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<br />W-9
<br />Request for 'taxpayer
<br />Give Form to the
<br />Rev. December 2014)
<br />identification Number and Certification
<br />Do not
<br />requester. Send to the IRS.
<br />)epartment
<br />of the Treasury
<br />Memel
<br />Revenue Service
<br />9 Name (as shown on your Income tax return). Name Is required on this line: do not leave this line blank.
<br />Treyzon & Associates, LLP
<br />2 Business name/disregarded entity name, If different from above
<br />N
<br />m
<br />m
<br />a
<br />3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
<br />4 main nione (codes apply only to
<br />certain entities, not individuals; see
<br />o
<br />❑ Individual/sole proprietor or ❑ C Corporation ❑ $ Corporation ❑✓ Partnership ❑Trust/estate
<br />Instructions on page 3):
<br />W o
<br />:p
<br />single -member LLC
<br />❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=padnership) d
<br />Exempt payee code Of any)
<br />from FATCA
<br />m u
<br />o
<br />Note. For a single -member LLC that Is disregarded, do not eheok LLC; check the appropriate box In the Ilse above for
<br />Exemption reporting
<br />the tax classification of the single -member owner,
<br />coda (If any)
<br />6 C
<br />❑ Other (see instructions) F
<br />(Apples beeceertepo lolnedoutiMe i4a)
<br />U
<br />Ie
<br />G Address (number, street, and apt. or suite fie.)
<br />Requester's name and address (optional)
<br />a
<br />1901 Avenue of the Stars, Suite 935
<br />6 City, state, and ZIP code
<br />Los Angeles, CA 90067
<br />7 List account number(s) here (optional)
<br />Taxpayer Identification Number (TIN)
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I social security summer
<br />backup withholding. For proprietor,
<br />r die this Is generally your social security number (page However, for a -m m�
<br />resident ellen, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other
<br />entitles, It is your employer identification number (EIN). If you do not have a number, see How fo get u
<br />TIN on page 3. or
<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 />
<br />
<br />Certification
<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 withhoiding 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 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 tan 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. a _
<br />I'IQYe I U.S. personP AP7��(/'•'� �— Datedd16
<br />General
<br />General Instruc;i6ns
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release it) is at www.lrs.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 (FIN)
<br />which may be your social security number (SSN), individual taxpayer identification
<br />number (ITIN), adoption taxpayer Identification number (ATIN), or employer
<br />identification number (EIN), 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 1 D99 -DIV (dividends, Including those from stooks 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 1099-5 (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Film 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T
<br />(tuition)
<br />• Fan 1099-0 (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 alien), to
<br />provide your correct TIN.
<br />1i do not return Form W-9 to the requester with a TIN, you might be subject
<br />to backup withholding. See What /s backup withholding? on page 2.
<br />By signing the filled -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 allecable 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 codes) entered on this form Of any) Indicating that you are
<br />exempt from the FATCA reporting, is correct. See Abatis FATCA reporting? on
<br />page 2 for further Information.
<br />Cat. No. 10231x Form W-9 (Rev. 12-2014)
<br />
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