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Form W -9 (Rev. 8 -2013)
<br />Exempt payee code. Generally, individuals (including sole proprietors) are not
<br />exempt from backup withholding. Corporations are exempt from backup
<br />withholding for certain payments, such as interest and dividends. Corporations are
<br />not exempt from backup withholding for payments made in settlement of payment
<br />card or third party network transactions.
<br />Note. If you are exempt from backup withholding, you should still complete this
<br />form to avoid possible erroneous backup withholding.
<br />The following codes Identify payees that are exempt from backup withholding:
<br />1 —An organization exempt from tax under section 501(a), any IRA, or a
<br />custodial account under section 403(b)(7) If the account satisfies the requirements
<br />of section 401(f)(2)
<br />2 —The United States or any of its agencies or instrumentalities
<br />3 —A state, the District of Columbia, a possession of the United States, or any of
<br />their political subdivisions or instrumentalities
<br />4 —A foreign government or any of its political subdivisions, agencies, or
<br />instrumentalities
<br />5 —A corporation
<br />6 —A dealer in securities or commodities required to register in the United
<br />States, the District of Columbia, or a possession of the United States
<br />7 —A futures commission merchant registered with the Commodity Futures
<br />Trading Commission
<br />8 —A real estate investment trust
<br />9 —An entity registered at all times during the tax year under the Investment
<br />Company Act of 1940
<br />10 —A common trust fund operated by a bank under section 584(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 4947
<br />The following chart shows types of payments that may be exempt from backup
<br />withholding. The chart applies to the exempt payees listed above, 1 through 13.
<br />IF the payment is for...
<br />THEN the payment is exempt for...
<br />Interest and dividend payments
<br />All exempt payees except
<br />for 7
<br />Broker transactions
<br />Exempt payees 1 through 4 and 6
<br />through 11 and all C corporations. S
<br />corporations must not enter an exempt
<br />payee code because they are exempt
<br />only for sales of noncovered securities
<br />acquired prior to 2012.
<br />Barter exchange transactions and
<br />Exempt payees 1 through 4
<br />patronage dividends
<br />Payments over $600 required to be
<br />Generally, exempt payees
<br />reported and direct sales over $5,0001
<br />1 through 52
<br />Payments made in settlement of
<br />Exempt payees 1 through 4
<br />payment card or third party network
<br />transactions
<br />r See Form 1099 -MISC, Miscellaneous Income, and its instructions.
<br />z However, the following payments made to a corporation and reportable on Form
<br />1099 -MISC are not exempt from backup withholding: medical and health care
<br />payments, attorneys' fees, gross proceeds paid to an attorney, and payments for
<br />services paid by a federal executive agency.
<br />Exemption From FATCA reporting code. The following codes identify payees
<br />that are exempt from reporting under FATCA. These codes apply to persons
<br />submitting this form for accounts maintained outside of the United States by
<br />certain foreign financial Institutions. Therefore, if you are only submitting this form
<br />for an account you hold in the United States, you may leave this field blank.
<br />Consult with the person requesting this form If you are uncertain if the financial
<br />institution Is subject to these requirements.
<br />A —An organization exempt from tax under section 501(a) or any individual
<br />retirement plan as defined in section 7701(a)(37)
<br />B —The United States or any of Its agencies or instrumentalities
<br />C —A state, the District of Columbia, a possession of the United States, or any
<br />of their political subdivisions or Instrumentalities
<br />D —A corporation the stock of which Is regularly traded on one or more
<br />established securities markets, as described In Reg. section 1.1472-1 (c)(1)(1)
<br />E —A corporation that is a member of the same expanded affiliated group as a
<br />corporation described in Reg. section 1.1472-1 (c)(1)(1)
<br />F —A dealer in securities, commodities, or derivative financial instruments
<br />(Including notional principal contracts, futures, forwards, and options) that is
<br />registered as such under the laws of the United States or any state
<br />Page 3
<br />G —A real estate investment trust
<br />H —A regulated investment company as defined in section 851 or an entity
<br />registered at all times during the tax year under the Investment Company Act of
<br />1940
<br />I —A common trust fund as defined in section 584(a)
<br />J —A bank as defined in section 581
<br />K —A broker
<br />L —A trust exempt from tax under section 864 or described in section 4947(a)(1)
<br />M —A tax exempt trust under a section 403(b) plan or section 457(g) plan
<br />Part I. Taxpayer Identification Number (TIN)
<br />Enter your TIN in the appropriate box. If you are a resident alien and you do not
<br />have and are not eligible to get an SSN, your TIN is your IRS Individual taxpayer
<br />Identification number (ITIN). Enter it in the social security number box. If you do not
<br />have an ITIN, see How to get a TIN below.
<br />If you are a sole proprietor and you have an EIN, you may enter either your SSN
<br />or EIN. However, the IRS prefers that you use your SSN.
<br />If you are a single- member LLC that is disregarded as an entity separate from its
<br />owner (see Limited Liability Company (LLC) on page 2), enter the owner's SSN (or
<br />EIN, If the owner has one). Do not enter the disregarded entity's EIN. If the LLC is
<br />classified as a corporation or partnership, enter the entity's EIN.
<br />Note. See the chart on page 4 for further clarification of name and TIN
<br />combinations.
<br />How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
<br />for an SSN, get Form SS -5, Application for a Social Security Card, from your local
<br />Social Security Administration office or get this form online at www.ssa.gov. You
<br />may also get this form by calling 1 -800- 772 -1213. Use Form W -7, Application for
<br />IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS -4,
<br />Application for Employer Identification Number, to apply for an EIN. You can apply
<br />for an EIN online by accessing the IRS website at www.1m.gov /businesses and
<br />clicking on Employer Identification Number (EIN) under Starting a Business. You
<br />can get Forms W -7 and SS -4 from the IRS by visiting IRS.gov or by calling 1-800 -
<br />TAX -FORM (1 -800- 829 - 3676).
<br />If you are asked to complete Form W -9 but do not have a TIN, apply for a TIN
<br />and write "Applied For" in the space for the TIN, sign and date the form, and give it
<br />to the requester. For interest and dividend payments, and certain payments made
<br />with respect to readily tradable instruments, generally you will have 60 days to get
<br />a TIN and give it to the requester before you are subject to backup withholding on
<br />payments. The 60 -day rule does not apply to other types of payments. You will be
<br />subject to backup withholding on all such payments until you provide your TIN to
<br />the requester.
<br />Note. Entering "Applied For" means that you have already applied for a TIN or that
<br />you intend to apply for one soon.
<br />Caution: A disregarded U.S. entity that has a foreign owner must use the
<br />appropriate Form W -8.
<br />Part II. Certification
<br />To establish to the withholding agent that you are a U.S. person, or resident alien,
<br />sign Form W -9. You may be requested to sign by the withholding agent even if
<br />items 1, 4, or 5 below indicate otherwise.
<br />For a joint account, only the person whose TIN is shown in Part I should sign
<br />(when required(. In the case of a disregarded entity, the person identified on the
<br />"Name" line must sign. Exempt payees, see Exempt payee code earlier.
<br />Signature requirements. Complete the certification as indicated in items i
<br />through 5 below.
<br />1. Interest, dividend, and barter exchange accounts opened before 1984
<br />and broker accounts considered active during 1983. You must give your
<br />correct TIN, but you do not have to sign the certification.
<br />2. Interest, dividend, broker, and barter exchange accounts opened after
<br />1983 and broker accounts considered inactive during 1983. You must sign the
<br />certification or backup withholding will apply. If you are subject to backup
<br />withholding and you are merely providing your correct TIN to the requester, you
<br />must cross out item 2 in the certification before signing the form.
<br />3. Real estate transactions. You must sign the certification. You may cross out
<br />item 2 of the certification.
<br />4. Other payments. You must give your correct TIN, but you do not have to sign
<br />the certification unless you have been notified that you have previously given an
<br />incorrect TIN. "Other payments" include payments made in the course of the
<br />requester's trade or business for rents, royalties, goods (other than bills for
<br />merchandise), medical and health care services (including payments to
<br />corporations), payments to a nonemployee for services, payments made in
<br />settlement of payment card and third party network transactions, payments to
<br />certain fishing boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of secured
<br />property, cancellation of debt, qualified tuition program payments (under
<br />section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your correct TIN, but you
<br />do not have to sign the certification.
<br />29A -25
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