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Form W-9 (Rev.
<br />What Name and Number To Diver the Requester
<br />For this type of account:
<br />Give name and SSN of,
<br />1. Individual
<br />The individual
<br />2, Two or mora individuals Uolnt
<br />The actual owner of the account or,
<br />account)
<br />If combined fordo, the first
<br />Individual on the account'
<br />3, Custodian account of a minor
<br />The minor'
<br />(Uniform Gift to Minors Act)
<br />4. a. The usual revocable savings
<br />Tho grantor -trustee'
<br />trust (grantor Is also trustee)
<br />b. So-called trust acooual that is
<br />The actual owner'
<br />not a logo[ or valid trust under
<br />state law
<br />S. Sale proprietorship or disregarded
<br />The evmer'
<br />entity owned by an Individual
<br />O. Grantor trust filing under Optimal
<br />The grantor'
<br />Form 1099 Filing Method 1 (see
<br />Regulation section 1.871-4(b)(2)(I)(A))
<br />For this type of account;
<br />Give name and EIN of:
<br />1. Disregarded entity not owned by en
<br />the owner
<br />Individual
<br />S. 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. Association, club, religious,
<br />The organization
<br />charitable, educational, or other
<br />tax-exempt organization
<br />11. Partnership or mufti -member LLC
<br />The partnership
<br />12. A broker r registered nominee
<br />The broker or nominee
<br />18. Account with the Department of
<br />The public entity
<br />Agriculture In the name of a public
<br />entity (such as a state or tocai
<br />government, school district, or
<br />prison) that receives agricultural
<br />program payments
<br />14. Grantor trust Fllin9 under the Form
<br />Thetrust
<br />1041 FIIIng Method or the Optional
<br />Form 1009 Filing Method 2 (see
<br />Regulation section 1,071.4(b)(2)(7(12))
<br />,List liratand cimle the neme.loos person whasenumberyou furnish. it only arra parsunon a
<br />left -t acaounl has an SSN, thatperson's numbermual be furnished
<br />Cycle the mll rem. and Relish the minor's SSN.
<br />°You must shav you-Indlv&ui name and you may also enter your business or °DDA" name on
<br />the"Dusineas name/dlsregartlog entity" name line. You may use eitheryaur SSN or RN it you
<br />have one), but the IRS encourages you to use your SSN,
<br />a tht lint and elmla the nam. of the trust, Valuta, or pension last. (Coast furnish the TIN of the
<br />pea.rpl represertidve or tube unless the legal entity Itself Is trot designated In the acaourd
<br />line,) Aisu see 3preirfmfes forpartnwshipson page 1.
<br />•Nate. Ga mOl 0190 moot IM91de a Form w-9 to taetae 01 trust.
<br />Privacy Act Notice
<br />Section 0109 of the Internal Revenue Cede
<br />the IRS to report Interest, dividends, or can
<br />of debt; or contributions you made to an IR
<br />reporting the above Information. Routine at
<br />of Columbia, and U.S. commonwealths am
<br />ATTACHMENT
<br />Note. If no name is all when more than one name Is listed, the number will be
<br />considered to be that of the first name listed.
<br />Secure Your Tax Records from Identity Theft
<br />Idontitytheft eecum when someone uses your personal Information such as your
<br />name, social security norther (SSKI, or other identifying information, without your
<br />permission, to commit fraud or other crimes An Identity thlef may use your SSN to
<br />Set a job or may flle a tax return using your SSN to receive a refund.
<br />'to reduce your risk:
<br />• Protect your 85N,
<br />• Ensure your employer is protecting your SSN, and
<br />• Be careful when choosing a tax property.
<br />If your tax records are 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 tel
<br />If your tax records are not currently affected by Identity theft but you think you
<br />are at risk due to a lest or stolen purse or wallet, questionable credit card activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
<br />Form 14039.
<br />For more Information, see Publication 4535, Identity Theft Prevention and Victim
<br />Assistance.
<br />Mellow 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 />througph normal channels, may be eligible for Taxpayer Advocate Service (FAS)
<br />oasis awe. You can reach TAS by calling the TAS tall -free case Intake line at
<br />1-877.777-4773 or TTY/TDD 1-800-829.4059.
<br />Pratectyourselt from auspicious emaifs or pnishing schemes. Phishingfsthe
<br />creation and use of emall and websites designed to mimic legitimate business
<br />smalls and wsbeftes. The most common act Is sending an email to a user falsely
<br />claiming to bo an established legitimate enterprise In an attempt to scam the user
<br />Into surrendering private Information that Villi be used for Identity theft.
<br />Th. IRS does not intima contacts with taxpayers via emaile. Also, the IRS does
<br />not request personal detailed intonation through small or ask taxpayers for the
<br />PIN numbers, passwords, or similar secret access information far their credit card,
<br />bank, or other financial accounts.
<br />If you receive an unsolicited small claiming to be from the IRS, forward this
<br />message to phlehing®fm gov. You may also report misuse of the IFIG name, logo,
<br />or other IRS property to the Treasury Inspector General for Tax Adunislration at
<br />1-800-380-4484, You can forward auspicious emaifs to the Federal Trade
<br />Commission at: spam®um gov or conduct them at www.gc.govddfheft or 1,877.
<br />IDTHEFr (1-877-438-4338).
<br />Visit IRG,govto learn more about identity theft and how to reduce your risk
<br />coned TIN to parsons including federal agencies) Who am required to Ills in
<br />mortgage interest you paid; the acquisition or abandonment of secured prof
<br />Lemon detecting this form uses the Information on the farm to file Informattel
<br />giving it to Lha Department of Justice for civil and criminal litigation and to of
<br />ilsterrino their laws, The information Rise may he disclosed to other countries
<br />federal and state agencies to enforce civil and criminal laws, or to federal law
<br />whether or not you are required to Flla a tax return. Under section 3408, pays
<br />payments to a payee who does not give a TIN to the payer. Certain penalties
<br />75G-33
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