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Form W-9 (Rev. 12-2014)
<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 8
<br />Check the appropriate box In line 3 for the U.S. federal tax classification of the
<br />person whose name is entered on line 1. Chock only one box In 11 n 3.
<br />Limited Liablllty Com pang fLLC). 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. It the LLC has filed Form 8832 or 2553 to
<br />be taxed as a corporation, check the "Limited Liablllty, Company" box and in the
<br />space provided enter "G" for C corporation or "S" for S corporation. If it Is a
<br />aingle-member LLC that is a disregarded entity, do not check the "Limited Uablllly,
<br />Company" box; instead check the first box in line 3 "Individual/sato proprietor or
<br />single -member LLC."
<br />Lino 4, Exemptions
<br />If you are exempt from backup withholding and/or FATCA reparling, enter in the
<br />appropriate space In line 4 any codes) that may apply to you.
<br />Exempt payee code.
<br />• Generally, Individuals (including sale proprietors) era 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 third party network transactions,
<br />• Corporatlons are hot exempt from broths withholding with respect to attorneys'
<br />fees or gross proceeds paid to attorneys, and corporations that provide medical or
<br />health care services are not exempt with respect to payments reportable on Farm
<br />1099-MISG.
<br />The following codes identify payees that are exempt from backup withholding.
<br />Enter the appropriate cede in the space In line 4.
<br />1—An organliation exempt from tax under section tight (a), any IRA, or a
<br />custodial account under section 403lb)(7) If the account satisfies the requirements
<br />of section 401(f)(2)
<br />2—The United Slates 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 subdivisions, agencies, or
<br />instrumentalities
<br />5—A corporation
<br />e—A dealer In securities or commodities required to mglster in the United
<br />States, the District of Columbia, ora U.S. commonwealth or possession
<br />7—A futures commission merchant registered with the Commodity Futures
<br />Trading Commission
<br />e—A real estate Investment trust
<br />9—An entity registered at all times during the tax year under the Investment
<br />Company Act of 1640
<br />10—A common trust fund operated by a hank under section 584(a)
<br />11—A finmCka institution
<br />12—A middleman known in the IltVeddeent community as a nominee or
<br />custodian
<br />13—A trust exempt from tax under section 664 or described In section 4947
<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 />IF the payment is far...
<br />THEN the payment is exempt for...
<br />Interest and dividend payments
<br />All exempt payees except
<br />for 7
<br />Brefow ransarld.ns
<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 />Barter exchange transactions and
<br />Exempt payees i through
<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 l through
<br />payment card or third party network
<br />transactions
<br />I Sae Form loo9-MISG, Miscellateaus Income, and Its Instructions.
<br />'However, filo fallowing payments made to a corporation and reportable on Form
<br />1099-MISG are net exempt from Lookup withholding: medical and health care
<br />payments, attorneys' fees, gross proceeds paid to an attorney reportable under
<br />section 60458, and payments forsetvicaa paid by a federal executive agency.
<br />Exemption from FATCA reporting code. The fallowing codes identify payees
<br />that are exempt from reporting under FATCA. These codes apply to persons
<br />remelting this form for accounts maintained outside of the United States by
<br />certain foreign financial Ihatita tlorm Therefore, If you are only submitting this form
<br />for an account you hold in the United States, you may leave this field blank.
<br />Consult with the person requesting this farm If you are uncertain if the financial
<br />Institution is subject to these requirements. A requester may indicate that a code Is
<br />not required by providing you with a Form W-9 with "Not Applicable" (or any
<br />similar Indication) written or printed on the line for a FATCA exemption code.
<br />A—An organization exempt from tax under section 501(a) or any Individual
<br />retirement plan as donned in section 7701(a)(37)
<br />B—Th. United States or any of its 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 If deed on one or more
<br />established securities markets, as dawallbod In Regulations section
<br />1.1472-1(c)(1)(I)
<br />E—A corporation that Is a member of the same expanded affiliated group as a
<br />corporation described in Regulations section 1.14724(c)(1)(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 States or any state
<br />G—A real estate Investment trust
<br />H—A regulated Investment company as defined in section 851 or an entity
<br />registered at all times during the tax year under the Investment Company Act of
<br />1940
<br />I --A common trust fund as defined in section 584(a)
<br />J—A bank es defined in section 581
<br />K—A broker
<br />L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
<br />M—A tax exempt If under a section 403(b) plan or section 467(g) plan
<br />Note. You may wish to consult with the fihardal Institution 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 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 (ITIN), Enter It in the social security number box. If you do not
<br />have an ITIN, sae How to get a TIN below.
<br />If you are a sole propi later and you have an EIN, you may enter either your SSN
<br />or EIN. However, the IRS prefers that you use your SSN.
<br />If you are a single-membetLLC that is disregarded as an entity separate from Its
<br />owner (see Llmffed Liability Company (LLC) on this page), enter the owner's SSN
<br />(or EIN, If the owner has one). Do not enter the disregarded entity's EIN. If the LLG
<br />is classified as a corporation or partnership, enter the entity's EIN.
<br />Note. See the chart on page 4 for further clarification of name and TIN
<br />combinatime.
<br />Haw 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 wwwssa.gov, You may also get this term by
<br />calling 1-600-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
<br />Identification Number, to apply tot 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 wehshe at www.lrs.gowbus/nesses and clicking on Employer
<br />Identification Number (EIN) Under Starting a Business. You can gat Forms W-7 and
<br />SS -4 from the IRS by Vlahing IRS.gov or by calling 1 -800 -TAX -FORM
<br />(1-800-829-3676),
<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 TIN, sign and data the from, 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 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 be
<br />subject to backup withholding on all such payments until you provide your TIN to
<br />the requester.
<br />Note. Entering "Applled For" means that you have already applied for aTIN or that
<br />you Intend to apply for one soon.
<br />Caution: A disregarded U.S. entity that has a foreign ownermust use the
<br />appropriate Farm W-8.
<br />75N-51
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