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Form W-9 (Rev, 8 -201
<br />Exempt payee coda. Generally, Individuals (Including sale 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 parry 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 fallowing codes Identify payees that are exempt from backup withholding:
<br />1--An organization exempt from tax under section 801(a), any IRA, or
<br />custodial account under section 403(b)(7) If the account satlsflea 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 adbdlvislcns or Instrumentalltlse
<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 thatax year underthe Investment
<br />Company Act of 1940
<br />10 —A common trust fund operated by a bank under sactlon 584(a)
<br />11 —A financial Institution
<br />12 —A middleman known In the Investment community as a nominee or
<br />custodian
<br />1S —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 1S.
<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 transaction
<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 $60o required to be
<br />Generally, exempt payees
<br />reported and direct sales over j36,0001
<br />1 through 62
<br />Payments made In settlement of
<br />Exempt payees 1 through 4
<br />payment card or third party network
<br />transactions
<br />'See Form 1099 -MISC, Miscellaneous Income, and its Instructions,
<br />' However, the following payments made to a corporation and reportable on Form
<br />1099 -MISC are not exempt from backup withholding: medical and health cars
<br />payments, attorneys' fees, gross proceeds paid to an attorney, and payments for
<br />servioos 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 />conch 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 it 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 Dish let of Columbia, a posseasion of the United States, or any
<br />of their political subdivisions or instmmentallties
<br />D —A corporation the stack of which Is regularly traded on one or more
<br />established securities markets, as described In Reg. section 1.1472-1 (a)(1)(1)
<br />E —A corporation that is a member of the same expanded offilated group as a
<br />corporation described in Reg. section 1A472- 1(c((1)(I)
<br />F —A dealer In securities, commodities, or derivative financial instruments
<br />(Including notional principal contracts, futures, forwards, and options) that Is
<br />reglstamd as such under the laws of the United States or any state
<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(x)
<br />J —A bank as defined In section 581
<br />K —A broker
<br />L— Atrust exemptfrom tax under section 684 or described In sectlon 4947(a)(1)
<br />M —A tax exempt trust under a section 403(b) plan or sactlon 457(8) 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 end are not eligible to get an SSN, your TIN Is your IRS Individual taxpayer
<br />Idandfiastlon number (ITIN). Enter It In the social security number box. If you do not
<br />have an ITIN, see How to got 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 Immedlately. To apply
<br />for an BEN, get Form 53 -5, Application for a Social Security Card, from your local
<br />Social Security Ad mJ Narration office or get this form online at www.ase.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 BIN online by accessing the IRS website at www.1m,gowbusinesses and
<br />cllcking 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 farm, and give It
<br />to the requester, For Interest and dividend payments, and certain payments made
<br />with respect to readlly tradable Instruments, generally you will have 60 days to get
<br />a TIN and give It to the requester berate 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 Far" means that you have already applied for a TIN or that
<br />you Intend to apply for one soon.
<br />Caution: Adisregarded U.S. entity that has a foreign owner must use the
<br />appropriate Form W -8.
<br />Part II, Certification
<br />To establish toths withholding agent that you are a U.S. person, or resident alien,
<br />sign Form W4 You maybe requested to sign by the withholding agent even If
<br />Items 1, 4, or 5 below Indicate atherwlse.
<br />For ajoint 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 trio
<br />"Name" line must sign. Exempt payees, sea Exempt payee code earlier.
<br />Signature requirements. Complete the certlflcatlan as Indicated In Items 1
<br />through 5 below.
<br />1. Interest, dividend, and barter exchange accounts opened before 1964
<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 />certlfloatlon 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 crass 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 coursa 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 nonemployse for services, payments made In
<br />settlement of payment card and third party network transactions, payments to
<br />certain fishing boat crew member's 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 SEA, 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 />251 -50
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