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Farm W-9 (Rev. 1
<br />Line 2
<br />If you have a business name, trade name, DBA name, or disregarded entity name,
<br />you may enter it an line 2.
<br />Line 3
<br />Chock the appropriate box In line 3 for the U.S. federal tax classification of the
<br />person whose name Is entered on line 1. Check only one box In line 3.
<br />Limited 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 fled Form 8832 or 2553 to
<br />be taxed as a corporation, check the "Umited Liabillty Company" box and in the
<br />space provided enter "C" for C corporation or "S" for S corporation, 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 lino 3 "Individual/sole proprietor or
<br />single -member LLC."
<br />Line 4, Exemptions
<br />If you are exempt from backup withholding and/or FA7CA reporting, enter In the
<br />appropriate apace In line 4'any code(&) that may apply to you.
<br />Exempt payee code.
<br />• Generally, Individuals (including sola proprietors) era not exempt from hookup
<br />withholding,
<br />• Except as provided below, corporations are exempt from backup withholding
<br />let certain payments, inoluding Interest and dividends.
<br />a Corporations are not exempt from backup withholding for payments made In
<br />settlement of payment card or third parry network transactions,
<br />a Corporations are not exempt from backup withholding with respect to attorneys
<br />fees or gross proceeds paid to attorneys, and corporations that provide medical o
<br />health care servlces are net exempt with respect to payments reportable on Form
<br />1099-MISC.
<br />The following codes 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) If the account satisfies the requirements
<br />of section 401(1)(2)
<br />2—The Unwed States or any of Its agencies or instrumentalities
<br />3—A stale, the District of Columbia, a U.S. commonwealth or poancaslam or
<br />any of their political subdivisions or instrumentalities
<br />4—A foreign government or any of Its political subdivisions, agencies, or
<br />Instrumentalities
<br />5—Acerpomtian
<br />6—A dealer In securities or commodities required to register In the United
<br />States, the Disidet of Columbia, ora 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 trust fund operated by a bank undersection 584(a)
<br />11—A financial institution
<br />12--A middlemen known In the Investment community as a nominee or
<br />custodian
<br />13—A trust exempt from tax under section 064 or described In section 4447
<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 />'However, the following payments Hindu to a corporation and reportable on Form
<br />1099-MISC arc not exempt from backup withholding: medical and health care
<br />payments, attorneys' fees, gross proceeds paid to an attorney reportable under
<br />section 604510. and payments for 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 Stales by
<br />certain 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 field blank.rs
<br />Consult with the peon requesting this form if you are uncertain If the financial
<br />Institution is subject to these requirements. A requester may ketosis that a code Is
<br />not required by provlding you with a Form W. 9 with "Not Applicable" (or any
<br />sin4lor Indication) written or printed on the line for a FATCA exemption code.
<br />A—An organization exempt from tax under section Sol (a) or any Individual
<br />retirement plan as defined in section 7701(a)(37)
<br />0 --The United States or any of ita agencies or instrumentalities
<br />C—A state, the District of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivisions or instrumentalities
<br />D—A corporation the stock of which is regularly traded on one or more
<br />established securities markets, as described In Regulations section
<br />1.1472-1(c)(1)O
<br />E—A corporation that Is a member of the same expanded affiliated group as a1.1472-1(o)(1)(1)corporation described In Regulations section 1.1472-1(c)(1)
<br />F --A dealer In securities, commodities, or derivative financial Instruments
<br />(including notional principal contracts, futures, (onwards, and options) that Is
<br />registered as such under the laws of the Mind States or any state
<br />G --A real estate Investment trust
<br />r
<br />IT —A regulated Investment company as defined in section 851 or an entity
<br />registered at all III ran during the tax year under the Investment Company Act of
<br />1940
<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 noncovered securities
<br />acquired prior to 2012.
<br />Beller exchange transactions and
<br />Exempt payees i through 4
<br />patronage dividends
<br />Payments over $600 required to be
<br />Generally, exempt payees
<br />reported and direct sales over$5,000'
<br />1 through 5?
<br />Payments made In settlement of
<br />Exempt payees 1 through 4
<br />payment card or third party network
<br />transactions
<br />I See Form 1099-MISC, Miscellaneous Income, and Its Instrucllons.
<br />1—A common trust fund as defined in section 504(a)
<br />J—A bank ea defined In section 561
<br />K—A broker
<br />L—A trust exempt from fax under&ectien 664 or described In section 4947(a)(1)
<br />M—A tax exempt trust under a section 403(b) plan or section 457(g) plan
<br />Note. You may wish to consult with the financial institu0on 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 Farm W-9 will mail your information returns.
<br />Line 6
<br />Enter your city, state, and AP code.
<br />Part I. Taxpayer Identification Number (TIN)
<br />Ent air your TIN In the appropriate box. If you are a resident alien and you do not
<br />have and are not eligible to get an SSN, your TIN Is your IRS individual taxpayer
<br />Identification number (ITN). Enter it in the social security number box. If you do not
<br />have an ITIN, see Now to gat a TIN below.
<br />If you are a sale proprietor and you have an LIN, you may enter either your SSN
<br />or LIN. How.wo, the IRS prefers that you use your SSN.
<br />If you are a single -member LLC that Is disregarded as an entity separate from Its
<br />owner (see Umited 41ability Company (LLC) on this page), enter the owner's SSN
<br />(or EI N, If the owner has one). Do not enter the disregarded entity's LIN. if the LLC
<br />is classified as a corporation or partnership, enter the entity's LIN.
<br />Note, See the chaff an 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 ane 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 newssa.gov. You may also get this farm by
<br />calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
<br />Identification Number, to apply for an [TIN, or Form SS -4, Application for Employer
<br />hamfificallon Number, to apply for an LIN. You can apply for an MIN online by
<br />accessing the IRS webslm at www.lrs.gov/bustnessas and clicking on Employer
<br />Identification Number(EIN) under Starting a Business. You can gel Farms W-7 and
<br />SS -4 from the IRS by visiting IRS,gov or by calling 1 -600 -TAX -FORM
<br />(1-000-829-3676),
<br />If you are asked to complete Form W-9 but do not have aTIN, apply for a TIN
<br />and write "Applied For" In the space for the TIN, sign and date the form, and give it
<br />to the requester. For Interest and dividend payments, and certain payments made
<br />with respect to readily tradable Instruments, generally you will have 80 days to gat
<br />a TIN and give it to the requester beton you are subject to backup withholding on
<br />payments. The 60 -day rule does not apply to other types of payments. You will be
<br />subject to backup withholding on all such payments until you provide your TIN to
<br />the requester.
<br />Note. Entering "Applied For" means that you have already applied for a TIN or that
<br />you Intend to apply for one soon.
<br />Cautlon: A d/sregarded U.S, emtfty that has a foreign owner must use the
<br />appropriate Form W -S.
<br />75M-57
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