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Oct 25 10 10:02a
<br />t� W -9 Request for Taxpayer
<br />0 Pa °C10bef 200s tdentiflcation Number and Certification
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<br />shown on your Income tax
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<br />Business name, It dfbrwd from
<br />P.9
<br />titre form to the
<br />requeder. Do nat
<br />sold io titre IRS.
<br />Check app q-.Ms box: Iff inc9v **VSo* W*W w ❑ Corporation ❑ partneM*
<br />❑ Limited Iieb*ty compery. Hater the tax clafaifieation 113-dereWrded wilily. C- mporation, p=partren:110) ► ....... ❑ ❑ odw ge htrctla f p�
<br />City, state, and ap code
<br />List accow.t
<br />and apt w elite no.)
<br />(optiof"
<br />Requssw's name and address (OptlOfnsl)
<br />Enter your TIN in the appropriate box. The TiN provided must match the name gNen on Line 1 to avoid
<br />backup withholding. For Individuals, this is your social security number (SSN), However, for a resident
<br />alien, sole proprietor, or disregarded etity, no the Part 1 Instructions an page 3. For other ettiftea, it Is
<br />your employer identification number (Ettii. If you do not have a number, sea How so get a TW an page 3.
<br />8oeh1 securbty number
<br />or
<br />Under penalties of perjury. I curtly that:
<br />1. The number shown on this form is my correct taxpayer identification number (or 1 am waiting 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 041 have not been notified by the Internal
<br />Revenue Service ORS) that i am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
<br />notified me that I am no longer subject to backup withholding, and
<br />3. I am a U.S. citizen or other U.S. person (defined below).
<br />Certification iestructlons. You must cross out Item 2 above if you have been notified by the MS that you are ormwily, subject to backup
<br />For
<br />withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions. Item 2 does not apply.
<br />gage interest paid, acquisition or abandonment of secured property, cancellation of debt, con ribytiona to an Individual retirerrie't
<br />arrangement PRA). and generally, payments other than interest and dividends, you are riot required to sign the Certification. but you., t
<br />Provide your correct TIN. See the instructior:kj on page 4. A
<br />�n Signature of
<br />Here U.& person ► —/ —Z� — _ Dale ► Je
<br />General lnstruc ons v �
<br />Definition of a U,S, person. For federal tax purposes, you are
<br />Section references are to the Internal Revenue Code unless
<br />considered a U.S. person it you are_
<br />otherwise noted.
<br />• An individual who is a U.S. citizen or U.S. resident alien.
<br />PurpOse of Form
<br />e A partnership, corporation, company, or association created or
<br />A Person who Is required to file an information return with the
<br />organized in the United States or under the laws of the United
<br />Stagy.
<br />IRS must obtain your correct taxpayer identification number (n"
<br />to report, for example, income paid to you, real estate
<br />a An estate (other than a foreign estate), or
<br />transactions, mortgage irrtarest you paid, acquisftion or
<br />abandorxnent of secured Property, cancellation of debt,
<br />• A dome stic trust (aS deified in Regulations section
<br />301 dourest
<br />or
<br />contributions you made to an IRA.
<br />Special rules for partnerships. Partnerships that conduct a
<br />Use Form W -9 only if you are a U.S. Person (including a
<br />trade or business in the United States are generally required to
<br />resident alien), to provide your correct TiN to the person
<br />Pay a withholding tax on any foreign partners' share of income
<br />requesting it (the requester) and, when applicable, to:
<br />from such business. Further, in certain cases where a Form W-9
<br />I. Certify that the TIN you are giving is correct (or you are
<br />waiting for a number to be issued),
<br />has not been received, a partnership is required to presume that
<br />a partner is a foreign parson, and pay the wffhhofding tax,
<br />Therefore; if you are a U.S. person that is a partner in a
<br />2. Certify that you are not subject to backup withholding, or
<br />partnership conducting a trade or business In the United States,
<br />3. Claim exemption from backup withholdi ng It are a U.S.
<br />exempt payee. if applicable, you are also certifying
<br />hr9 that
<br />provide Form W -9 to the partnership to establish your U.S.
<br />tatus and avoid withholding on Your share of partnership
<br />as a
<br />U.S. person, your allocable share of an y partnership income from
<br />income.
<br />a U.S. trade or business is not subject to the withholding tax on
<br />foreign partners' share of effectively connected income.
<br />The pew Who gives Form W -9 to the partnership for
<br />Purposes of establishing its U.S. status and avoiding withholding
<br />Nobs, if a requester gives You a form other than Form W -9 to
<br />request your TIN, you must use the requester's form If it is
<br />on its allocable share of net income from the partnership
<br />conducting a trade or business In the United States is in the
<br />substantially sirnilar to this Form W -9.
<br />following cases:
<br />0 The U.S. owner of a disregarded entity and not the entity,
<br />Gat. No.
<br />10231x Form -9 (Acv. 1041007)
<br />25K -33
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