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Form W-9 (Rev. 12-2014)
<br />Line 2
<br />If you have a business name, bade name, DBA name, or disregarded entity name,
<br />you may enter it on line 2.
<br />Line 3
<br />Check the appropriate box in line 3 fortho U.S. federal tax classification of the
<br />person whose name Is entered on line 1. Check only one box In line 3.
<br />Identical Liability Company(LLC), If the name on line 1 Is an LLC treated as a
<br />partnership for U.S, federal tax purposes, check the "Limited Liability Company"
<br />box and enter "P" in the space provided. If the LLC has flied Form 8832 or 2663 to
<br />be taxed as a corporation, check the "Limited Liability Company" box and In the
<br />opera provided enter "C" far Corporation or"S" for 8 corpomdon. If It Is a
<br />single -member LLC that Is a disregarded entity, do not check the "Limited Liability
<br />Company" box; Instead check the first box In line 3 "Individual/sole proprletnr or
<br />single -member LLC."
<br />Line 4, Exemptions
<br />if you are exempt from backup withholding and/or FATCA reporting, enter In the
<br />appropriate space In line 4 any c af.(s) that may apply to you.
<br />Exempt payee sada.
<br />• Generally, individuals (including sole pmprietora) are not exempt from backup
<br />withholding.
<br />• Except as provided below, corporations are exempt from backup withholding
<br />for certain payments, Including Interest and dividends.
<br />• Corporations are not exempt from backup withholding for payments made In
<br />settlement of payment card or thlyd party network transactions.
<br />o Corporations are not exempt from backup withholding with respect to attorneys'
<br />fans or gross proceeds paid to attorneys, and corporations that provide medical or
<br />beef Ili care services are not exempt with respect to payments reportable on Farm
<br />1099-MISC.
<br />The following rode. identify payees that are exempt from backup withholding.
<br />Enter the appropriate code In the space In line 4.
<br />1—An organization exempt from tax under section 501(a), any IRA, or a
<br />custodial account under section 403(b)(7) tithe account satisfies the requirements
<br />of section 401 (1)(2)
<br />2—The Untied States or any of its agencies or Instrumentalities
<br />3—A state, the District of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivisions or Instrumentalities
<br />4—A foreign government or any of Its political suedlvalons, agencies, or
<br />Instrumantalltles
<br />5—A corporation
<br />6—A dealer in securities or commodities required to register In the United
<br />States, the District of Columbia, or a U.S. commonwealth or possession
<br />7—A futures commission merchant registered with the Commodity Futures
<br />Trading Commission
<br />8—A real estate Investment trust
<br />9—An entity registered at all times during the tax year under the Investment
<br />Company Act of 1940
<br />10—A common treat fund operated by a bank under section 684(a)
<br />11 —A financial Institution
<br />12—A middleman known In the Investment community as a nominee or
<br />custodian
<br />13—A frust exempt from tax under section 664 or described in section 4947
<br />The fallowing char) shows types of payments that may be exempt from backup
<br />withholding. The chart applies to the exempt payees Ilakid 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 tmnnaollam
<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 noncoverad securities
<br />acquired prior to 2012.
<br />Barter exchange transactions and
<br />Exempt payees l through
<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 5°
<br />Payments made In settlement of
<br />Exempt payees l through
<br />payment card or third party network
<br />transactions
<br />I See Form 1099-MISC, Miscellaneous Income, and Its instructions.
<br />Page 3
<br />'However, the fallowing payments made to a corporation and reportable on Form
<br />1099-MISC are not exempt from backup withholding: medical and health cam
<br />payments, attorneys' fans, gross proceeds paid to an attorney reportable under
<br />section 6045(f), and payments for services paid by 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 entries of the United States by
<br />certain foreign fllterclal Institutions. Therefore, If you are only submitting tills form
<br />for an account you hold in the United States, you may leave this field blank.
<br />Consult with the person requesting this form if you are mandate If the financial
<br />Institution la subject to these requirement& A requester may Indicate that a code Is
<br />not required by providing you with a Form W-0 with "Nut Applicable" (or any
<br />similar Indication) written or printed on file line fora FATCA exemption code.
<br />A— An organization exempt from tax under section 501(a) or any Individual
<br />retirement plan as defined In section 7701(a)(37)
<br />B—Tho United States or any of Its sustains or Instrumentalities
<br />C—A state, the District of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivlslans or Instrumentalities
<br />D—A corporation the stock of which is regularly traded on one of more
<br />established securities markets, as described in Regulations section
<br />1.1472-1(c)(1)(g
<br />E—A corporation that Is a member of the same expanded affiliated group as a
<br />corporation described In Regulations section 1.1472-1(cJ(i)(I)
<br />F --A dealer in securities, commodities, or derivative financial Instruments
<br />(including notional principal contracts, futures, forwards, and options) that is
<br />registered as such under the laws of the United Staten or any state
<br />G—A real estate Investment trust
<br />IT—A regulated Investment company as defined In section 861 or an entity
<br />reglstaisd at all times during the tax year under the Investment Company Act of
<br />1946
<br />1—A common trust fund as defined In section 584(0)
<br />J—A bank as defined in section 581
<br />K—A broker
<br />L—A trust exempt from ex under section 964 or described in section 4947(a)(1)
<br />M—A tax exempt trust under seder 4o3(b) plan orsncelon 457(g) plan
<br />Note. You may wish to consult with the financial institutiwr requesting this form to
<br />determine whether the FATCA code and/or exempt payee code should be
<br />completed.
<br />Line 5
<br />Enter your address (number, street, and apartment or suite number). This Is where
<br />the requester of this form. W-9 will mail your Information returns.
<br />Line 6
<br />Enter your city, state, and ZIP code.
<br />Part 1. Taxpayer Identification Number (TIN)
<br />Enter your TIN In the appropriate box. If you are a resident allen and you do not
<br />have and am not eligible to get an SSN, yourTiN Is your IRS individual taxpayer
<br />Identification number #TIN. Enter it to the social security number box. If you de not
<br />have an R IN, see Now k get a TIN below.
<br />If you are a sole proprietor and you have an BIN, you may enter either your SSN
<br />or EIN. However, the IRS posters that you use your SSN.
<br />If you ere o single -member LLC that Is disregarded as an entity separate from Its
<br />owner (sea Limited IJablity Company (LLC) on this page), enter the owner's SSN
<br />(or FIN, If the owner has one). Be not enter the disregarded entity's EIN. If the LLC
<br />Is classified as a corporation or partnership, enter the entity's SIN.
<br />Note. See the shad on page 4 for further clarification of name and TIN
<br />combinations.
<br />How to get a TIN. If you do not have a TIN, apply for one Immediately. To apply
<br />for an SSN, get Form SS -5, Application for a social Security Card, from your local
<br />SSA office or get this form online at www.ssa.gov. You may also gat this form by
<br />calling 1-800-772-1215. Use Form W-7, Applioatioh for IRS Individual Taxpayer
<br />Identification Number, to apply for an ITIN, or Form SS -4, Application for Employer
<br />Identification Number, to apply for an EIN. You can apply for an EIN online by
<br />accessing the IRS website at wean langov/businesses and clicking on Employer
<br />Idetrtifieatlon Number (EIN) under Starting a Business. You can gat Farms W-7 and
<br />SS -4 from the IRS by visiting IRB.gov of by calling 1 -808 -TAX -FORM
<br />(1-800-828'+1876),
<br />If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN
<br />and write "Applied For" in the space for the TI IJ, sign and date the form, and give It
<br />to the requester. For intereaL and dividend payments, and certain 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 60 -day rule does not apply to other types of payments, You will he
<br />subject to backup withholding on all such payments until you provide, your TIN to
<br />the requester.
<br />Net.. Entering "Applied For" means that you have already applied for a TIN or that
<br />you Intend to apply for one soon.
<br />Caution: A disregarded U.S. entity that has a foreign owner must use the
<br />approprlale Form W-8.
<br />75H-45
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