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Docusign Envelope ID:ABA0F1AB-1 F56-41 F1-8C93-C2D999BB641A
<br /> Form W-9(Rev.10-2018) Page 3
<br /> Criminal penalty for falsifying information.Willfully falsifying IF the entity/person on line 1 Is THEN check the box for...
<br /> certifications or affirmations may subject you to criminal penalties a(n)...
<br /> including fines andlor imprisonment,
<br /> Misuse of TINS.If the requester discloses or uses TINS in vlolation of Corporation Corporation
<br /> federal law,the requester may be subject to civil and criminal penalties. ' Individual Individuallsole proprietor or single-
<br /> - Sole proprietorship, or member LLC
<br /> Specific Instructions - Single-member limited liability
<br /> company(LLC)owned by an
<br /> Line 1 individual and disregarded for U,S.
<br /> You must enter one of the following on this line;do not leave this line federal tax purposes.
<br /> blank.The name should match the name on your tax return. • LLC treated as a partnership for Limited liability company and enter
<br /> If this Form W-9 is for ajoint account(other than an account U.S.federal tax purposes, . the appropriate tax classification.
<br /> maintained by a foreign financial institution (FFi)),list first, and then - LLC that has filed Form 8832 or (P=Partnership; C=C corporation;
<br /> circle,the name of the person or entity whose number you entered in 2563 to be taxed as a corporation, or S=S corporation)
<br /> Part I of Form W-9, If you are providing Form W-9 to an FFI to document or
<br /> a joint account, each holder of the account that is a U,S.person must - LLC that is disregarded as an
<br /> provlde.a Form W-9. entity separate from its owner but
<br /> a, Individual.Generally,enter the name shown on your tax return. If the owner is another LLC that is
<br /> you have changed your last name without informing the Social Security not disregarded for U.S,federal tax
<br /> Administration(SSA)of the name change,enter your first name,the last purposes.
<br /> name as shown on your social security card,and your new last name. . Partnership Partnership
<br /> Note:ITIN applicant:Enter your individual name as It was entered on Trus#/estate Trustlestate
<br /> your Form W-7 application, line 1a.This should also be the same as the
<br /> name you entered on the Form 104011040AI1040EZ you filed with your Line 4, Exemptions
<br /> application.
<br /> b. Sole proprietor or s€nglo-member LLC.Enter your individual If you are exempt from backup withholding and/or PATCHreporting,
<br /> name as shown on your 104011040A11040E.Z on line 1,You may enter enter in the appropriate space on line 4 any code(s)that maayyapply
<br /> to
<br /> You'
<br /> your business,trade,or"doing business as"(DBA)name on line 2,
<br /> c. Partnership,LLC that is not a single-member LLC,C Exempt payee code.
<br /> corporation,or S corporation.Enter the entity's name as shown on the - Generally,individuals(including sole proprietors)are not exempt from
<br /> anti ty's tax return on line 1 and any business,trade,or DBA name on backup withholding.
<br /> line 2, • Except as provided below, corporations are exempt from backup
<br /> d. Other entities.Enter your name as shown on required U.S.federal withholding for certain payments, including interest and dividends.
<br /> tax documents on line 1.This name should match.the name shown on the - Corporations are not exempt from backup withholding for payments
<br /> charter or other legal document creating the entity,You may enter any made in settlement of payment card or third party network transactions.
<br /> business,trade,or DBA name on line 2. - Corporations are not exempt from backup withholding with respect to
<br /> e. Disregarded entity.For U.S.federal tax purposes, an entity that Is attorneys' fees or gross proceeds paid to attorneys,and corporations
<br /> disregarded as an entity separate from Its owner is treated as a that provide medical or health care services are not exempt with respect
<br /> "disregarded entity." See Regulations section 301,7701-2(c)(2)(Ill).Enter to payments reportable on Form 1099-MISC.
<br /> the owner's name on line 1.The name of the entity entered on line The following codes identify payees that are exempt from backup
<br /> should never be a disregarded entity.The name on line 1 should be the withholding, Enter the appropriate code in the.space in line 4,
<br /> name shown on the Income tax return on which the income should be
<br /> reported. For example,If a foreign LLC that is treated as a disregarded 1—An organization exempt from tax under section 501(a),any IRA,or
<br /> entity for U.S.federal tax purposes has a single owner that is a U.S. a custodial account under section 403(b)(7)If the account satisfies the
<br /> person,the U.S.owner's name is required to be provided on line 1.If requirements of section 401(f)(2)
<br /> the direct owner of the entity is also a disregarded entity,enter the first 2—The United States or any of its agencies or instrumentalities
<br /> owner that Is not disregarded for federal tax purposes.Enter the 3—A state,the District.of Columbia, a U.S.commonwealth or
<br /> disregarded entity's name on line 2,"Business nameldisregarded entity possession,or any of their political subdivisions or instrumentalities
<br /> name."If the owner of the disregarded entity Is a foreign person,the
<br /> owner must complete an appropriate Form W-S instead of.a Form W-9, 4—A foreign government or any of its political subdivisions, agencies,
<br /> This is the case even If the foreign person has a U,S.TIN. or instrumentalities
<br /> Line 2 5--A corporation
<br /> If you have a business name,trade name,DBA name,or disregarded 6--"-A dealer in securities or commodities required to register in the
<br /> entity name,you may enter i#on line 2, United States,the District of Columbia, or a U,S.commonwealth or
<br /> Y Y Y possession
<br /> Line 3 7—A futures commission merchant registered with the Commodity
<br /> Check the appropriate box on line 3 for the U.S.federal tax Futures Trading Commission
<br /> classification of the person whose name is entered on line 1.Check only 8—A real estate investment trust
<br /> one box on line 3. 9—An entity registered at all times during the tax year under the
<br /> Investment Company Act of 1940
<br /> 10—A common trust fund operated by a bank under section 564(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
<br /> 4947
<br />
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