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W'9 Request for Taxpayer Give form to the
<br />Form
<br />Rev. October 2007)
<br />Identification Number and Certification requester. Do not
<br />send to the IRS.
<br />Department of the Treasury
<br />ntemal Revenue Service
<br /> Name (as shown on your income tax return)
<br />Q Kirby Jack Quint
<br />0 Business name, if different from above
<br />a
<br />C
<br />0
<br />CL c
<br />Check appropriate box: ?? Individual/Sole proprietor ? Corporation ? Partnership
<br />?
<br />Exempt
<br />?
<br />ar ______.
<br />El Limited liability company. Enter the tax classification (D=disregarded entity, C=corporation, P=partnership) payee
<br />`o ? Other (see instructions) ?
<br />c Address (number, street, and apt. or suite no.) Requester's name and address (optional)
<br />c 35 N. Precision Drive
<br />S
<br />U
<br />City, state, and ZIP code
<br />m Pueblo West, CO. 81007
<br />ai List account number(s) here (optional)
<br />CD
<br />Identification
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid Social security number .
<br />backup withholding. For individuals, this is your social security number (SSN). However, for a resident 522 ; 06 3647
<br />alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
<br />your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
<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.
<br />Certification
<br />Under penalties of perjury, 1 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 I 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 - '? ntly subject to backup
<br />withholding because you have failed to report all interest and dividends c ns, item 2 does not apply.
<br />For mortgage interest acquisition or abandonment of secured prop n individual retirement
<br />paid, arrangement (IRA), and generally, payments other than interest and divid t fication, but you must
<br />provide your correct TIN. See the instructions on page 4. .„-
<br />Sign Signature of Here U.S. person 0, Date 0,
<br />General lnstructiong
<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 aTorm 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)
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