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<br />- orm W-9
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<br />Request for Taxpayer
<br />Give form to the
<br />Rev. October 2007)
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<br />Identifi Number and Ceftll ft
<br />requester. Do not
<br />send to the IRS.
<br />)apartment of the Treasury
<br />ntemal Revenue Service
<br />Name (as shown on your income tax return)
<br />Overlook Mine, LLC
<br />Business name, if different from above
<br />-
<br />d /b /a Reclamation Ridge
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<br />c Check
<br />appropriate box: El Individual /Sole proprietor El Corporation ❑ Partnership
<br />►
<br />Exempt
<br />❑
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<br />Q Limited liability company. Enter the tax classification (D= disregarded entity, C= corporation, P= partnership) .......
<br />payee
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<br />❑ Other (see instructions) IN-
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<br />Address (number, street, and apt. or suite no.)
<br />Requester's name and address (optional)
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<br />P.O. Box 2002
<br />City, state, and ZIP code
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<br />rn
<br />Winter Park, CO 80482
<br />List account number(s) here (optional)
<br />Taxpayer lidentification Number `TIM)
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid [ S- - ia — lsecurity number
<br />backup withholding. For individuals, this is your social security number (SSN). However, for a resident
<br />alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is or
<br />your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.
<br />Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number
<br />number to enter. 41 2261450
<br />Certification
<br />Under penalties of perjury, I certify that:
<br />1. 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 />2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
<br />Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
<br />notified me that 1 am no longer subject to backup withholding, and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below).
<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 your correct TIN. See the instructions on page 4. (� +
<br />Sign Signature of ^' Q �� boo �`- kee n e ( Date 111
<br />Here U.S. person I.- / �` V U 1
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless
<br />otherwise noted.
<br />Purpose of Form
<br />A person who is required to file an information return with the
<br />IRS must obtain your correct taxpayer identification number (TIN)
<br />to report, for example, income paid to you, real estate
<br />transactions, mortgage interest you paid, acquisition or
<br />abandonment of secured property, cancellation of debt, or
<br />contributions you made to an IRA.
<br />Use Form W -9 only if you are a U.S. person (including a
<br />resident alien), to provide your correct TIN to the person
<br />requesting it (the requester) and, when applicable, to:
<br />1. Certify that the TIN you are giving is correct (or you are
<br />waiting for a number to be issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S.
<br />exempt payee. If applicable, you are also certifying that as a
<br />U.S. person, your allocable share of any partnership income from
<br />a U.S. trade or business is not subject to the withholding tax on
<br />foreign partners' share of effectively connected income.
<br />Note. If a requester gives you a form other than Form W -9 to
<br />request your TIN, you must use the requester's form if it is
<br />substantially similar to this Form W -9.
<br />Definition of a U.S. person. For federal tax purposes, you are
<br />considered a U.S. person if you are:
<br />• An individual who is a U.S. citizen or U.S. resident alien,
<br />• A partnership, corporation, company, or association created or
<br />organized in the United States or under the laws of the United
<br />States,
<br />• An estate (other than a foreign estate), or
<br />• A domestic trust (as defined in Regulations section
<br />301.7701 -7).
<br />Special rules for partnerships. Partnerships that conduct a
<br />trade or business in the United States are generally required to
<br />pay a withholding tax on any foreign partners' share of income
<br />from such business. Further, in certain cases where a Form W -9
<br />has not been received, a partnership is required to presume that
<br />a partner is a foreign person, and pay the withholding tax.
<br />Therefore, if you are a U.S. person that is a partner in a
<br />partnership conducting a trade or business in the United States,
<br />provide Form W -9 to the partnership to establish your U.S.
<br />status and avoid withholding on your share of partnership
<br />income.
<br />The person who gives Form W -9 to the partnership for
<br />purposes of establishing its U.S. status and avoiding withholding
<br />on its allocable share of net income from the partnership
<br />conducting a trade or business in the United States is in the
<br />following cases:
<br />• The U.S. owner of a disregarded entity and not the entity,
<br />Cat. No. 10231X Form W -9 (Rev. 10 -2007)
<br />
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