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Form W-9 (Rev. 18-2014)
<br />Line 2
<br />If you have a business name, trade name, DHA name, ordisragarded entity name,
<br />you may enter It on line 2.
<br />Line 3
<br />Chock the appropriate box Ih Ilne 3 forthe U.S. federal tax ciasalflcation of the
<br />person whose name is entered on line 1. Check only one box in Ilse 3.
<br />Limited Liability Company (LLC). If the name on line t is an LLC treated as a
<br />partnership for U.S, federaltax purposes, check the "Limited Liability Company"
<br />box and enter "P" In the space provided. If the LLC has filed Form 8632 or 2653 to
<br />be toxod as a corporation, check the "Limited Liability Company" box and In the
<br />space provided enter "C" for C corporation or "S" for S corporation. If It is a
<br />single -member LLC that is a disregarded entity, do not check the "Limited Liability
<br />Company" box; Instead Short<the first box in line 3 "Indivlduallsole proprietor or
<br />single -member LLC."
<br />Lina 4, Exemptions
<br />If you are exempt from backup withholding end/or FATCA reporting, enter in the
<br />appropriate space in line 4 any coders) that may apply to you.
<br />Exempt payee code.
<br />- Generally, Individuals (including sole proprietors) are 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 tot payments made In
<br />settlement of payment card or third party network transactions.
<br />a Corporations are not exempt from backup withholding ivlth respect to attorneys'
<br />fees or gross proceeds paid to attorneys, and corporations that provide medical or
<br />health care services aro net exempt with respect to payments reportable on Form
<br />1099-M15C.
<br />The following cedes identify payees that are exempt from backup withholding.
<br />Enter ho appropriate code In the space In line 4.
<br />1—An organization exempt from tax under section 80'1(a), any IIIA, or a
<br />custodial account under section 403(6)(7) If the account satlefles the requirements
<br />of section 461(q(2)
<br />2—The United States or any of Its agencies or hatrumentalltloa
<br />3—A state, the District of Columbia, a U.S. commonwealth or possessioh, at
<br />any of their political subdivisions or Instrumentalities
<br />4—A foreign government m any of Its political subdivisions, agencies, or
<br />Instmmentallties
<br />S --A corporation
<br />6—A dealer in securities or commodities required to register In the United
<br />States, the District of Columbia, or a U.S. commonwealth or possession
<br />7—A futures commission merchant registered with the Commodity Futures
<br />Trading Commission
<br />8—A real estate Investment trust
<br />e—An entity registered atoll 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 />I I—A Iinanclal Institution
<br />12—A middleman known In the Investment community as a nominee or
<br />custodian
<br />13—A trust exempt from lex 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 Its ad above, 1 through 13.
<br />IF the payment is for...
<br />THEN the payment is exempt far...
<br />Interest and dividend payments
<br />All exempt payees except
<br />for
<br />Braker transactions
<br />Exempt payees 1 through 4 and 6
<br />through ii and all C corporations. S
<br />corporations must not enter an exempt
<br />payee cede because they are exempt
<br />only for sales of noncovered securities
<br />acquired prior to 2012.
<br />Better exchange transactions and
<br />Exempt payees 1 through 4
<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 1 through 4
<br />payment card or third party network
<br />transactions
<br />I See Form 1099-MISC, Mleardlaneous Income, and Its instructions,
<br />Page 3
<br />'However, the tollowmil payments made to a corporation and reportable an Form
<br />1099-MISO ere not exempt from backup withholding: medical and health one
<br />payments, adomays' fees, gross proceeds paid to an attorney reportable under
<br />section 0045(Q, and payments for services paid by a federal executive agency.
<br />Exemption from FATOA reporting code. The following codes Identity payees
<br />that are exempt from reporting under FATCA. These codes apply to persons
<br />Submitting this form for accounts maintained oufaldo of the United States by
<br />certain foralgn financial Institutions. Therefore, If you are only submitting this form
<br />for an account you held In the Noted States, you may leave this field blank.
<br />Consult with the person requesting this form If you of mountain If the financial
<br />Institution Is subject to these Ioqulrements. A requester may Indicate that a code Is
<br />net required by providing you with a Form W-9 with "Not Applicable" (or any
<br />similar Indian Ilan) wrihen or printed on the line far a FATCA exemption code.
<br />A—An organization exempt from tax under section 501(a) or any individual
<br />retirement plan as defined in section 7701(a)(37)
<br />8—The United States or any of Its allenriss or inabumentalliles
<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 traded on one or more
<br />established securities markets, as described in Regulations section
<br />1.1472-1(c)(1)(i)
<br />E—A corporation that Is a mem her of the same expanded affiliated group as a
<br />corporation described in Regulations section 1.1472.1(e)(f)(i)
<br />F -A dealer in securities, commodities, or met vailve 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 amAlon 051 or an entity
<br />registered at all times during the tax year under the Investment Company Act of
<br />1940
<br />1—A common tract fund as defined in section 504(a)
<br />J—A bank as defined In confirm 5B1
<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 trust under a section 403(6) plan or section 457(g) plan
<br />Note. 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 />Lines
<br />Enter your address (number, street, and apartment or suite re amner). This la where
<br />the requester of this Form W-9 will mall 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 net eIlgIb[a to get an SS N, your TIN Is your IRS Individual taxpayer
<br />identlffcation number (]TIN). Enter It In the social security number box. If you do not
<br />have an ITIN, see How to get a TIN below,
<br />If yam are a sole proprietor and you have an EIN, you may enter either your SIGN
<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 Untried Llablflfy, 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 LLC
<br />Is classified ea a corporation or partnership, enter the entity's EIN.
<br />Note. See the chart on page 4 forfurther clarification of name and TIN
<br />combinations.
<br />How to get a TIN. If you do not have aTIN, apply for one Immediately. To apply
<br />far an SSW, get Fan SS -5, Application for a Social Security Card, from your [Deal
<br />SSA office or get this form online at www.ssa.gov. You may also get this form by
<br />calling 1-600-772-1213. Use Form W-7, Application for IRS individual Taxpayer
<br />Identigcatlon Number, to apply for an ]TIN, or Form SS -4, Application for Employer
<br />Identification Number, IS apply far an FIN. You can apply far an FIN onllne by
<br />accessing the IRS womins at www.ifs.gowbusinasses and clicking on Employer
<br />IdentfHeatlon Number (EN) under Starling a Business. You can get Forms W-7 and
<br />SS -4 from the IRS by visiting IRS.gov or by calling 1 -800 -TAX -FORM
<br />(1-800-8291
<br />If you are asked to complete Form W-9 but do not have aTIN, apply for aTIN
<br />and write "Applied For" in the space for the TIN, sign and date the form, and give it
<br />to the requester, For Intemst and dividend payments, and certain payments made
<br />with respect to readily tradable Instruments, generally you will have 60 days to got
<br />a TIN and give It to the requester before you are subject to backup withholding on
<br />payments. Tha 60 -day rale class 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 />Nate. Entering "Applied For" means that you have already applied for a TIN ol'that
<br />you intend to apply for one soon.
<br />Caution: A dlsregarded U.S. entity that has a foreign owner must use the
<br />appropnate Form W -B.
<br />75R-49
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