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<br />Form W-9
<br />(Rev October 2007)
<br />Department of the Treasury
<br />Internal Revenue Seneca
<br />c
<br />Part I
<br />Part II
<br />Sign
<br />Here
<br />Name (as shown on your Income tax retum)
<br />Business name, if different from above
<br />Check appropnate box: ❑ Individual/Sole propnetor NI Corporation ❑ Partnership
<br />❑ Limited liability company. Enter the tax classification (D= disregarded entity, C= corporation, P= partnership) ►
<br />❑ CON (see instructions) ►
<br />Address (number, street, and apt or suite n?)
<br />112 E- IZ � ` � t'P.
<br />City, state, and ZIP code
<br />List account number(s) here (optional)
<br />Taxpayer Identification Number (TIN)
<br />Certification
<br />Signature of
<br />U.S. person •
<br />Request for Taxpayer
<br />Identification Number and Certification
<br />Grand SL I e t Tr c .
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
<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
<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
<br />number to enter.
<br />4 r1L' f t'I C C
<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 retum 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 Foml W -9 only if you are a U.S. person (inclu4Ing' ` i
<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 y140 r l. -•
<br />waiting for a number to be issued),
<br />2. Certify that you are not subject to backup withNj ling, or
<br />3. Claim exemption from backup withholding if you arq }.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 11N, you must use the requester's form if it is
<br />substantially similar to this Form W -9.
<br />Date •
<br />Mfal - 2 L5
<br />Give form to the
<br />requester. Do not
<br />send to the IRS.
<br />❑
<br />Exempt
<br />payee
<br />Requester's name and address (optional)
<br />Social security number
<br />•
<br />
<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 I am waiting for a number to be issued to me), and
<br />2. I 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. I 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 />s/L z /Zo
<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 />r I :)rade or business in the United States are generally required to
<br />`
<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 />ijas not been received, a partnership is required to presume that
<br />l 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 />. p.rtrie'rship 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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