-,r~~ on page 2)
<br />`e
<br />~ -
<br />o• CherX apprapnare Sox: ^ lndknduav5ole proprietor ^ Corpcradon ^ Partne~sftip ^ CNar D
<br />m Address (number, street and apt or rube no.) Requasrers tame and address (oQtlenaq
<br />m
<br />b
<br />CRy, irate, and DP code
<br />Erroer your TIN in the appropriate box. Far
<br />individuals, dtis is your social. secudty number
<br />(SSN}. However, ff you are a resident alien OR a
<br />sale prapdemr, see the inswcdans on pace 2.
<br />For odt~ enrides, d is your employer
<br />idendfimtier, number (E1N). IF yey do not have a
<br />ntunher, see iiaw to get a TIN do pace Z
<br />Nate If me sccnurrc is in mot than one name,
<br />sea. the chap on page 2 for yufdelfrtes on whose
<br />number to aster.
<br />lJrtder penalties of perjury, 1 ~Y thaG
<br />Saeial setnarty mnnber
<br />OR
<br />acmurx number(s) hem (aptlord) Y
<br />Engrtayer id¢midiratlan rurmber
<br />Far Fagees Exempt Fmm 8ac:atp
<br />'difrte'thWditlg {Sex the irtsbudions
<br />an Dace 2)
<br />1. The numbs shown on this forrrt is my correct taxpayer identifimdon number (or i am waiting far a ntmtberm lie isstretl m me}, and
<br />2 I am no[ subject m badtup wdhhelding bemuse: (a)' i arP exempt from backup wthholding, or W9 I have sat trees notified by the frttemaJ
<br />Revenue Service pR5) that I am suttjeG m 6aclcup vithholding as a result of a Facture m report ail krterest or dividends, or (e) the IRS has
<br />notified me that I am no bnger sunject in hadcup witlthtriding.
<br />"fir . Y<sr rrut4 c¢~ cut it~n 2 above if you have been notified lrj.ihe )RS tlrat yrw are nurerdly 9rhhjefY m har.cup
<br />wimhel~s 6aa~ vcu true fared b rem ail inte^e~ and dvidress art yraataa r,*a7. ~ rEt ~cde trar>~, ii-arr 2 ate sat aady.
<br />For morapge inten?st paw, acgrrisitmr cr abartdonmerrc of sersrred property, rartcel~don of debt cwrtribudar5 m an fnr6vidrtd ~ztirerrerrc
<br />arrangement (IRA}, and genera9y, Payments other than interest and dividends, You are not requitgd to sign the Cegification, but you must
<br />provide your rnrrect TIN. {See the irrstmrxions on page 2.)
<br />iSigrr
<br />ff~s Soartavure t*
<br />Purpose of Porno, A Person who is ~ . tAffrat is backup +vrit6rPeoidittg? Persons
<br />required m file an information rearm. wish making rPnain payments m ycu must
<br />me IRS must get your correct taxpayer withhepld and}pay to the IRS 3l% of such
<br />idertdfimticn ntmiher (I1N) m repoR, for paymems under certain conditions. This is
<br />-:~E:tamaie, inc~rte Paid'iu-yot:;-~a:~esir: ---- -~ ~e,^.fled= badu:p w@hhciding." Paymer2s. ~:
<br />-~"Car o'2~^I."oiiS~ mcrtgage ilitare5i joa'paid; .. - ~ °that rnay~be st:bjecY m r~ ',::p. m- t::~aid;ny
<br />acquisition of a6andonmern of secured indude iraerest,~ dividends, broker and
<br />property, cancelladan of debt, or barter exdtange vansactions, lusts;
<br />comribudons you~made m an IRA. royalties. rronemployee pay, and certain
<br />Use Fonn W-9, ifyw are a.U.S. person Paymen6 from fishing boa[ operafars. Real
<br />(including a resident sties), m give your estate transactions are sat subject to
<br />carreci 73N m the~persan requesting "Ri litre baryerp withholding.
<br />requester) and when applicable, m: If you give the requester your,cortect
<br />1. Certify the TIN you are ghring is TIN, make the proper cerdfimddns, and
<br />crrect (or you are waiting for a number m report all Your taxable interest and
<br />he issued}, - p dividends on your tax return, payments
<br />Z Certify you are not subject is 6adtup Y°u receive will not be subject m backup
<br />vnthttelding. Paymens you receive vvfii be
<br />withholdng, or subject m 6adcup withholding iF
<br />3. Claim exemption fmm backup 1, You do not famish your TIN m the
<br />withhcldng ifiycu era an exempt payer regrussier, or -
<br />If you era a foreign per~n, IRS Prefers 2 You do not certify your TIN when
<br />ycu use a Farm W-8 (certificate of fareian regtrired (see the Part II[ instructions on
<br />saws). Afmr Decsrther 3Y, Z000, foreign page 2 for details}, or
<br />persons must use an appropriate Farm
<br />IN_8•
<br />3, The IRS tells the reque5er that you
<br /> famished an intmne~f TIN or
<br />Nate: If a requesfz• gives you a fans atlrer q, Tne iR5 mIL= cu that ou era cubic-ct
<br />vran Form lN-9 to raauas your TJN, you Y Y
<br />must use the reque<t~s farm ;fit is m backup withholding beceusa You did not
<br />su(:.randaily smriar b this Farm ih'-5. r°-"cart alt _yaur irrteresand dividends an
<br />your ax rerun (fcr r2?a-tabie inerest and
<br />dividends only}, cr
<br />~ You do not czitify id the n;quesie~:~: ..
<br />chat you are not subject m backup
<br />widdtalding under 3 above (for reportable
<br />interesp and dividend atxnurrts opened
<br />after 1g23 e~y}.. - _ . _ ~, .. "
<br />..Certain payees end payments'are~-:.. ....
<br />exempt from backup withholding. See the
<br />Pori ti instructions artd the separate
<br />Insar~tHOns for the Rerltresier of Form
<br />'afF&
<br />Pe~Bfies
<br />Parlors tm itmodsir T9N. If ycu fail m famish
<br />your correct TIN m a requester, you are
<br />sutrject to a penalty of 390 for each arch
<br />fa8ure unless your facture is due m '~
<br />reasonable cause artd sat m vridful neglect.
<br />Civil penalty far Sala information unite
<br />re=per, to witlrhotding. )f you make a
<br />false sfatemerit with no reasonable basis
<br />it7aT results in nc badwp withholding, ycu
<br />aresubjetxto a 5500 penalty.
<br />Crionurai perraity for faisiyirra
<br />irtfonnarian, W7lfully falsifjing• .
<br />cert~cadans or affirmations may subject
<br />ydtr m Qvninal pen` aloes indudina fines
<br />and/or imprisonment
<br />~sisa ai TNs. If the requera diticsz< -
<br />cr uses T1Ns in viciadan ar FedE z! law, 7te
<br />raeuester may be subject m suit and.
<br />aiminal penahie<.
<br />s~NO. 10231 Faun type-~ yRev.11-49)
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