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Form W-9 (Rev. 12-2014) Page 3
<br />Line 2
<br />11 you have a business name, trade name, DBA name, or disregarded entity name,
<br />you may enter it an line 2,
<br />Line 3
<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. Check only one box In line 3,
<br />Limited Liability Company (LLC), If the name an line t is an LLC treated as a
<br />partnership for U.S. federal tax purposes, check the "Limited Liability Company"
<br />box and enter 'Pe In the space provided. If the LLC has filed Form 8822 or 2553 to
<br />be laxed as a corporation, check the "Limited Liability Company" box and In the
<br />space provided enter "O" for C corporation or "S" for S corporation, If it is a
<br />single -member LLC that is adisregarded entity, do not check the "Limited Liability
<br />Company" box: Instead check the fist box In line 3 "Individual/sole proprietor or
<br />single -member LLC."
<br />Line 4, Exemptions
<br />If you are exempt from backup withholding and/or FATCA reporting, enter In the
<br />appropriate space in line 4 any code(s)that may apply to you.
<br />Exempt payee code.
<br />Generally, individuals (including sole proprietors) are not exempt from backup
<br />withholding,
<br />a Except as provided below, corporations are exempt from backup Withholding
<br />for certain payments, Including Interest and dividends.
<br />a Corporations are not exempt from backup withholding for payments made In
<br />settlement of payment card or third party network transactions.
<br />a Corporations are not exempt from backup withholding with respect to attorneys'
<br />fees or grass proceeds paid to attorneys, and corporations that provide medical or
<br />health care services are not exempt with respect to payments reportable on Form
<br />1099-MISC.
<br />The following codes Identify payees that are exempt from backup withholding.
<br />Enter the appropriate code In the space in line 4.
<br />1—An organization exempt from tax under section 501(a), any IRA, or a
<br />custodial account under section 403(b)(7) If the account satisfies the requirements
<br />of section 401(Tf(2)
<br />2—The United States or any of its agencies or Instrumentalities
<br />3—A state, the Meat of Columbia, a U.S. commonwealth or possesslon, or
<br />any of their political subdivislons or instrumentalilles
<br />4—A foreign government or any of Its political subdivisions, agencies, or
<br />Instrumentalities
<br />5—A corporation
<br />6—A dealer in securities or commodities required to register In the United
<br />Stales, the District of Columbia, or a U.S, commonwealth orposses tion
<br />7—A futures commission merchant registered with the Commodity Futures
<br />Trading Commission
<br />6—A real estate Investment trust
<br />8—Ah entity registered at all times during the tax year under the Investment
<br />Company Act of 1940
<br />10—A common trust fund operated by a bank under section 584(a)
<br />11—A financial Institution
<br />12—A middleman known in the investment 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 train backup
<br />withholding. The chart applies to the exempt payees listed above, l through 13.
<br />IF the payment is for...
<br />THEN the payment is exempt for...
<br />Interest and dividend payments
<br />All exempt payees except
<br />for 7
<br />Broker transactions
<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 noncevered securities
<br />acquired prior to 2012.
<br />Barter exchange transactions and
<br />Exempt payees 1 through 4
<br />patronage dividends
<br />Payments over $600 required to he
<br />Generally, exempt payees
<br />reported and direct sales over $5,000'
<br />1 through 52
<br />Payments made In eetllement of
<br />&t payees 1 through 4
<br />payment card or third party network
<br />transactions
<br />I See Form 1099-MISC, Miscellaneous Income, and Its Instructions.
<br />'However, the following payments made to a corporation and reportable on Form
<br />1099-MISC are not exempt from backup withholding; medical and health care
<br />payments, atlerneys' fees, gross proceeds paid to an attorney reportable under
<br />section 6045th and payments for services paid by a federal executive agency.
<br />Exemption from FATCA reporting coda. The following codes Identify payees
<br />that are exempt from reporting under FATCA. These codes apply to persons
<br />submitting this form for accounts maintained outside of the United States by
<br />certain foreign financial institutions. 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 form if you are uncedaln 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 60 Us) or any Individual
<br />retirement plan as defined in section 77DI(a)(37)
<br />B—Tho 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 mg ularly traded on one or more
<br />established securities markets, as described in Regulations section
<br />1.1472-1(.)(1)(1)
<br />E—A carpomlion that la a member of the same expanded affiliated group as a
<br />corporation described In Regulations section 1.1472-1(.)(1)01
<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 ..defined In section 561
<br />I broker
<br />L—A trust exempt from tax under section 664 or described In section 4947(a)(1)
<br />M—A tax exempt trust under section 403(6) plan Or ... unit 457(8) plan
<br />Nate. You may wish to consult with the financial 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 Farm W-9 will mail your Information returns.
<br />Line 6
<br />Enter your city, state, and ZIP code.
<br />Part I. 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 SEN, 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, see How to gat a TIN below.
<br />If you are a sole proprietor 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 -member LLC that Is disregarded as an entity separate from Its
<br />owner (see Limited Liability Company (LLC) on this page), enter the owner's SEN
<br />(or EIN, If the owner has one). Do not enter the disregarded entity's EIN. If the LLC
<br />Is classified as a corporation or partnership, enter the entity's FIN,
<br />Note. See the chart on page 4fer further clarification of name and TIN
<br />combinations.
<br />How to gat a TIN. If you do not have aTIN , 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 www.ssa,gov. You may also get this form by
<br />calling 1-800-772-1213. Use Form W-7, Application far IRS Ihall Taxpayer
<br />droll ligation Number, to apply for an ITIN, or Form SS -4, Application for Employer
<br />Identl(!.alien Number, to apply for an FIN. You can apply for an EN online by
<br />accessing the IRS website at www3nrGoWbuslnesses and clicking on Employer
<br />Identlflcatlon Number BIN) under Starting a Business. You can get Forms W-7 and
<br />SS -4 from the IRS by visiting IRS.gov or by calling 1-600-TAX-FOHM
<br />(1-000-029-3676).
<br />if you are asked to complete Form W-9 but do not have a TM, apply for a TIN
<br />and write "Applied Far" In the spaca for the TIN, sign and date the form, 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 "Applied For" means that you have already applied for a TIN or that
<br />you Intend to apply for one soon.
<br />Caution: Adisregarded U.S. chilly that has a fomlgn owner must use the
<br />appropriate Form Ill
<br />75Q-52
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