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Form
<br />®Give
<br />Request for Taxpayer
<br />FM u m _
<br />Form to the
<br />(Rev. December
<br />2014)
<br />Identification Number and Certification
<br />entitles, it is your employer identification number (EIN). If you do not have a number, see How to get a
<br />requester. Do hot
<br />epartmentoltu?asury
<br />send to the IRS.
<br />ntemal
<br />Revenue 5ewlca
<br />1 Name (as shown on your income tax return). Name is required on this line; do net leave this line blank.
<br />2 Business name/disregarded entity name, It different from above
<br />N
<br />m
<br />m
<br />a
<br />3 Chock appropriate box for federal lax classification; check only one of the following seven boxes)
<br />4 Exemptions (codes apply ants to
<br />certain entities, not Individuals; see
<br />o
<br />❑ hidlvlduoVsole proprietor or ❑ G Corporation ❑ 5 Gorporatim ❑ Partnership ❑ Trust/estate
<br />Instructions an page 31:
<br />m
<br />a esingle-member
<br />LLC
<br />Exempt payee code (if any)
<br />0
<br />© Limited liability company. Enter tho lax classification (C=C corporation, S=S corporation, P=partnership)
<br />o
<br />Note. Pura single -member LLC that Is disregarded, do not check LLC; check the appropriate box in the line above for
<br />Exemption from FATCA reporting
<br />the tax classification of the single -member owner.
<br />code Of any)
<br />G(ApplMs
<br />R
<br />El Other (see instructions)
<br />to acmunlc mainhlnedouLlda lNa call
<br />a
<br />iE
<br />s Address (number, street, and apt. or suite no.)
<br />Requester's name and address (optional)
<br />u
<br />a
<br />a
<br />m6
<br />_
<br />City, stato, and ZIP code
<br />a
<br />m
<br />7 List account numbers) here (optional)
<br />W�M
<br />Taxpayer Identification Number (PIN)
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
<br />( 5001al security number
<br />backup withholding. For Individuals, this Is generally your social security number ( However, fora
<br />resident alien, sale propr, page ietor, or disregarded entity, see the part I Instructions on page 3, For other
<br />FM u m _
<br />entitles, it is your employer identification number (EIN). If you do not have a number, see How to get a
<br />TIN on page 3.
<br />or
<br />Note. If the account Is In more than one name, see the Instructions for line 1 and the chart on page 4 for I Employer identification number
<br />�
<br />guidelines on whose number to anter. �1 �IF
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this form is my correct taxpayer idelitifloation number (or I am waiting for a number to be Issued to me); and
<br />2. lam 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 QRS) 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 code(s) entered on this form (If any) indicating that I am exempt from FATCA reporting Is correct.
<br />Certification Instructions. You must areas 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 certification, but you most provide your correct TIN. See the
<br />instructions on page 3.
<br />sign Signature of
<br />Here I U.S. person t Date
<br />General Instructions
<br />Section references are to the internal Revenue Code unless otherwise noted,
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release it) Is at www.lrs,gcv/flag.
<br />Purpose of Form
<br />An Individual or entity (Farm W-9 requestsr) who Is required to file an information
<br />return with the IRS must obtain your correct taxpayer Identification number (11 N)
<br />which may be your social security number (SSN), individual taxpayer Identllloatton
<br />number QTIN), adoption taxpayer Identification number(ATIN), or employer
<br />Identification number (EI N), to report on an information return the amount paid to
<br />you, or other amount reportable on an Information return. Examples of Information
<br />returns include, but are not limited to, the following:
<br />• Form 1099 -INT (Intereat earned or paid)
<br />• Form 1099 -DIV (dividends, Including those from stocks or mutual funds)
<br />• Form 10i19-M[SG (various types of Income, prizes, awards, or gross proceeds)
<br />• Form 1099-B (stock or mutual fund sales and certain other transactions by
<br />hookers)
<br />• Form 1099-S (proceeds (ram real estate transactions)
<br />• Form 1 uSM<(merchant card and third party network transactions)
<br />• Form 1098 (home mortgage Interest), 1098-E (student loan interest), 1098-T
<br />tuition)
<br />• Form 1099-0 (canceled daht)
<br />• Form 'I099 -A (acquisition or abandonment of secured property)
<br />Use Form W-9 only If you are a U.S, person (Including a resident ellen), to
<br />provide your correct TIN.
<br />If you do not return Form W-9 to the requester with a TIN, you might be subject
<br />to backup withholding. See What Is backup withhoking? on page 2.
<br />By oldning 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 U.S. person, your allocable share of
<br />any partnership Income from a U.S. trade or business is not subject to the
<br />withholding tax an foreign partn rm'share of effectively connected Income, and
<br />4. Certify that FATCA code(d) entered on this form (it any) Indicating that you are
<br />exempt from the FATCA reporting, Is correct. Sea What la FATCA reporting? on
<br />page 2 for further Information.
<br />Cat, No, 102M
<br />75R-47
<br />Form W-9 (Rev. 12-201 g
<br />
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