Form w'9
<br />Request for Taxpayer
<br />Give Form to the
<br />the
<br />Identification Number and Certification
<br />requester. Do not
<br />116,om"gest
<br />Depart Tr
<br />send to the IRS.
<br />R. en e8awasury
<br />Internal Revenue Service
<br />Name (as shown on your income tax return)
<br />City of Santa Ana
<br />ni
<br />Business name/disregarded entity name. If different from above
<br />Check appropriate box for federal tax classification:
<br />Exemptions (see Instructions):
<br />o
<br />❑Individual/sole proprietor 0Corporation ©S Corporation Partnership ❑Trust/estate
<br />m
<br />2
<br />Exempt payee code (If any)
<br />❑ Limited liability company. Enter the tax classification (C=C corporation, 5=8 corporation, P=partnerahlp) 0.
<br />Exemption from PATCA reporting
<br />a
<br />�
<br />code (If any)
<br />❑✓ Other (sea instructions) ► Government
<br />S
<br />Address (number, street, and apt, or suite no,)
<br />Requester's name and address (optional)
<br />OM
<br />20 Civic Center Plaza
<br />y
<br />m
<br />City, state, and ZIP code
<br />m
<br />�
<br />Santa Ana, CA 92701
<br />List account number(s) here (optional)
<br />JJ Taxpayer Identification Number TIN
<br />Enter your TIN In the approprlate box. The TIN provided must match the name given on the "Name" line
<br />Social security number
<br />However, for a
<br />resident ellen, sols proprietor, or disregarded entity, sae the Part I instructions on page 3. For other
<br />re avoid backup le pr, withholding. For Individuals, this is your social security number n page
<br />r
<br />entitles, It Is your employer identification number (EIN). If you do not have a number, see How to get a
<br />I IN an 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 />v©oonnnooIR
<br />Under penalties of perjury, I certify that:
<br />1. The number shown an this form Is my correct taxpayer identification number (or I am walling 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 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 US, person (defined below), and
<br />4. The FATCA code(s) entered on this form (if any) Indlcating 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 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 pace 3.
<br />Her Signature of //f /f. //. 1— �J
<br />Here U.S. person► ���/ �f./�/j+ bete►
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Future developments. The IRS has created a page on IRS.gov for Information
<br />about Form W,9, at www.lra.gov/w9. Information about any future developments
<br />affecting Farm W�9 (such as legislation enacted after we release It) will be posted
<br />on that page.
<br />Purpose of Form
<br />A person who Is required to file an information return with the IRS must obtain your
<br />correct taxpayer Identification number (TIN) to report, for example, Income paid to
<br />you, payments made to you in settlement of payment card and third party network
<br />transactions, real estate transactions, mortgage Interest you paid, acquisition or
<br />abandonment of secured property, cancellation of debt, or contributions you made
<br />to an IRA.
<br />Use Form W-9 only if you are a U.S, person (including a resident alien), to
<br />provide your correct TIN to the person requesting It (the requester) and, when
<br />applicable, to:
<br />1. Certify that the TIN you are giving Is correct (or you are waiting for a number
<br />to be issued),
<br />2. Certify that you are not subject to bacli withholding, or
<br />3. Claim exemption from backup withholding If you are a U.S. exempt payee. If
<br />applicable, you are also certifying that as a U.S. porson, 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'%hare of effectively connected income, and
<br />4, Certify that FATCA code(s) entered on this form (If any) Indicating that you are
<br />exempt from the FATCA reporting, Is correct,
<br />Note. If you are 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 />slmllar 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 are:
<br />• An Individual who Is a U.S. citizen or U.S. resident alien,
<br />• A partnership, corporation, company, or association created or organized in the
<br />United States or under the laws of the United States,
<br />• An estate (other than a foreign estate), or
<br />• A domestic trust (as defined In Regulations section 301.7701-7).
<br />Special rules for partnerships. partnerships that conduct a trade or business in
<br />the United States aro generally required to pay a withholding tax under section
<br />1446 on any foreign partnere' share of effectively connected taxable Income from
<br />such business. Further. In certain cases where a Form W-9 has not been received,
<br />the rules under ssctlon 1446 require a partnership to presume that a partner Is a
<br />foreign person, and pay the section 1446 withholding tax. Therefore, If you are a
<br />U.S. person that Is a partner In a partnership conduotinp a trade or business In the
<br />United States, provide Form W-9 to the partnership to establish your U.S. statue
<br />and avoid section 1446 withholding on your share of partnership Income.
<br />Cat. No. 10231X Form W-9 (Rev. 6-2919)
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