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Farmi
<br />social security number
<br />Request for Taxpayer
<br />Give Form to the
<br />(Rev. December 20141
<br />Identification (dumber and Certification
<br />entities, it is your employer Identification number (EIN). If you do not have a number, see Now !o get a
<br />requester. Do not
<br />Dof IheTreasury
<br />send to the IRS.
<br />Internal
<br />Revenue SerNce
<br />1 Name (as sham on your Income tax return). Name is required on this line; do not leave this line blank.
<br />Ci
<br />2 Business nameldisregarded entity name, if different from above
<br />M
<br />m
<br />m
<br />n
<br />3 Check appropriate box for federal tax classif0alion; check only one of the following seven boxes:
<br />4 Exemptions (codes apply only to
<br />m
<br />❑IndividuaVsole proprietor or E]CCorporation ❑SCorporation PartnershipPaership ❑TrusVestate
<br />certain entities, not Individuals; see instructions on page 3):
<br />m e
<br />uingle-member LLC
<br />❑ Umited liability company. Enter the tax classification (C=C corporatlon, SS corporation, P=partnership) b-
<br />Exempt payee code (f arty)
<br />0
<br />0
<br />Note. Fa a single -member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for
<br />Exemption from FATCA reporting
<br />c
<br />the lax classification of the single -member owner.
<br />code (if any)
<br />El Other (see lnsiructbns)►
<br />f0.aar%mv>.mnrminu:vwemow use
<br />;E
<br />5 Address (number, street, and apt. orsuite no.)
<br />Requesters name and address (opltonaq
<br />u
<br />v
<br />a
<br />U)
<br />e City, state, and LP code
<br />0
<br />rn
<br />7 Ust account numbers) here (optlonaQ
<br />IMB
<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
<br />social security number
<br />number (page However, fora
<br />backup withholding. For individuals, this Is generally your social I instructions
<br />resident ellen, sole proprietor, or disregarded entity, see the Part i Instructions on page 3. Fof other
<br />—m _
<br />entities, it is your employer Identification number (EIN). If you do not have a number, see Now !o get a
<br />TIN on page 3.
<br />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 I Employer Identification number
<br />guidelines on whose number to enter. F—T-1 F—F—F—F—r
<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 toren (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 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 />•OlenI Signature of
<br />Here U.S.perscn► Date►
<br />General Instructions
<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.fts govHw9.
<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 (rIN )
<br />which may be your social security number (SSN), Individual taxpayer Identification
<br />number (ITIN), adoption taxpayer Identification number (ATIN), or employer
<br />IdentAcation 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 />• Farm 1099.1 NT (interest earned or paid)
<br />• Form 1099 -DN (dividends, including those from stocks or mutual funds)
<br />• Farm 1099-MISC (various types of Income, prizes, awards, or gross proceeds)
<br />• Form 1099-B (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Form 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network i eMilss ions)
<br />• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T
<br />(tuition)
<br />• Fomi 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only It you are a U.S. person (including a resident allen), to
<br />provide your correct TIN.
<br />ffyou do not return Form W-9 to the requester with a TIN, you might be subject
<br />to backup withholding. See What Is 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. Cerfify 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 codes) entered on this form (if any) indicating that you are
<br />exempt from the FATCA reporting, Is correct. See What is FATCA reporting? on
<br />page 2 for further information.
<br />'Cat. No. 10231% Form W -s (Rev. 12-2014)
<br />75E-70
<br />
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