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Form W-0 Request for Taxpayer <br />SubsWL a Form Identification Number and Certification Give stein to the <br />Stae. of C:otwado 8.2007 requester. Do not <br />xsme n send to the IRS. <br />o <br />if different from above <br />OPT <br />Chen appropriate box <br />Individual/ Sole Proprietor ? Corporation ? Partnership ether <br />? ? Exempt from backup withholding <br />a Address (number, street, ad apt. or suite no.) <br />Requester <br />City, stag and ZIP code. <br />List Account nun g <br />her(s) here (optional) <br />limit Tannyer Identification Number (TM <br />Enter your nN in the appropriate box For individuals, this is your social security number (SSN) However. <br />for a resident alien, sole proprietor or disregarded entity. see the Part 1 instructions on Social Security number <br />other entities, k is your employer identification number (EIN). If you do not have a number, see How to For <br />a TIN on page 3. <br /> <br /> <br />Under penalties of perjury, I certify that <br />1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued tome), and <br />2. 1 am not subject to backup withholding because. (a) 1 am exempt from backup withholding, or (b) I have not been notified by the <br />Intemai 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 />3. 1 am a U.S. person (including a U.S. resident alien). <br />Certiftcatbn 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 inber+eat and dividends on your tax return. For real estate transactions, item 2 does not apply. <br />For mormage interest paid, acquisition or abandonment of secured property, cancellation of <br />retirement <br />debt, contributions (IRA), and generally,eyments other than interest and dividends, you are not required to sign the Can gn the ertification, individual <br />provide Your correct <br />but you must <br />TIN. (See tly3 in?tructior>S-6R?ac?e 3.1 <br />H <br />Date ? p <br />Minority and Women-owned usimnses (iMAVBEs) Self Certification (Please check all boxes that <br />apply) <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 individual(s) who also control(s) and operate(s) it. "Control' in this context means exercising the power to make policy <br />decisions. 'Operate' means actively involved in the day-today management. If you business is jointly owned by both men and women or is a <br />large publicly held corporation, please check the box labeled 'Plot Applicable.' <br />Gender Information: <br />? Female-Owned X Male-Owned <br />Owner Ethnicity Information <br />? African American <br />? Hispanic American <br />? Asian/Pacific American <br />? Native American <br />Small Business Information <br />? Not Applicable <br />XWhite (non-Hispanic) ? Not Applicable <br />? Other. <br />Small Business (a business that is organized for prom is independently owned and operated, and has 25 or fewer full time equivalent <br />employees.) <br />W Yes ? Nc