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W-g(Rev. 8-2013)
<br />Exempt payee code. Generally, individuals (including sole proprietors) ars not
<br />exempt tram backup wlthholding. Corporations are exempt from backup
<br />withholding for certain payments, suoh as Interest and dividends. Corporations are
<br />not exempt from backup withholding for payments made in settlement of payment
<br />card arthird party network transactions.
<br />Note. If you are exempt from backup withholding, you should still complete this
<br />form to avoid possible erroneous backup wlthholding.
<br />The fallowing codas Identify payees that are exempt from backup withholding:
<br />1—An organization exempt from lex under section 601(a), any IRA, or a
<br />custodial account under section 40S (b)17) If the account satisfies the requirements
<br />of section 401(f)(2)
<br />2—The United States or any of Its agencies or instrumentalltles
<br />3—A state, the District of Columbia, a possession of the United States, or any of
<br />their political subdivisions or Instrumentelflles
<br />4—A foreign government or any of Its political subdivisions, agencies, or
<br />Instrumentalities
<br />6—A corporation
<br />6—A dealer in securities or commodities required to register in the United
<br />$miss, the District of Columbia. or a possession of the United Slates
<br />7—A futures commission merchant registered with the Commodity Futures
<br />Trading Commission
<br />S—A real estate Investment trust
<br />9—An entity registered at all times during the tax year under the Investment
<br />Company Act of 1040
<br />10—Acommon trust fund operated by a bank under section 584(a)
<br />11—A financial institution
<br />12—A middleman known In the Investment community as a nominee or
<br />custodian
<br />13—A trust exempt from tax under section 604 or described In sectfon 4947
<br />The following chart shows types of payments that may be exempt from backup
<br />withholding. The chart applies to the exempt payees listed above, 1 through 13.
<br />IF the payment is for...
<br />THEN the payment is exempt for...
<br />Interest and dividend payments
<br />All exempt payees except
<br />for 7
<br />Broker transactions
<br />Exempt payees 1 through 4 and 6
<br />through 11 and all C corporations. S
<br />corporations must not enter an exempt
<br />payee code because they are exempt
<br />only for sales of nonoovered securities
<br />acquired prior to 2012.
<br />Barter exchange transactions and
<br />Exempt payees 1 through 4
<br />patronage dividends
<br />Payments over$600 required to be
<br />Generally, exempt payees
<br />reported and direct sales over $5,0001
<br />1 through 5s
<br />Payments made In settlement of
<br />Exempt payees 1 through
<br />payment card or third party network
<br />transactions
<br />1 Soo Form 1009-M ISO, Miscellaneous Income, and Its Instructions.
<br />'However, the following payments made to a corporation and reportable on Form
<br />1099-11,4ISC ore net exempt from hanlmp withholding: medical and health care
<br />payments, attomeys' fees, gross proceeds paid to an attorney, and payments for
<br />services paid by a federal executive agency.
<br />Exemption from FATCA reporting code. The following codes Identify payees
<br />that are exempt from reporting under FATCA. These codes apply to persons
<br />submitting this form for accounts maintained outside of the United States by
<br />extant foreign financial institutions. Therefore, if you are only submitting this form
<br />for an account you hold In the United States, you may leave this fiend blank.
<br />Consult with the person requesting this torn If you are uncertain if the financial
<br />Institution Is subject to these requirements.
<br />A—An organizal(en exempt from fax under section 501(a) or any Individual
<br />retirement plan as defined in section 7701(a)(37)
<br />S—The United States or any of Its connotes or Instrumentalities
<br />C—A slate, the District of Columbia, a possession of the United States, or any
<br />of their political subdivisions or Instrumentalities
<br />D—A corporation the stock of which fs regularly traded on one or more
<br />established acoustics makets, as described In Reg, section 1.1472-4(c)(1)(Q
<br />E—A corporation that Is a member of the same expanded affiliated group as a
<br />corporation descrlbed In Reg. section 1.1472-1(o)(1)Q)
<br />F—A dealer In securities, commodities, or derivative financial Instruments
<br />(Including notlonal princllean contracts, futures, forwards, and options) that la
<br />registered as such underlhe Imus of the United States or any state
<br />ATTACHMENT
<br />Page 3
<br />G—A mal estate Investment trust
<br />H—A regulated Investment company as defined In section 851 or an entity
<br />registered at all times during the tax year under the Investment Company Act of
<br />1940
<br />I—A common trust fund as defined In section 584 (0)
<br />J—A bank as defined in section 681
<br />K—A broker
<br />L—A trust exempt from tax under section 664 or described In section 4947(a)(1)
<br />M—A tax Exempt trust under asection 4030) plan or &action 457(8) plan
<br />Part I. Taxpayer Identification Number (TIN)
<br />Enter your TIN In the appropriate box. If you are a resident alien end you do not
<br />have and are not eligible to gel an SSN, your TIN Is your IRS Individual taxpayer
<br />Identification number (ITIM. Enter It In the social security number box. If you do not
<br />have an [TIN, see How to got a TIN below.
<br />If you are a sole proprietor and you have an EIN, you may enter either your SSN
<br />or EIN. However, the IRS prefers that you use your SSN.
<br />If you are a single -member LLC that Is disregarded as en entity separate from Its
<br />owner (see Limited Liability Company (LLC) on page 2), enter the owner's SSN (or
<br />EIN, if the owner has one). Do not enter the disregarded entity's EIN. If the LLC Is
<br />classified as a corporation or partnership, enter the entity's EIN.
<br />Nate. See the chart on page 4 for further clarlficatlon of name and TIN
<br />combinations.
<br />Haw to get a TIN. if you do not have a TIN, apply for one immediately. To apply
<br />for an SSN, get Farm SS -5, Application for a Social Security Card, from your local
<br />Social Security Administration office or get this form online at www.ssa.gov. You
<br />may also get this forth by calling 1-800-772-1213. Use Form W-7, Application for
<br />IRS Individual Taxpayer Identification Number, to apply for an [TIN, or Form 88-4,
<br />Application for Employer IdentlWatlon Number, to apply for an EIN. You can apply
<br />for an EIN online by accessing the IRS website at wwdebs.gov7huslnesses and
<br />olloking on Employer NAMEScation Number (EIN) an der Sterling a Business. You
<br />can get Forms W-7 and SS -4 from the IRS by visiting IRS.gov or by calling 1 -800 -
<br />TAX -FORM 0-600.029-3670).
<br />If you ere asked to complete Form W-9 but do not have aTIN, apply for a TIN
<br />and write "Applied Far" In the space for the TIN, sign and date the form, and give It
<br />to the requester. For Interest and dividend payments, and cortain payments made
<br />with respect to readily tradable Instruments, generally you will have 60 days to get
<br />a TIN and give It to the requester before you are subject to backup withholding on
<br />payments, The e0 -day rule does not apply to other types of payments. You will ba
<br />subject to backup withholding on all such payments until you provkle your TIN to
<br />the requester.
<br />Note. Enlering "Applied Far' means that you have already applied fore TIN or that
<br />you Intend to apply for one soon.
<br />Caution: Adisregarded U.S. entity that has a foreign owner must use the
<br />appropriate Form W-8.
<br />Part II, Certification
<br />To establish to the withholding agent that you aro a U.S, person, or resident alien,
<br />sign Form W-9. You may be requested to sign by the wlthholding agent even if
<br />Items 1, 4, or 6 below indicate otherwise,
<br />For ajolnt account, only the person whose TIN Is shown in Part I should sign
<br />(when required). In the case of a disregarded entity, the person identified on the
<br />"Name" line roust sign. Exempt payees, use Exemptpeyee code earlier.
<br />Signature requirements. Complain the certification as Indicated In Items 1
<br />through S below.
<br />1. Interest, dividend, and barter exchange accounts open ad before 1984
<br />and broker accounts considered as Elva during 1983. You must give your
<br />aspect TIN, but you de not have to sign the certification.
<br />2. Interest, dividend, broker, and barter exchange accounts opened after
<br />1088 and broker accounts so said a red Inactive during 1983. You must sign the
<br />codification or backup withholding will apply. If you are subject to backup
<br />wilhholtling and you are merely providing your correct'fIN to the requester, you
<br />must cross out Item 2 in the certifluatlan before signing the form.
<br />3. REM estate Irusactions. You must sign the cedl(Ieallon. You may cross out
<br />Item 2 of the cedification.
<br />4. Other payments. You must give your correct TIN, but you do not have to sign
<br />the cedificalicn unless you have been notified that you have previously given an
<br />Incorrect TIN. 'Other payments" Include payments made In the course of the
<br />requester's trade or business for rents, royalties, goods (other than bills for
<br />merchandise), medical and health care sarvlces (including payments to
<br />corporations). payments to a nonemployee for services, payments made in
<br />settlement of payment card and third party network tmreacttons, payments to
<br />certain fishing boat crew members and fish smah, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />S. Mortgage interest paid by you, ecqulsilion or abandonment of secured
<br />property, cancellation of richt, qualifled tuition program payments (under
<br />section 620), IRA, Covardell ESA, Archer MSA or NSA contributions or
<br />distributions, and penal on distribuGana. You most give your consent TIN, but you
<br />do not have to sign tha notification.
<br />75G-32
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