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Form W-9 (Rev. 12-2014) Page 4
<br />Part U. Certification
<br />To establish to the withholding agent that you are a U.S. person, or resident ailen,
<br />sign Form W-9. You may he requested to sign by the withholding agent even if
<br />Items 1, 4, or 5 below indicate otherwise.
<br />For a joint account, only the person whose TIN Is shown In Part I should sign
<br />(when required). In the case of a disregarded entity, the person Identified on line 1
<br />must sign. Exempt payees, see Seempf payee 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 1984
<br />and broker accounts considered active during 1983. You must give your
<br />correct TIN, but you do not have to sign the celtlfication.
<br />2, Interest, dividend, broker, and barter exchange accounts opened after
<br />1983 and broker accounts considered Inactive during 9983. You must sign the
<br />cedlriealion or backup withholding will apply. If you are subject to backup
<br />withholding and you are merely providing your correct TIN to the requester, you
<br />must erose out Item 2 In the petrification before signing the form.
<br />3. Real estate transaction.. You must sign the certification. You may crass 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 party network transactions, payments to
<br />certain fishing boat crew members and fishermen, and grace proceeds paid to
<br />attorneys (including payments to corporations).
<br />S. Mortgage interest paid by you, acquielfor or abandonment of secured
<br />property, cancellation of debt, qualified tuition program payments (under
<br />section 629), IRA, Coverall ESA, Archer MSA or NSA 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 aoceunl:
<br />Give name and SSN of:
<br />1. Individual
<br />The individual
<br />2. Two or more individuals (joint
<br />Th. actual owner of the account or,
<br />account)
<br />it combined funds, the first
<br />Individual on the account'
<br />3. Custodian account of a minor
<br />The miner'
<br />(Uniform Gift to Minors Act)
<br />4. R. The usual revocable savings
<br />The gmnfor-truslae'
<br />imat (grantor Is also trusted)
<br />Is. So-called trust account that is
<br />The actual owner'
<br />not a legal or valid trust under
<br />elate law
<br />5. Sole pmpdamrahip or dleregarded
<br />The owner'
<br />entity owned by an individual
<br />6. Grantor trust filing under Optional
<br />The grardor'
<br />Form 1099 Filing Method 1 (see
<br />Regulations section 1,671-4(b)(2)(1)
<br />(Al)
<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 LLC electing
<br />The corporation
<br />corporate status on Form 8832 or
<br />Form 2553
<br />10. Association, club, religious,
<br />The organization
<br />charitable, educational, or other tax-
<br />exempt organization
<br />11. Partnership or mulfl-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 />prison) that receives agricultural
<br />program payments
<br />14. Grantor trust filing under the Form
<br />The trust
<br />1041 Filing Method crthe Optional
<br />Form 1099 Filing Method 2 (see
<br />Regulations section 1.671-4(b)(2)(i)
<br />IN
<br />' List Bml and oleate the name of the parson whose number you furnish. reply one parsonon a
<br />].lot account hes an SSN, that person's number net be furnished.
<br />°Chale the mtnm's name and furnish the minor's SSN.
<br />'You must ehaw your Individual name and you may also entaryour business or OBAname on
<br />the "Business n univdisregarded entity" name tine. You may use.Itmuy..r SSN cr EIN Of you
<br />have ene),but the IRS enceuragos you to use your BSN.
<br />' Llan fest and elude the name of the trust, estate, or pension trust. (Go not furnish the TIN of the
<br />pemonal representative or trustee unless the legal entity Itself Is not deralpnated In the account
<br />title.) Also see Special vies for podnorshlre on page 2.
<br />'Note. Grantor also must provide a Form W-9 to trustee of must.
<br />Note. If no name Is circled when more than one name ie 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, with ut your permission, to commll
<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 proposer,
<br />If your tax records are affected by Identity theft and you receive 3 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 lost or stolen purse or wallet, questionable credit card activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
<br />Form '14039.
<br />For more Information, see Publication 4535, Identity Thelt 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 />assistance. You can reach TAS by calling the TAS toll -true case Intake line at
<br />1-877-777-4778 or TTY/7DD 1-800-829-4059.
<br />Protect yourself from suspicious emalls or Clutching schemes. Phishing is the
<br />creation and use of email and websites designed to mimic legitimate business
<br />emalls 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 seam the user
<br />into surrendering private Information that will be used for Identity theft.
<br />The IRS does not initiate contacts with immayers via emalls, 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, or other financial accounts.
<br />If you receive an uncoliclled email claiming to be from the IRS, forward this
<br />message to phishing®im.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 />Trude Commission at: spareQucegov or contact them at www. efc.9ov/ldtheR or
<br />1-877-IDTR EFT (1-B77-438-4338).
<br />Visit IRS.gov to learn more about Identify theft and how to reduce your risk.
<br />Privacy Act Notice
<br />Section 6109 of the Internal Revenue Code requires youto provideyour correct
<br />TIN to persons (including federal agencies) who are required to file Inimmu en
<br />returns with the IRS to report interest, dividends, or certain other Income paid to
<br />you; mortgage Interest you paid; the aequlsitlon or abandonment of secured
<br />property; the cancellation of debt; or contributions you made to an IRA, Archer
<br />MSA, of RSA. The person collecting this form uses the Information on the for 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 US
<br />commonwealths and possessions for use in administering their laws. The
<br />Information also may be disclosed to other countries under closely, to federal and
<br />state agencies to enforce civil and criminal laws, or to federal law enforcement and
<br />imalligence agencies to combat terrorism. You must provide your TIN whether or
<br />not you are required to fife 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 TIN to the payer. Certain penalties may also apply for
<br />providing false or fraudulent Information.
<br />75N-52
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