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orm VV_9 Request for Taxpayer <br />Identification Number and Certification Give form to the <br />substitute ?c:rn requester. Do not <br />State of Colorado B-2007 i <br />send to the IRS. <br />M, -_? OAd <br />?I t <br />M& Business name, if different trozn above <br />C <br />CL <br />4 Check appropriate box: <br />0Individuall Sole Proprietor © Corporation partnership Other E3Exempt ffoin backup withholding <br />10 ..................... <br />c Ad s (nwn r, street, and apt. or suite no.) Requester: <br />City, state, and ZIP code. <br />List Acco t mber(s) ere (opti na}l <br />Enter your TIN in the appropriate box. For individuals, this is your social security number (SSN) However, Social Sett? for a resident alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For <br />other entities, it is your employer identification number (EIN). If you do not have a number, see How to get 2 a TIN on page 3. Note: H the account is in more than one name, see the chart on page 3 for guidelines on whose Employer identification number <br />number to enter. <br />Under penalties of perjury, I certify that., <br />The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and <br />I am not subject to backup withholding because. (a) I am exempt from backup withholding, or (b) I have not been notified by the <br />Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or <br />(c) the IRS has notified me that I am no longer subject to backup withholding, and <br />1 1 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 notified 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 to sign the Certification, but you must <br />provide our correct TIN. (See the instructions on nanp R ) <br />of <br />U.S.person ? <br />Minority and Women-owned 9dsinesses (M/WSEs) Self <br />Date ? <br />(Please check all boxes that apply) <br />)n- <br />In an effort to track levels of participation by women and minorities doing business with the State of Colorado, the following information is <br />requested, Please Indicate the appropriate category of ownership for your company. 'Owned' in this context means a business that Is at least 51 <br />percent owned by an individualrsl who atan rontrnlrcl and a-Amt.! t it "ypntrCl" In IN a ,,. mean_ <br />decisions. 'Operate' means actively involved In the day-to-day management. If you business is+jointly ownedIbytboth men and women on is a <br />large publicly held corporation, please check the box labeled "Not Applicable." <br />Gender Information: <br />EJ Female-arwnod 1L dale-Owned D. Not Applicable <br />Owner Ethnicity Information <br />Ci African American © Asian/Pacific American ,KWhite (non-Hispanic) 0 Not Applicable <br />11 Hispanic American C1 Native American © Other; <br />Small Business information <br />Small Business (a business that is orrgafted for profit, is independently owned and operated, and has 25 or fewer full tine equivalent <br />employees.) <br />x1yes 0 Nir