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Form
<br />W-9
<br />Request for Taxpayer
<br />Give Form to the
<br />(Rev. December 2014)
<br />Identification Number and Certification
<br />requester. Do net
<br />Department
<br />of the Treasury
<br />send to the IRS.
<br />Internal
<br />Revenue 8aNlce
<br />1 Name (as shown on your Income tax return). Name is required on frits line; do not leave this line blank.
<br />2 Business name/disregarded entity name, if different korn above
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<br />of
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<br />3 Check appropriate box for federal tax classification; check only one of the following seven boxes;
<br />4 Exemptions (codes apply only to
<br />cousin entitles, not Individuals; sea
<br />°
<br />❑Individual/sole proprietor or ❑ C Corporation L]5 Corporation [I Partnership Ttnst/estote
<br />Instructions on page 3):
<br />s,
<br />o
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<br />single -member LLC
<br />Limited liability Company. Enter the tax classification fC=C corporation, 3=9 corporation, P= artnershlp) P
<br />Exempt payee code Of any)
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<br />Note. For a single-m er LLC hthat is disregarded, do not check ULC; check the appropriate box in the line above for
<br />Exemption from FATCA reporting
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<br />the tax clas.lticatlon oof the single -member owner.
<br />code (If any)
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<br />❑ Char is.. Instructions) P
<br />(A,ls.bo .vua telmalned aW!ae the us)
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<br />5 Address (number, street, and apt. or suite no.)
<br />Requester's name and address (optional)
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<br />6 City, state, and ZIP code
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<br />7 List account numbers) here (optional)
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<br />Taxpayer Identification Number (TIN)
<br />Enteryour TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number
<br />backup withholding. For individuals, this is generally your social security number (Sae. However, fora m T
<br />resident alien, Bele proprietor, or disregarded entity, sea the part I Instructions on page 3. For other
<br />entitles, it is your employer Identification number (EIN). If you do not have a number, see Now to Beta
<br />TIN on page 3. of
<br />Note. if the account is In mom than one name, see the Instructions for line 1 and the chart on page 4 for I Employee Identification number
<br />guidelines on whose number to enter. F—T-1 F—F—T—F-F-F-F—I
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this farm is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and
<br />2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
<br />Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S, citimn or other U.S. person (defined below); and
<br />4. The FATCA. code(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting is correct.
<br />Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
<br />because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage
<br />Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
<br />generally, payments other than interest and dividends, you are not rsquired to sign the certification, but you must provide your correct TIN. See the
<br />instructions an page 3.
<br />Sign Signature of
<br />Here I U.S. person Date t"
<br />General instructions
<br />Section references are 1. the Internal Revenue Cade unless otherwise noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release Il) Is at www.hs gov/fw9.
<br />Purpose of Form
<br />An Individual or entity (Form W-9 requester) who Is required to file an information
<br />return with the IRS must obtain your correct taxpayer Identification number (TIN)
<br />which may be your social security number (SSN), Individual taxpayer Identification
<br />number (ITIN), adoption taxpayer ldentificatlon number (ATIN), or employer
<br />Identification number(EIN), to report on an Information return the amount paid to
<br />you, or otherafaDme reportable on an information return. Examples of Information
<br />returns Include, but are not limited to, thefollowing:
<br />• Form 1099 -INT (Interest earned or paid)
<br />• Form io99-DN (dividends, including those from stocks or mutual funds)
<br />• Form im l-MISC (varloustypos of Income, prizes, awards, or gross proceeds)
<br />• Form 11 (.fork or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Form 1099-3 (proceeds from real estate transactions)
<br />• Form 'I099 -K (merchant card and third party nate ork tmnsactlons)
<br />• Form 1098 (home mortgage interest), 1098-E (student loan In forest), 1098-T
<br />(tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-0 only If you are a U.S, person (Including a resident alien), to
<br />provide your correct TON.
<br />If you do not relurn Form W-9 to the requester with a TIN, you might be sub/act
<br />to backup withholding. See What Is backup withholding? on page 2.
<br />By signing the filled -out form, you:
<br />1. Certify that the TIN you are giving Is correct (or you are waiting for a number
<br />to be issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
<br />applicable, you are also certifying that as a US. person, your allocable share of
<br />any partnership Income from a U.S. trade or business Is not subject to the
<br />withholding tax on foreign partners' share of effeollvaly connected Income, and
<br />4, Certify that FATCA equals) entered on this form (If any) Indicating that you are
<br />exempt from the FATCA reporting, is correct. See What is FATCA reporting? on
<br />page 2 for further information.
<br />Cat. No. 1023ix
<br />75N-49
<br />Form W-9 (Rev. 12-2014)
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