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Farm W-9 (Rev. 12-20141
<br />Part If. Certification
<br />To establish to the withholding agent that you are a U.S. person, or resident alien,
<br />sign point You may be requested to sign by the withholding agent even if
<br />Items 1, 4, or below Indicate otherwise.
<br />Fora joint account, only the person whose TIN Is shown in Part I should sign
<br />(when required). In fhe case of a disregarded entity, the person identified on line I
<br />most sign. Exempt payees, see Exempt payee code cath at,
<br />Signature requirements. Complete the certification a. Indicated in Items 1
<br />through 5 below.
<br />'I. Interest, dividend, and barter exchange accounts opened before 1084
<br />and broker accounts considered active during 1883. You must give your
<br />correct TIN, but you do not have to sign the cetiiffcation.
<br />2. Interest, dividend, broker, and barter exchange accounts opened after
<br />1983 and broker accounts considered inactive during 1883. You must sign the
<br />cer iflcalion or bae(fup withholding will apply. If you are subject to backup
<br />withholding and you. aro merely providing your correct TIN to the requester, you
<br />must cross cut Iteirm in the certification before signing the farm.
<br />3. Real estate transactions, You most sign the certification. You may cross out
<br />item 2 of the .edification.
<br />4. Other payments. You must give your correct TIN, but you do not have to sign
<br />the cedltication 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 />handbag lse), mantel and health care services (including payments to
<br />corporations), payments to a nonemployee for services, payments made In
<br />settlement of payment card and third party network transactions, payments to
<br />certain fishing boat area, members and fishermen, and gross proceeds paid to
<br />attorneys Occluding payments to corporation).
<br />S. Mortgage Interest paid byyeu, acquisition or abandonment of secured
<br />property, cancellation of debt, qualified tuition program payments (under
<br />section 629), IRA, Caverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your cor set Tl N, but you
<br />do not have to sigh the codification.
<br />What Name and Number To Give the Requester
<br />For this type of ... cost:
<br />Give name and SSN ph
<br />1. Individual
<br />The individual
<br />2. Two or more Individuals Qoint
<br />The actual owner of the account or,
<br />account)
<br />if combined funds, the first
<br />Individual on the account'
<br />S. Custodian account of a minor
<br />The minor'
<br />(Uniform Gift to Minors Act)
<br />4. a. The usual revocable savings
<br />The greeter -trustee'
<br />imst (grantor Is also trustee)
<br />b. So-called trust account that Is
<br />The actual owner'
<br />not a legal or valid trust under
<br />state law
<br />5. Solo propriat... hip or disregarded
<br />The owner'
<br />entity owned by an Individual
<br />S. Grantor trust filing under Optional
<br />The grantor'
<br />Form 1098 Filing Method 1 (see
<br />Regulations section 1.871-4(b)(2)(f)
<br />(A))
<br />For this type of account:
<br />Give name and EIN of:
<br />7. Disregarded entity not owned by an
<br />The owner
<br />individual
<br />8. A valid trust, estate, or pension trust
<br />Legal entity`
<br />9. Corporation or LLG electing
<br />The corporation
<br />corporate status on Form 8932 or
<br />Form 2553
<br />10. Association, club, religious,
<br />The organization
<br />charitable, educational, or other tax-
<br />exempt organeatlon
<br />11. Partnership or multi -member LLG
<br />The partnership
<br />12. A brokeror registered nominee
<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 Flling Method or the Optional
<br />Form 1099 Flling Method 2 (see
<br />Regulations section 1.671-4(b)(2)(1)
<br />(e)1
<br />fist first and sirda the name of the person whose number you fu lab. II only one comes ora
<br />joint account has an SSN, that person's numbermust he furnished.
<br />a Circle the manor's name and furnish the minm'r SSN.
<br />You must show your Individual name and you may also enter your business or boAnrme on
<br />the "northern name/dlsregzrded orally" name Ilne. You may use either your SSN or EIN Of ycu
<br />have one), but the IRS encourages you to use your SSN.
<br />List boat end circle the name of the trual, eslals, or pension treat, (Do not furnish the TIN of the
<br />personal representative or hurter matron the legal entity itself Is not designated In the account
<br />MIST Also ere Special rules for padneRhlps on page 2,
<br />-Nola. Grantor also net pmvide a Form W-91. trustor of test.
<br />Note. if he name Is circled 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 />Identity theft occurs when Situation uses your personal Information such as your
<br />name, SSN, or other Identifying Information, without your permission, to commit
<br />fraud or other crimes. An identity thief may use your SSN to gel a fob or may file a
<br />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 />r Re careful when choosing a tare preparar.
<br />If your tax records are affected by Identity theft and you receive a notice from
<br />it IHS, 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 lost or stolen purse or wallet, questionable credit card activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1-800-900-4490 or submit
<br />Form 14039.
<br />For more Information, see Publication 4535, Identity Theft Prevention and Victim
<br />Assistance.
<br />Vletlms of identity (haft who are experiencing economic harm or a system
<br />problem'or are seeking help In resolving tax problems that have not been resolved
<br />through normal channels, may be eligible far Taxpayer Advocate Service grAS)
<br />assistance. You can reach TAS by calling the TAS toll-free case intake line at
<br />1-077-777-4778 or Try/ Ph) 1 -800-820-4059,
<br />Protect yourself from suspicious emalls or phishing schemes. Finishing is the
<br />creation and use of small and websites designed to mimic legitimate business
<br />Smalls and websites. 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 theft.
<br />The IRS does not Initiate contacts with taxpayers via emate, Also, the IRS does
<br />not request personal detailed Information through email or ask taxpayers for the
<br />PIN numbers, passwords, or similar secret access Information for their credit card,
<br />bank, ar other financial accounts.
<br />If you receive an unsolicited email claiming to be from the IRS, forward this
<br />message to phishing@lm.gov. You may also report misuse of the IRS name, logo,
<br />or other IRS property to the Treasury Inspector General for Tax Administration
<br />(TIGTA) at 1-500-368-4484. You can forward suspicious smalls to the Federal
<br />Trade Commission at: spamall gov or contact them at Svi legowldlheft or
<br />1-ItTf-IDTHEFT (1.877.438-4338).
<br />Visit IArl to learn more about Identify theft and how to reduce your risk.
<br />Privacy Act Notice
<br />Section 6100 of the Internal Revenue Code requires you to provide your correct
<br />TIN to persons (including federal agencies) who are required to file Information
<br />returns with the IRS to report Interest, dividends, or certain other income paid to
<br />you; mortgage Interest you paid; the acquisition or abandonment of secured
<br />property; the cancellation of debt; or contributions you made to an IRA, Archer
<br />MGA, or HSA. The person collecting this for uses the information on the torp to
<br />file information returns with the IRS, reporting the above information. Routine uses
<br />of this Information Include giving It to The Department of Justice for civil and
<br />criminal litigation and to cities, states, the District of Columbia, and U.S.
<br />commonwealth. and possessions for use In administering their laws. The
<br />Information also may be disclosed to other countries under a treaty, to federal and
<br />state agencies to enforce doll and criminal laws, at to federal law enforcement and
<br />Inielllgenca agenates to combat terrorism. You must pmvide your TIN whether or
<br />not you are received to its a Not return. Under section 3406, payers must generally
<br />withhold a percentage of taxable Interest, dividend, and certain other payments to
<br />a payee who does hot give a TIN to the payer. Certain penalties may also apply for
<br />providing false or fraudulent information.
<br />75J-55
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