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'Farm w-9
<br />Rev. October MM
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<br />Name
<br />Request for Taxpayer al" form to the
<br />Identiflcatlon Number and Certification requester. Do not
<br />send to the IRS.
<br />an your frraome tax return)
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<br />Bushess name,-If daft rw from
<br />Check eppropdate box ? IWMdueVSde proprietor ? Corporation ? ParlneraNp
<br />? limited Gabdlty company. Enter the tax classification (D-diareparded entuy, C-eorPoration, PaPennarSbP) ? 0 pay8 _8 t
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<br />Address (number and apt. or
<br />suite ?0-),-) Requester s name and address lootkxtail
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<br />City. Me. and 21P code
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<br />Ust account ) hero
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on Une Ito avoid soc4t ?b number
<br />backup withholding. For Individuals, this is your social security number (SSN). However, for a resident
<br />alien, sole proprietor, or disregarded enft see the Part I instructions on page 3. For other entitles, it Is
<br />your employer identification number (EN). If you do not have a number, see How to get a TUN 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
<br />number to enter.
<br />Under penalties of perjury, it 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 (!RS) first 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 belo".
<br />Certification kwbucfiona 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 pald,l acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
<br />arrangement ORA). and generally, payments other than Interest and dividends, you are not required to sign the Certification, but you must
<br />provide your correct MN. See the instructions on page 4.
<br />Sign
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<br />-& Dairson Gieneral Instructlons- ,
<br />Section references are to the internal Re 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, Inoome 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 toI 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 &u 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 it you are a U.S.
<br />exempt payee. it 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 Isl not subject to the withholding tax on
<br />foreign partners' share of effectively connected income.
<br />Note. If a requester gives you a fain 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 />gate ? /,
<br />Definition of a U.S. person. For federal tax purposes, you are
<br />considered a U.S. person If you are,
<br />e An individual who is a U.S. citizen or U.S. resident alien,
<br />e A partnership, corporation, company, or association created or
<br />organized in the United States or under the laws of the United
<br />states,
<br />e An estate (other than a foreign estate), or
<br />0 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 re '
<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 Forth 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 />0 The U.S. owner of a disregarded entity and not the entity,
<br />
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