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Form W-9 (Rev. 12-2014) Page 3
<br />Line 2
<br />If you have a business name, trade name, DBA name, or disregarded entity name,
<br />you may enter it on line 2.
<br />Line 3
<br />Check the appropriate box in line 3 for the U.S. federal tax classification of the
<br />person whose name is entered on line 1. Check only one box in line 3.
<br />Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a
<br />partnership for U.S. federal tax purposes, check the "Umited Liability Company°
<br />box and enter "P" in the space provided. If the LLC has filed Form 8832 or 2553 to
<br />be taxed as a corporation, check the "Umited Liability Company" box and in the
<br />space provided enter "C" for C corporation or "S" for S corporation. If it is a
<br />single -member LLC that is a disregarded entity, do not check the "Limited Liability
<br />Company" box; instead check the first box in line 3 "Individual/sole proprietor or
<br />single -member LLC."
<br />Line 4, Exemptions
<br />If you are exempt from backup withholding and/or FATCA reporting, enter in the
<br />appropriate space in line 4 any code(s) that may apply to you.
<br />Exempt payee code.
<br />- Generally, Individuals (including sole proprietors) are not exempt from backup
<br />withholding.
<br />- Except as provided below, corporations are exempt from backup withholding
<br />for certain payments, including Interest and dividends.
<br />- Corporations are not exempt from backup withholding for payments made in
<br />settlement of payment card or third parry network transactions.
<br />- Corporations are not exempt from backup withholding with respect to attorneys'
<br />fees or gross proceeds paid to attorneys, and corporations that provide medical or
<br />health care services are not exempt with respect to payments reportable on Form
<br />1099-MISC.
<br />The following codes identify payees that are exempt from backup withholding.
<br />Enter the appropriate code in the space In line 4.
<br />1—An organization exempt from tax under section 501(a), any IRA, or a
<br />custodial account under section 403(b)(7) if the account satisfies the requirements
<br />of section 401 (1)(2)
<br />2—The United States or any of its agencies or instrumentalities
<br />3—A state, the District of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivisions or instrumentalities
<br />4—A foreign government or any of Its political subdivisions, agencies, or
<br />Instrumentalities
<br />5—A corporation
<br />6—A dealer in securities or commodities required to register In the United
<br />States, the District of Columbia, or a U.S. commonwealth or possession
<br />7—A futures commission merchant registered with the Commodity Futures
<br />Trading Commission
<br />8—A real estate investment trust
<br />9—An entity registered at all times during the tax year under the Investment
<br />Company Act of 1940
<br />10—A common trust fund operated by a bank under section 584(a)
<br />11—A financial Institution
<br />12—A middleman known in the Investment community as a nominee or
<br />custodian
<br />13—A trust exempt from tax under section 664 or described in section 4947
<br />The following chart shows types of payments that may be exempt from backup
<br />withholding. The chart applies to the exempt payees listed above, 1 through 13.
<br />IF the payment is for...
<br />THEN the payment is exempt for...
<br />Interest and dividend payments
<br />All exempt payees except
<br />for 7
<br />Broker transactions
<br />Exempt payees 1 through 4 and 6
<br />through 11 and all C corporations. S
<br />corporations must not enter an exempt
<br />payee code because they are exempt
<br />only for sales of noncovered securities
<br />acquired prior to 2012.
<br />Barter exchange transactions and
<br />Exempt payees 1 through 4
<br />patronage dividends
<br />Payments over $600 required to be
<br />Generally, exempt payees
<br />reported and direct sales over $5,0001
<br />1 through 5'
<br />Payments made in settlement of
<br />Exempt payees 1 through 4
<br />payment card or third party network
<br />transactions
<br />However, the following payments made to a corporation and reportable on Form
<br />1099-MISC are not exempt from backup withholding: medical and health care
<br />payments, attorneys' fees, gross proceeds paid to an attorney reportable under
<br />section 6045(f), and payments for services paid by a federal executive agency.
<br />Exemption from FATCA reporting code. The following codes identify payees
<br />that are exempt from reporting under FATCA. These codes apply to persons
<br />submitting this form for accounts maintained outside of the United States by
<br />certain foreign financial institutions. Therefore, if you are only submitting this form
<br />for an account you hold in the United States, you may leave this field blank.
<br />Consult with the person requesting this form if you are uncertain if the financial
<br />Institution is subject to these requirements. A requester may Indicate that a code is
<br />not required by providing you with a Forth W-9 with "Nat Applicable" (or any
<br />similar Indication) written or printed on the line for a FATCA exemption code.
<br />A—An organization exempt from tax under section 501(a) or any individual
<br />retirement plan as defined in section 7701(a)(37)
<br />B—The United States or any of Its agencies or instrumentalities
<br />C—A state, the District o1 Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivisions or instrumentalities
<br />D—A corporation the stock of which is regularly traded on one or more
<br />established securities markets, as described in Regulations section
<br />1.1472-1(c)(1)(p
<br />E—A corporation that is a member of the same expanded affiliated group as a
<br />corporation described in Regulations section 1. 1472-1 (c)(1)(i)
<br />F—A dealer in securities, commodities, or derivative financial Instruments
<br />(including notional principal contracts, futures, forwards, and options) that is
<br />registered as such under the laws of the United States or any state
<br />G—A real estate investment trust
<br />H—A regulated investment company as defined in section 851 or an entity
<br />registered at all times during the tax year under the Investment Company Act of
<br />1940
<br />I—A common trust fund as defined In section 584(a)
<br />J—A bank as defined In section 581
<br />K—A broker
<br />L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
<br />M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
<br />Note. You may wish to consult with the financial institution requesting this form to
<br />determine whether the FATCA code and/or exempt payee code should be
<br />completed.
<br />Line 5
<br />Enter your address (number, street, and apartment or suite number). This Is where
<br />the requester of this Form W-9 will mail your Information returns.
<br />Line 6
<br />Enter your city, state, and LP code.
<br />Part I. Taxpayer Identification Number (TIN)
<br />Enter your TIN In the appropriate box. If you are a resident alien and you do not
<br />have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer
<br />identification number (ITIN). Enter it in the social security number box. If you do not
<br />have an [TIN, see How to get a 7/N below.
<br />If you are a sole proprietor and you have an EIN, you may enter either your SSN
<br />or EIN. However, the IRS prefers that you use your SSN.
<br />If you are a single -member LLC that is disregarded as an entity separate from its
<br />owner (see Limited Liabil fy Company (LLC) on this page), enter the owner's SSN
<br />(or EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC
<br />is classified as a corporation or partnership, enter the entity's EIN.
<br />Note. See the chart on page 4 for further clarification of name and TIN
<br />combinations.
<br />How to get a TIN. If you do not have a TIN, apply for one immediately. To appy
<br />for an SSN, get Form SS -5, Application for a Social Security Card from your local
<br />SSA office or get this forth online at www.ssa.gov. You may also get this form by
<br />calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
<br />Identification Number, to appy for an [TIN, or Form SS -4, Application for Employer
<br />Identification Number, to apply for an EIN. You can apply for an EIN online by
<br />accessing the IRS website at www.irs.gov/bus1nesses and clicking on Employer
<br />Identification Number (EIN) under Starting a Business. You can get Fortes W-7 and
<br />SS -4 from the IRS by visiting IRS.gov or by calling 1 -800 -TAX -FORM
<br />(1-800-829-3676).
<br />If you are asked to complete Forth W-9 but do not have a TIN, apply for a TIN
<br />and write "Applied For" in the space for the TIN, sign and date the form, and give it
<br />to the requester. For Interest antl dividend payments, and certain payments made
<br />with respect to readily tradable Instruments, generally you will have 60 days to get
<br />a TIN and give it to the requester before you are subject to backup withholding on
<br />payments. The 60 -day rule does not apply to other types of payments. You will be
<br />subject to backup withholding on all such payments until you provide your TIN to
<br />the requester.
<br />Note. Entering "Applied For means that you have already applied for a TIN or that
<br />r See Forth 1099-MISC, Miscellaneous Income, and its instructions. you intend to apply for one soon.
<br />Caution: A disregarded U.S. entity that has a foreign owner must use the
<br />appropriate Fomr, W-8.
<br />25C-16
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