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Fpm,
<br />W'9
<br />Request for Taxpayer
<br />, A domestic bust es defined in Regulations section 301.7701-7),
<br />( e9
<br />Give Form to the
<br />(Rev. August 2013)
<br />Identification Number and Certification
<br />the United States are generally required to pay a withholding tax under section
<br />requester. Do not
<br />Deparhnent of the Treasury
<br />1. Certifythat the TIN u are rvl Is correct or you are waiting for a number
<br />you B pg ( Y g
<br />such business. Further, In certain cases whore a Form W-9 has not been received,
<br />the rules under section 1446 require a partnership to presume that a partner Is
<br />send to the IRS.
<br />Intemal
<br />Revenue Service
<br />U.S. person that Is a partner in a partnership conducting a trade or business In the
<br />3. Claim exemption from backup withholding 9 you are a U.S. exempt payee. If
<br />United States, provide Form W-9 to the partnership to establish your U.S, status
<br />and avoid section 1446 withholding on your share of partnership Income.
<br />applicable, you ere also certifying that as a U.S. person, your allocable share of
<br />Name (a9 shown on your income tax return)
<br />any partnership Income from a U.S. trade or business Is not subject to the
<br />City of Santa Ana
<br />N
<br />Business name/disregarded entity name, If different from above
<br />m
<br />rn
<br />m
<br />°
<br />Check appropriate box for federal tax classification:
<br />Exemptions (see Instructions):
<br />m
<br />ElIndlvidual/sole proprietor E]C Corporation E]S Corporation ❑ Partnership ❑ Trust7estate
<br />c
<br />Exempt payee code (Ir any)
<br />0c
<br />❑ Umhed llabllity company. Enter the tax classification(C=C corporation, S=S corporation, P=partnership)►
<br />Exemption from FATCA reporting
<br />code Of any)
<br />S
<br />❑✓ Other loss Instructions) 0- Government
<br />9
<br />Address (number, street, and apt. or suite rw.)
<br />Requester's name and address (optionali
<br />0
<br />a
<br />20 Civic Center Plaza
<br />N
<br />g
<br />City, state, and ZIP code
<br />N
<br />Santa Ana, CA 92701
<br />Ust account number(s) here (options!
<br />Taxpayer Identification Number (TIN)
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on the "Name" line Social security number
<br />to avoid backup withholding. For Individuals, this is your social security numberHowever, for e - m -�
<br />resident alien, sole proprietor, or disregarded entity, see the Part I Instructions ann page 3. For other
<br />entitles, It Is your employer Went'dicatlon number (EIN). If you do not have a number, see How to get a
<br />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 Employer Identification number
<br />number to enter.
<br />9 5 - 610101017 8 5
<br />Certification
<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 he 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 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 me 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 code(s) entered on this form Of 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 we 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 ORA), and
<br />generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
<br />Instructions on cane 3. f _
<br />Here Signature of
<br />Here Iu.s.peraon► /f/f/i4 /Z— n/fl Dete►/9 490/"5�
<br />General Instructions
<br />Section references are to the Informal Revenue Code unless otherwise noted
<br />Future developments. The IRS has created a page on IRS.gov for Informatlon
<br />about Forth W-0, at www.1m.gov1w9. Information about any future developments
<br />affecting Form W-9 (such as legislation enacted after we release It) wll I be posted
<br />on that page.
<br />Purpose of Form
<br />withholding tax on foreign partners"phare of effectively connected Income, and
<br />4. Certify that FATCA codo(s) entered on this farm If any) indicating that you are
<br />exempt from the FATCA reporting, la coreact.
<br />Note. If you ere a U.S. person and a requester gives you a form other than Form
<br />W-9 to request your TIN, you must use the requester's form if it is substantially
<br />similar to this Form W-9.
<br />Definition of a U.S. person. For federal tax purposes, you are considered a U.S,
<br />person if you aro:
<br />A person who Is required to his an Information return with the IRS must obtain your - An Individual who la a U.S. rilizen or U.s, resident alien,
<br />correct taxpayer Identification number TIN) to report, for example, Income paid to • A partnership, corporation, company, or association created or organized In the
<br />you, payments made to you In settlement of payment card and third party network United States or under the laws of the United States,
<br />transactions, real estate transactions, mortgage Interest you paid, acquisition or
<br />, An estate (other then a foreign estate), or
<br />abandonment of asoured property, cancellation of debt, or contd buttons you made
<br />to an IPA
<br />, A domestic bust es defined in Regulations section 301.7701-7),
<br />( e9
<br />Use Form W-9 only Ifyou are a U.S, person Oncluding a resident ellen), to
<br />Special rules for partnerships. Partnerships that conduct a trade or business in
<br />provide your correct TIN to the person requesting It (the requester) and, when
<br />the United States are generally required to pay a withholding tax under section
<br />applicable, to:
<br />1446 on any foreign partners' share of effectively connected taxable Income from
<br />1. Certifythat the TIN u are rvl Is correct or you are waiting for a number
<br />you B pg ( Y g
<br />such business. Further, In certain cases whore a Form W-9 has not been received,
<br />the rules under section 1446 require a partnership to presume that a partner Is
<br />to be Issued),
<br />foreign person, and pay the section 1446 withholding tax. Therefore, If you are a
<br />2. Certify that you we not subject to backup withholding. or
<br />U.S. person that Is a partner in a partnership conducting a trade or business In the
<br />3. Claim exemption from backup withholding 9 you are a U.S. exempt payee. If
<br />United States, provide Form W-9 to the partnership to establish your U.S, status
<br />and avoid section 1446 withholding on your share of partnership Income.
<br />applicable, you ere 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 />Cat. No. 10231% Form W-9 (Rev. 8.2013)
<br />25C-71
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