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Form W-9
<br />Part II. Certiflcation
<br />To establish to the withholding agent that you area U.S. parson, or resident alien,
<br />sign Farm W-9. You may be requested to sign by the withholding agent even If
<br />Items 1, 4, or 5 below indicate oihenwkse.
<br />For a joint account, only the person whose TIN Is shown in Pad I should sign
<br />(when required). In the case of a diaragarded entity, the person identified an Ilene 1
<br />must sign. Exempt payees, see i5semptpayse code earlier.
<br />Signature requirements, Complete the certification as Indicated In Items 1
<br />through 5 below,
<br />1. Interest, dividend, and barter exchange accounts opened before 1004
<br />and broker accounts considered active during 1983. You must give your
<br />correct TIN, but you do not have to sign the codification.
<br />2. Interest, dividend, broker, and barter exchange accounts opened after
<br />1963 and broker accounts considered inactive during 1983. You must Slgh the
<br />oertlficeilon or backup withholding will apply. if you are subject to backup
<br />withholding and you at merely providing your correct TIN to the raquestar, you
<br />must areas out Item 21n the certification before signing the farm.
<br />B. Real estate transactions. You must sign the certification. You may areas out
<br />Item 2 of the certification.
<br />4. Other payments. You must give your correct TIN, but you do not have to sign
<br />the certification 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 services (Including payments to
<br />corporations), payments to a nonemployee for services, payments made In
<br />settlement of payment card and third parry network transacllohs, payments to
<br />certain fishing boat crew members and fishermen, and groes proceeds paid to
<br />attorneys (Including payments to corporations).
<br />5. Mortgage Interest paid by you, acquisition or abandonment of secured
<br />property, can eillallon of debt, qualified tuition program payments (under
<br />section 529)1 IRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions, You must give your correct TIN, but you
<br />do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this type of succumb
<br />Give name and SSN of:
<br />1. Individual
<br />The Individual
<br />2. Two ormone Individuals point
<br />The actual owner of the account or,
<br />account)
<br />If combined funds, the first
<br />Individual an the account'
<br />3. Custodian account of a minor
<br />The minors
<br />(Uniform Gift to Miners Act)
<br />4. a. The usual revocable savings
<br />The grantor -trustee'
<br />trust (grantor is also trustee)
<br />h. So-called trust account that Is
<br />The actual owner
<br />not a legal or valid trust under
<br />state law
<br />5. Sole proprietorship or disregarded
<br />The owner'
<br />entity owned by an individual
<br />6, Grantor trust filing under Optional
<br />The grantor'
<br />Form 1090 Filing Method 1 (sae
<br />Regulations sectlon 1.671-4(b)(2)(i)
<br />(A))
<br />Forthis type of account:
<br />Give name and EIN of:
<br />7. Disregarded entity not owned by an
<br />The owner
<br />Indtvldual
<br />8. A valid trust, estate, or pension it
<br />Legal entity'
<br />9. Corporation or LLC electing
<br />The corporation
<br />corporate status on Form 8832 or
<br />Form 2553
<br />10. A .... letter, club, religious,
<br />The organization
<br />charitable, educational, or other tax-
<br />exempt organization
<br />11. Partnership or multi -member LLC
<br />The partnership
<br />12. A broker or 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 />in loop) that receives agricultural
<br />program payments
<br />14. Grantor trust filing under the Form
<br />The trust
<br />1041 Filing Method or the Optional
<br />Fort 1099 filing Method 2 (see
<br />Regulations section '1.67'1-4(h)(2)p)
<br />'List first and curia the earn. of the pemoh whose number you furnish. If only ane person on a
<br />II account has an SSN, that parson's number must be monistical,
<br />'clubs the rumor's name and furnish the minm's SSN.
<br />s You must show your Individual name and you may also enter your business or DBA name on
<br />the ^Business nameldleregarded entity' name line, You may use eithar your SSN or SIN Of you
<br />have ane), but the IRS ancourages you to use your SSN.
<br />' Dat fret and circle the home of the trust, estate, or pension [oust. (Do not furnish the TIN of the
<br />personal repraseNalive or trustee unless the legal entity Itself Is not designated In the amount
<br />title.) Also see special rotas fer,semisahips on page 2.
<br />`Note. Grantor also most provide a Form W-9 to trustee of bugL
<br />Nate. If no 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 someone 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 get a Job 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 />• Be careful when choosing a tax prepares.
<br />If your tax records are affected by Identity theft and you receive a notice from
<br />the IRS, 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 last or stolen purse or wallet, questionable credit card activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4499 or submit
<br />Form 14039.
<br />For more information, see Publication 4535, Identlty Theft Prevention and Victim
<br />Assistance.
<br />Victims 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 />through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
<br />asealanoe. You can reach TAS by calling the TAS tall -hes case Intake line at
<br />1-877-777-4778 or TTY/TDD 1-800-829-4059.
<br />Protect yourself from suspicious email, or phishing schemes. Phlshing In the
<br />emotion and use of small and wabsll designed to mimic legitimate business
<br />amalls 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 hill contacts with taxpayers via amalls. Al... 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, or other financial accounts.
<br />If you receive an unsolicited email claiming to be from the IRS, forward this
<br />message to phfsh)ng@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 1-800-366-4484. You can forward suspicious emalls to the Federal
<br />Trade Commission at: spam®uee.gov or contact them at w,uw.Rc.goWldfhaft or
<br />1-877.1OTHEFT (1-877-438-4338).
<br />Visit IRS.gov to learn more about identity theft and how to reduce your risk.
<br />Privacy Act Notice
<br />Section 6109 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, orcertatn other income paid to
<br />you; mortgage Interest you paid; the acquisition or abandonment of assured
<br />properly; the cancellation of debt; or contributions you madato an IRA, Archer
<br />MSA, or HSA. The person collecting this form uses the Information on the form to
<br />file information returns with the IRS, reporting rhe above Information. Routine uses
<br />of this Informatlon Include giving it to the Department of Justice for civil and
<br />criminal litigation and to titles, states, the District of Columbia, and U.S.
<br />commonwealths and possessions for use In administering their laws. The
<br />Infol'motion Mao may be disclosed to other countries under treaty, to federal and
<br />state agencies to enforce civil and criminal laws, or to federal law enforcement and
<br />Intelligence agencies to combat lermrtsm. You must provide your TIN whether or
<br />not you are required to filo a tax 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 not give a U N to the payer. Certain penalties may ateo apply for
<br />providing false or fraudulent information.
<br />75M-58
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