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Form��9
<br />Request for Taxpayer
<br />Give Form to the
<br />(Rev. December 2014)
<br />Identification Number and Certification
<br />requester. Do not
<br />Depart of the Treasury
<br />send to the IRS.
<br />Internal Rment
<br />avenue Service
<br />1 Name (as shown on your Income tax return). Name is required on this line; do not leave this line blank.
<br />Knowledge and Intelligence Program Professionals (KIPP)
<br />N
<br />2 Business name/disregarded entity name, If different from above
<br />m
<br />a
<br />3 Check appropriate box for federal tax classification: check only one of the following seven boxes:
<br />4 Exemptions (codes apply only to
<br />o
<br />e
<br />❑ Indlvl le proprietor or ❑ G Corporation Q S Corporation El ❑Trust/estate
<br />LLC
<br />certain entitles, not Individuals; see
<br />Instructions on page 3):
<br />nd
<br />single-dmemuns ber
<br />❑ Limited liability company. Enter the tax classification (C=G corporation, 5=3 corporation, P=partnership)► $
<br />Exempt payee code (it any)
<br />`o
<br />Note. For a single -member _LG that Is disregarded, do not check LLC; check the appropriate box in the line above for
<br />Exemption from FATCA reporting
<br />_ e
<br />the tax classification of the single-memher owner.
<br />code (It any)
<br />p- 0
<br />❑ Other(see Instructions)►
<br />(Applies taeccovnh malnhinedouhltle the 9.aJ
<br />5 Address (number, street, and apt. or sub no.)
<br />Requester's name and address (optional)
<br />3605 Long Beach Blvd. - Suite 400
<br />n
<br />s City, state, and ZIP code
<br />Ito
<br />Long Beach, CA 90607
<br />7 List account numbers) here (optional)
<br />_-
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on Ina 1 to avoid
<br />backup withholding. For individuals, this is generally 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 (EINI). If you do not have a number, see Now to get a
<br />TIN on page 3.
<br />Note. If the account Is in more than one name, see the instructions for line 1 and the chart on page 4 for
<br />guidelines on whose number to enter.
<br />
<br />Under penalties of perjury, I certify that: --
<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 wlthholding; 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 (11 any) indicating that I am exempt from FATCA reporting is correct.
<br />Certification Instructions. You must cross out item 2 above If you have been 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 bade 3.
<br />0191 Signature of
<br />Here I U.S. person)
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Puture developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release it) is at www.1m.gov/hv9.
<br />Purpose of Form
<br />An Individual or entity (Form W-9 requester) who is required to file an Information
<br />return with the IRS must obtain your correct taxpayer identification number (TIN)
<br />which may be your social security number (SSN), individual taxpayer identification
<br />number ill sell lon taxpayer Identification number (ATIN), or employer
<br />Identification number (EIM, to report on an Information return the amount paid to
<br />you, or other amount reportable on an information return. Examples of information
<br />returns Include, but are not limited to, the following:
<br />• Form '1099 -INT (Interest earned or paid)
<br />• Form 1099 -DIV (dividends, Including those from stocks or mutual funds)
<br />• Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds)
<br />• Form 1099-8 (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Form 1999-S (proceeds from real estate transactions)
<br />• Form 1999-K (merchant card and third party network transactions)
<br />Date► 7 / /�1 42(.C�/l i -----
<br />st /
<br />Form 7098 (home mortgage Interest), 1098-E (student Ivan interest), 1098-7
<br />(tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only if you are a U.S. person (including a resident align), to
<br />provide your correct TIN.
<br />If you do not return Form W-9 to the requester with a TIN, you might be subject
<br />to backup withholding. See What is backup wlthholding? on page 2.
<br />By signing the filed -out form, you:
<br />1. Certify that the TIN you are giving Is correct (or you are waiting for a number
<br />to be Issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding If you are a U.S. exempt payee. If
<br />applicable, you are also certifying that as a U.S. person, your allocable share of
<br />any partnership Income from a U.S. trade or business is not subject to the
<br />withholding tax on foreign partners' Share of effectively connected Income, and
<br />4. Certify that FATCA budgie) entered on this form (it any) Indicating that you are
<br />exempt from the FATCA reporting, Is correct. See What Is FATCA refeorting7 on
<br />page 2 for further Information.
<br />Cat, No. 10231X
<br />Form W-9 (Rev. 12.2014)
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