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Form W-9 (Rev. 8-2013) Page 4
<br />What Name and Number To Give the Requester
<br />For this type of account:
<br />Give name and SSN of:
<br />1. Individual
<br />The individual
<br />2. Two or more individuals Qolnt
<br />The actual owner of the account or,
<br />account)
<br />if combined funds, the first
<br />Individual on the account'
<br />3. Custodian account of a minor
<br />The minor'
<br />(Uniform Gift to Minors Act)
<br />4. a. The usual revocable savings
<br />The grantor -trustee'
<br />trust (grantor is also trustee)
<br />b. So-called trust account that Is
<br />The actual owner'
<br />not a legal or valid trust under
<br />state law
<br />5. Sole proprietorship or disregarded
<br />The owner'
<br />entity owned by an Individual
<br />6. Grantor trust filing under Optional
<br />The grantor'
<br />Form 1099 Filing Method 1 (see
<br />Regulation section 1.671-4(b)(2)(Q(A))
<br />For this type of account:
<br />Give name and EIN of:
<br />7. Disregarded entity not owned by an
<br />The owner
<br />individual
<br />8. A valid trust, estate, or pension trust
<br />Legal entity °
<br />9. Corporation or LLC electing
<br />The corporation
<br />corporate status on Form 8832 or
<br />Form 2553
<br />10. Association, club, religious,
<br />The organization
<br />charitable, educational, or other
<br />tax-exempt organization
<br />11. Partnership or multi -member LLC
<br />The partnership
<br />12. A broker or registered nominee
<br />The broker or nominee
<br />13. Account with the Department of
<br />The public entity
<br />Agriculture In the name of a public
<br />entity (such as a state or local
<br />government, school district, or
<br />prison) that receives agricultural
<br />program payments
<br />14. Grantor trust filing under the Form
<br />The trust
<br />1041 Filing Method or the Optional
<br />Form 1099 Filing Method 2 (see
<br />Regulation section 1.1371-4(b)(2)(i)(B))
<br />List list and circle the name of the person whose number you furnish. If only one person on a
<br />joint account has an Si that person's number must be furnished.
<br />x Circle the minor's name and furnish the minor's SSN.
<br />You must show your Individual name and you may also enter your business or "DBA" name on
<br />the "Business name/disregarded entity" name line. You may use either your SSN or El tlf you
<br />have one), but the IRS encourages you to use your SSN.
<br />°
<br />List first and circle the name of the trust, estate, or pension trust. (Do not furnlsh the TIN of the
<br />personal representative or trustee unless the legal entity itself Is not designated in the account
<br />title.) Also see Special mass for partnerships on page 1.
<br />"Note. Grantor also must provide a Form W-9 to trustee of treat.
<br />Note. If no name is circled when more than one name is listed, the number will be
<br />considered to be that of the first name listed.
<br />Secure Your Tax Records from Identity Theft
<br />Identity theft occurs when someone uses your personal Information such as your
<br />name, social security number (SSN), or other Identifying Information, without your
<br />permission, to commit fraud or other crimes. An identity thief may use your SSN to
<br />get a job or may file a tax return using your SSN to receive a refund.
<br />To reduce your risk:
<br />• Protect your SSN,
<br />• Ensure your employer Is protecting your SSN, and
<br />• Be careful when choosing a tax preparer.
<br />If your tax records are affected by Identity theft and you receive a notice from
<br />the IRS, respond right away to the name and phone number printed on the IRS
<br />notice or letter.
<br />If your tax records are not currently affected by identity theft but you think you
<br />are at risk due to a lost or stolen purse or wallet, questionable credit card activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1-600-908-4490 or submit
<br />Form 14039.
<br />For more Information, see Publication 4535, Identity Theft Prevention and Victim
<br />Assistance.
<br />Victims of Identity theft who are experiencing economic harm or a system
<br />problem, or are seeking help in resolving tax problems that have not been resolved
<br />through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
<br />assistance. You can reach TAS by calling the TAS toll-free case intake Ilne at
<br />1-877-777-4778 or TTY/ -DD 1-800-829-4059.
<br />Protect yourself from suspicious emalls or phishing schemes. Phlshing is the
<br />creation and use of email and websites designed to mimic legitimate business
<br />emalls and websites. The most common act is sending an email to a user falsely
<br />claiming to be an established legitimate enterprise In an attempt to scam the user
<br />Into surrendering private Information that will be used for identity theft.
<br />The IRS does not Initiate contacts with taxpayers via emalls. Also, the IRS does
<br />not request personal detailed information through email or ask taxpayers for the
<br />PIN numbers, passwords, or similar secret access information for their credit card,
<br />bank, or other financial accounts.
<br />If you receive an unsolicited email claiming to be from the IRS, forward this
<br />message to phishing@irs.gov. You may also report misuse of the IRS name, logo,
<br />or other IRS property to the Treasury Inspector General for Tax Administration at
<br />1-800-366-4484. You can forward suspicious smells to the Federal Trade
<br />Commission at: spam@uce.gov or contact them at www.ftc.gov//dthef or 1-877-
<br />IDTHEFr(1-877-438-4338).
<br />Visit IRS.gov to learn more about identity theft and how to reduce your risk.
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<br />Privacy Act Notice
<br />Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (Including federal agencies) who are required to file information returns with
<br />the IRS to report Interest, dividends, or certain other Income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation
<br />of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file Information returns with the IRS,
<br />reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District
<br />of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to
<br />federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN
<br />whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other
<br />payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent Information.
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