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ATTACHMENT
<br />Form W-9 (Rev. 0-2013) Page 4
<br />What Name and Number To Give file 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 point
<br />The actual owner of the accoumtor.
<br />account)
<br />If combinod funds, the That
<br />Individual on the account'
<br />3. Custodian account of a minor
<br />The minor'
<br />(Uniform Gift to Minom Act)
<br />4. a. The usual revocable savings
<br />The grantor -trustee'
<br />trust (grantor is also trustee)
<br />lb, So-called trust account that is
<br />Tho actual owner'
<br />not a legal or valid trust under
<br />state law
<br />6. Sole proprietorship or disregarded
<br />Tile owner'
<br />entity owned by an Individual
<br />6. Grantor trust filing under Option[
<br />The grantor'
<br />Form 1099 Filing Method 1 (see
<br />Regulation section 1.671-4(b)(2)(1)(A))
<br />For this type of account;
<br />Give name and EN of:
<br />7, Disregarded entity not owned by an
<br />The owner
<br />Individual
<br />8. Avalld 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.A6soafation, club, religlom,
<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 Dammed
<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 Fling Method or the Optional
<br />Form 1009 Filing Method 2 (sae
<br />Regulation section 1.67'1.4(b)(2)@gl))
<br />List first and circle the name of the person whose number you furnish. It only one parson on a
<br />Joint account bass an SSN, that parser's number must be fumunod,
<br />aCma, the minors name antl human the minnr'a Sun.
<br />°You must show ycurindlvlMul name and you mny also anter your business cr °bort" name ei
<br />am "Business namNdaregardeq emIW name line. You may use anew yourSSN or EIN In you
<br />have ono), but the IRS encouraged you to use your SSN.
<br />List f r amt dela the mamof thahust, estate, or pension trust. (Del tout fumieh the TINof the
<br />personal mram m ntive or Trustee unless the legal entity ifi ell b andmigmmed In the ou:ount
<br />line.) Also sae apeallunt es for am n slaps on legal.
<br />'Nate. Desoto, him most puneda a Form WJr to lona o mf trust.
<br />Note. if no name Is elected when mora than one name Is listed, the number will be
<br />considered to be that of the Ilret name listed.
<br />Secure Your Tax Records from Identity Theft
<br />Identity theft occum 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 lob or may rile 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 proparer.
<br />If your tee records ore affected by Identity theft and you resolve 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 last or stolen puma or wallet, questionable credit card activity
<br />or credit report, contact fire IRS Identity Theft Hotline at 1.600-908.4490 or submit
<br />Form 14039,
<br />For more Information, see Publlcation 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 />though normal channels, may be eligible for Taxpayer Advocate Service CTAS)
<br />assistance, You can reach TAG by calling the TAS toll-free case Intake line at
<br />1-877-777-4778 or TfY/TDD 1-800-11059.
<br />Protect yourself Trani auspicious smalls or flushing schemes, Phisliingethe
<br />creation and use of small and websites designed to mimic legitimate business
<br />.mails and whistles. 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 then.
<br />The IRS does not Initlat. contacts with taxpayers via emalls. Also, the IRS does
<br />not request personal detallad Information through amull 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 resolve an unsolicited email claiming to be from the IRS, forward this
<br />message to phlshfDoWni 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 />1-800-366.4404. You can forward auspicious smalls to the Federal Trade
<br />Commission alb spam®Oco.gov or contact them at wornb7c,govlldihafl or 1.877
<br />I DTH EF- (1-077-438A:138).
<br />Visit IRG.gov to learn more about identify gtefl and how to reduce your risk
<br />'
<br />Privacy Act Notice
<br />Section 6169 of the Internal Revenue Cade requires you to provide your cement 'FIN to persons (Including federal agencies) who are required to fie Information returns with
<br />the IRS to report Interest, dividends, or certain outer Income paid to you; mortgage interest you paid; the acqulsfllon or sbandonmmnt of secured property; the cancellation
<br />of debt; or contributions you made to an IRA, Archer MSA, or IISA. The person collecting this form uses the Information on the fan to file Infnrmmtion 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, stales, the District
<br />of Columbia, and U.S. commonwealths and possessions for use In administering their lavrs, 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 tenoram. You must provide your TIN
<br />whether or not you are required to ilio a tax return. Undor 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.
<br />75F-56
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