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Form
<br />w -9
<br />Request for Taxpayer
<br />Give Form to the
<br />(Rev. August 2013)
<br />Identification Number and Certification
<br />requester. Do not
<br />Department
<br />of the Treasury
<br />send to the IRS.
<br />Internal
<br />Revenue Service
<br />Name (as shown on your Income tax return)
<br />N
<br />Business name /disregarded entity name, If different from above
<br />m
<br />rn
<br />m
<br />°
<br />Check appropriate box for federal tax classification:
<br />Exemptions (see Instructions):
<br />O
<br />❑ Individual/sole proprietor ❑ C Corporation ❑ 9 Corporation ❑ Partnerahlp ❑ True estate
<br />o
<br />Exempt payee code (If any)
<br />Sv
<br />❑ Limped liability company. Enterthetax classification( C- C corporation,S= Scerporatlon, P= partnership)►
<br />Exemption from FATCA reporting
<br />coda (If any)
<br />yr
<br />0
<br />❑ Cther(seelnstruotlonsj*
<br />de
<br />Address (number, street, antl apt. or sutra no.)
<br />Requester's name and address (optional)
<br />�
<br />City, state, and ZIP node
<br />v
<br />List account number(s) here (optional
<br />'
<br />JZB
<br />Taxpayer identification Number TIN
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line I Social security number
<br />to avoid backup withholding. For Individuals, this is your social security number (SSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other -
<br />entities, it Is your employer identification number (EN). If you do not have a number, see How to get a
<br />TIN on page 3.
<br />Note. If the account Is In more than one name, see the chart on page 4 for guidelines on whose Employer identification number
<br />number to enter, T
<br />1. The number shown on this form is my correct taxpayer Identification number (or I 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 (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 U.S. person (defined below), and
<br />4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting Is correct.
<br />Certification instructions. You must cross out Item 2 above If you have bean 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 page 3.
<br />sign I Signature of
<br />Here U.S. person I• Date 1
<br />Genera) 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 www1s.govlwa. Information about any future developments
<br />affecting Form W -0 (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 thll'd party network
<br />transactions, real estate itmonotions, mortgage Interest you paid, acquisition or
<br />abandonment or 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 tothe person requesting It (the requester) and, when
<br />applicable, to
<br />1. Certify that the TIN you are giving Is correct (or you are walking for a number
<br />to be Issued),
<br />2. Certify thatyou are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding If you area U,S, exempt payee. If
<br />applicable, you are also certifying that as a U.S. Parson, your allocable share of
<br />any partnership income from a U.S. trade or business Is not subleot to the
<br />withholding tax on foreign partners'share of effectively connected Income, and
<br />4. Certify that FATCA cadets) entered on this farm (If any) Indicating that you are
<br />exempt from the FATCA reporting. Is career
<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'rIN, you must use the requester's form if It Is substantially
<br />similar to this Form W -9.
<br />Definition of a U8. 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 allen,
<br />• A partnership, corporation, company, or association created or organized In the
<br />Unitod States or underthe laws of the United States,
<br />• An aerate (other than a foreign estate), or
<br />• A domestic trust (on defined In Regulations section 301.7701 -7).
<br />Special rules for partnorships, Partnerships that conduct a trade or business In
<br />the United States are generally required to pay a withholding tax under section
<br />1446 on any foreign partners' share of allectively connected taxable Income from
<br />such business. Further, In certain cases where a Form W -9 has not been received,
<br />the rules under section 1446 require a partnerahip to presume that a partner Is a
<br />foreign person, and pay the section 1446 withhoiding tax. Therefore, If you are a
<br />U.S. person that Is a partner in o partnership conducting a trade or business in the
<br />United States, provide Form W -9 to the partnership to establish your U.S. status
<br />and avoid section 1448 withholding on your share of partnership Income,
<br />Cat, No, IMIX Form W -9 (Rev. 84013)
<br />251 -48
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