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<br />I sooner security numoer
<br />Request for Taxpayer
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<br />Give Form to the
<br />(Rev. r, amber
<br />Identification Number and Certification
<br />entities, it is your employer identification number (EIN). If you do not have a number, see Hew to get a
<br />requester. Do not
<br />Oeparknenlaf
<br />th,ssary
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<br />TIN on page 3.
<br />send tO the IRS.
<br />In[ernoI
<br />Revenue Sem
<br />I Name (as shown on your Income tax return). Name Is required on this line; do not leave this line blank.
<br />2 Business name/disregarded entity name, if different from above
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<br />usm
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<br />3 Check appropriate box for fodoral tax classification; check only one of the following seven boxes:
<br />4 Exemptions (codes apply only to
<br />ce Main entitles, not individuals; see
<br />°❑
<br />ndviuesproprietorrletar or C Corporation S Corporation❑PartnershlP ❑Trust/estate
<br />tructon on page 3):
<br />m c
<br />single -member LLC
<br />❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=portrranchlp) P
<br />Exempt payees code (I! any) ---
<br />`p
<br />Nato. Fora single -member LLG that is disregarded, do not check LLC; check the appmenade box In the line above foY
<br />Exemption from FATCA reporting
<br />the tax classltloatlon of the single -member owner,
<br />code Of any)
<br />a— e
<br />❑ Other (see Instructions) P
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<br />5 Address (number, street, and apt, orsulte no.)
<br />Requester's name and address (optional)
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<br />at
<br />a
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<br />6 City, state, and XIP code
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<br />m
<br />7 List account numbers) here (aplional)
<br />Taxpayer Identification Number (TIN)
<br />Enter your TIN to the appropriate box. The TIN provided must match the name given on line 1 to avoid
<br />I sooner security numoer
<br />backup withholding. For individuals, this is generally your social security number ( page However, fora
<br />resident alien, sola proprietor, or disregarded entity, see the Part I instructions on page 3. For other
<br />`�
<br />_
<br />entities, it is your employer identification number (EIN). If you do not have a number, see Hew to get a
<br />.J
<br />TIN on page 3.
<br />or
<br />Note. If the account Is In more khan ane name, seethe instructions for line 1 and the chart on page 4 for (-Employer identification number
<br />guidelines on whose number to enter. FFI FTTTIr
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this form Is my correct taxpayer Identification number (or I am wafting for a number to he 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, citizen or other U.S. person (defined below); and
<br />4. The FATCA codes) 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 required to sign the certlflcatlon, but you must provide your correct TIN. See the
<br />instructions on page 3.
<br />sign Signature of
<br />Here I U.S. person P Date P
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless olherwle. noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release It) Is at ww wIm.gov/rw9.
<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 Identification number (ATIN), or employer
<br />identification number (EN), to report on an Information ratum the amount paid to
<br />you, or other amount reportable on an Information future. Examples of Information
<br />returns Include, but are not limited to, the following;
<br />• Form 1099 -INT (Intel car earned or paid)
<br />• Form 1091(dividends, including those from stocks or mutual funds)
<br />• Form 1099-M 180 (various types of Income, prizes, awards, or gross proceeds)
<br />• Form 1099-8 (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Form 1099-5 (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transacilons)
<br />• Form 1096 (home mortgage Interest), 1098-E (student loan Interest), 1098-T
<br />(tulten)
<br />• Form 1099-0 (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured propery)
<br />Use Form W-9 only If you are a U.S. person (including a resident alien), to
<br />provide your correct TIN.
<br />If you do not return Form W-9 to the requesierwlth a TIN, you might be subtlest
<br />to backup withholding. See What /s backup withholding? on page 2.
<br />Sy 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. Clalm exemption from backup withholding If you are a U.S. exempt payee. If
<br />applicable, you are also certifying that as a U.S. person, your allocable share of
<br />any partnership Income from a Us. trade or business Is not subject to the
<br />withholding tax on foreign f artri share of effectively connected Income, and
<br />4. Certify that FATCA code(s) 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, 10231X
<br />75Q-50
<br />Form
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