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~7723/2003, 12:48 209-965-4721
<br />
<br />7IMBERI-IME ENV
<br />
<br /> Request for Taxpayer
<br /> Identification Number and Certification
<br />
<br /> J±11 P.. Northcutt
<br />
<br /> Timberline Environmental Services
<br />,C~k appropr~am bOx= [] In~MduatiSele preprlet~ ~) Carpo~et~n , )-')' Par[Mrstlip ,,
<br />
<br />T~mm ?exposer I~nti~¢mtion Numbar.,[T)l~l)
<br />
<br />Enteryour TIN in the appropriate bo~. For
<br />individuals, this is your Soci~ll security nut~lber
<br />[SSN), However, ii' you ere a resident alien OR
<br />Sole proprietor, see the insb'uctions on ~ge ~,
<br />For other e~[itJe~, it is ~ur employer
<br />Identification number (EIN), If you do ~o[ have
<br />numar, ~e How To Get a ~N on page Z.
<br />
<br />I~IUI Ceflifica~on
<br />
<br />PAGE 04
<br />
<br />Give form to the
<br />requester. Do NOT
<br />send to the IRS.
<br />
<br />For Payees Exempt From Backup
<br />Witmmldlng (~ the Insb'uctions
<br />on p,age 2,)
<br />
<br />example, income paid to you, reel estate
<br />transactions, mortgage interest you paid,
<br />acquisition or abandonment of secured
<br />property, cancellation et debt, Or
<br />Contributions you made to an IRA.
<br /> Use Form W-9 to give your correct TIN
<br />to the person requesting it {the requester}
<br />end, when applicable, to:
<br /> 1. Certify the TiN you are giving is
<br />correct (or you are weiUng for e ~umber to
<br />be issued),
<br /> 2. Certify you are not subject to bacAup
<br />withholding, or
<br /> 3. Claim exemption from backup
<br />withholding iF you ere an exempt payee,
<br />Note: If a requester gives you a form other
<br />than a W-9 to request your TiN, .you m~lst
<br />use the requestet's ~rm ~f ~ is substantially
<br />similar to this Form W-9,
<br />Whet Is Backup Withholding?~Persons
<br />maki~ certaln payments to you must
<br />withhold and pay to the IRS 31% of such
<br />payments under certain conditions. This is
<br />called "backup wiihholdlng." Payments
<br />that may be sub~ect to backup withholding
<br />
<br />Date ~- 1-22-03
<br />
<br /> S. You do not oe~ify your TIN when
<br /> required, See the Pert IJ[ instructions on
<br />
<br /> Ce~tein payees and payments are
<br /> exempt from backup withholding, See the
<br /> Part l/[nStrucUo~ end the separate
<br /> I.$t/uctJon$ for the Requester of Form
<br /> 9il-~.
<br />
<br /> Penalties
<br /> Failure To Furnish TIN.--If you fail to
<br /> furnish your correc~ TIN to a recluesmr, you
<br /> are subject tO a penalty of $50 for each
<br /> such failure unless your faBure is due to
<br /> reasonable cause and not to willful neglect.
<br /> Civil Penalt~ for False Information With
<br /> Respect te WithhoitiinB.--.4f ~/ou make a
<br /> false statement with no reasonable basis
<br /> that results in no backup withholding, you
<br /> ere subject to a $500 peneRy.
<br /> Criminal Penalty for Falsifying
<br /> Jnformafion.~ Willfully falsifying
<br /> cartificati0ns or affirmetlons may sub~ect
<br /> you to cdminel penalties including fines
<br /> and/or imprisonment.
<br /> Misuse of TINs.~If the requester
<br /> discloses or uses TINs in violation of
<br /> Federal law. the requester may be subject
<br /> to civil and criminal penalties,
<br />
<br />royal~es, nonemployee pay. a~d certain
<br />payments from fishing boat operatorS. Real
<br />estate transactions ,are not subject to
<br />backup withholdfng.
<br /> If you give Ihs requester your correct
<br />YiN. make th~ p~p~ c~cations, and
<br />repo~ all your ~xab~e interest
<br />~ividends on your tax return, payments
<br />you mcelve will ~o[ be sub, act to backup
<br />~th~olding. Payments you receive will be
<br />subj.[ tO backup withho~i~9
<br /> 1. You do no~ furnish youf )IN
<br />requ~s[er, or
<br /> ~, The )R~ [e)is the requester [hat you
<br />turnis~ed an )ncor~e¢[ TiN. or
<br /> 3. The IRS tel)s y~u ~at you ere sdbjec~
<br />~0 backup wkhho)di~g because you did not
<br />repo~ al) your interest aAd dividends on
<br />your tax re~urn (~at referable inbred[ and
<br />
<br /> 4. You do no~ ce~fy to the requeb[er
<br />~ha~ you ate no[ subjec[ ~0 backup
<br />wi[h~oi~tng vnder 3 a~ove {~or repo~b[e
<br />in~eres~ and dividend accoun[s opened
<br />
<br />Purpose of Form.--A(per~on who is include interest, dividends, broker and
<br />required to file an Jrl[oflqO~on return with barter exchange transactions, rents,
<br />the IRS must cjet your correct taxpayer
<br />identification number [TIN) [o reporL for
<br />
<br />1. The number shown e, this f~rn is my correct taxpayer identification number (or I am waiting for a number to be issued to me), Jnd
<br />2. I am not subject to backup withholding because: is) I am exempt from backup Withholding. pr 03) I have not been notified by the Internal
<br /> Revenue Service (iRS) that t am subject to backup withholding as a result pi a tailure to report all interest or di~dends, Or (~ the iRS has
<br /> rtotlfied me that I am no longer subject tO backup withho~dlng.
<br />Certification Instrueticns.--You must cross out item 2 above if you have been ~oUfied by die IRS that you are CtaTentiy subject to backup
<br />w~hhcldin9 because 70u have failed to report e~ interest and c~lVlbentis on your tax return. Fat reel estate transactions, hem 2 does not apply.
<br />
<br />provide your co~rec[ TIN. (See the instrurUons on page 2.}
<br />
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