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Form "
<br />Request for Taxpayer L
<br />orm tome
<br />(Rev, December 2014) Identification Number and Certification ter. Do not
<br />oepanment of the Treasury o the 10
<br />nternal Revenue Service
<br />k.
<br />1 Nam��nhuwn on ourtncomu tax return). Name is required on this I lie do not leave this lino bank
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<br />2 Oualnass narne/dleregarded entity name, If d4f trent from above
<br />m........,______.._.___.._.. _....
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<br />p' 3 Chuck appropriate box for federal tax classification; shock only one of the following cover, hones: 4 Eoth for ora (codes apply only to
<br />C oestrin ammo&, net irkfividaihq see
<br />o )� Indlwdlanl7sole proprietor or � C Corporation ❑ S Corporation ❑ Panner hip �� 7msVe ,tale Instruotione on page 3):
<br />wp o alis In member LLC Exempt Payee code (if any)
<br />F 0 (] lure eted Mobility company. Enter the tam classification (C=C corporation, S=S corporation, P=partnorshlp)-------
<br />o Exemption from FATCA reporting
<br />p lieke. For s ahlgle roof Has LLC oral Is number
<br />o nrded, do not cheek LLC', check the appropriate box in the Ilne above for
<br />Ilte 7nx classification of IIFe single Inamber tiwllcr. g code (If any)
<br />,is 7d
<br />5 Ci state, and pnn.x io .—
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<br />1_ --- —d ,._ ......,,-
<br />� 8 Address nwltlber, street,and 1111 Or cotta no — � Requester's rlamd and address (optional)
<br />C Jj biz
<br />Enter your "FIN in the appropriate box. The 71N provided must match the name given on lino Ito avoid (somal
<br />samuny
<br />norm
<br />backup withholding. For individuals, this is generally your sci security number (SSN). However, for a
<br />resident allen, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
<br />entities, it Is your employer Identification number (LIN). If you do not have a number, see How to get a
<br />111
<br />TIN on page 3. or
<br />Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for Employer
<br />iduntifioat
<br />guidelines on whose number to enter.
<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 fie); 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 Revenue
<br />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 notified trio that I am
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S. citizen or other U.S, person (defined below); and
<br />4. The FATCA couple) entered on this form (if any) Indicating that I am exempt from FATCA reporting Is correct.
<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 withholding
<br />because you have failed to report all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage
<br />Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and
<br />generally, payments ether than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
<br />Instructions on pagro 3. _.. .....
<br />Sign Signature of t ,%N
<br />HereU.S. personb "j
<br />General Instructions
<br />Section refm'ences safe the Internal Revenue Code unless otherwise noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release It) is at www.lrsgov/iw9,
<br />Purpose of Form
<br />All Individual or anhty(Fckm NI 9 lophr tll9l f who Is rebuked In file an 1niformdtfon
<br />rNb.imwith the lRt must cousin, yom t•odeet taxpayer khattfirrohon nurnbar.(TIN)
<br />which may be your social security upnni BIS", Individual taxpaynr rentlrorann
<br />number (111N) adoption Laxp lyaor WmAlllostiorl onrn0pr ATIN), or employer
<br />Iocirtilcnllol rumba, (E IN), to upon, on ail In9ornatfon rob.ini If is innounl paid to
<br />you, or other amount reportable on an information return, Exampbs of information
<br />returns include, but are not limited to, the following,
<br />• Form 1099 -INT (interest earned or paid)
<br />• Form 1099 -DIV (dividends, Including those from stocks or mutual funds)
<br />• Form 1099-MISC (various types of Income, prized, awards, or gross proceeds)
<br />• Form 1090-0 (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />= Form 1009-3 (proceeds from real estate transactions)
<br />• Farm 1099-K (merchant card slid third party network transactions)
<br />bates
<br />• Form 1096 (home mortgage Interest), 1096-E (student loan instant), 1099-T
<br />(tuition)
<br />a Form 1099-0 (canceled debt)
<br />• From 1099-A (acquisition or abandonment of seared properly)
<br />Use Form W-9 only if you are a U.S. person (including a resident al air), to
<br />provide your correct TIN.
<br />I( you do net return Form W 9 to the requester with a TIN, you might be subject
<br />to baclvp wirhltotding, See What 6a backup withholding? on page 2.
<br />By signing the filled -out form, you:
<br />I CmzMy-triial it,(, PIN-youNraytiving is woman (or you am- writing fma-rwanber _._..
<br />to be issued),
<br />2. Certgy that you are not sub(ect to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U,S. exempt payee. It
<br />applicable, you are also certifying that as a U.S. person, your allocable share of
<br />any partnership Income from a U.S. trade or business is not subject to the
<br />withholding tax on foreign partners' share of effectively connected income, and
<br />4. Certify that FATCA shape) entered on this form (if any) Indicating that you are
<br />exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
<br />page 2 for further information.
<br />Cal. No. 10231 X Form W-9 (Rev. 12-2014)
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