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=Grim
<br />Me
<br />Request for Taxpayer
<br />Give Form to the
<br />Rev. December 2014)
<br />Da! mthe
<br />identification Number and Certification
<br />requester. Do not
<br />)ev.
<br />Treasury
<br />send to the IRS.
<br />Metrial
<br />Revenue Service
<br />7 Name (as shown on your income tax natural. Name Is required an this line; do not leave this line blank.
<br />Chattel, INC
<br />2 Business name/disregarded entity name, If differentfrom above
<br />of
<br />m
<br />3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
<br />4 Exemptions (codes apply only to
<br />certain entitles, not Individuals; see
<br />o
<br />❑ Individual/sole proprietor or ❑ C Corppratlon Q S Corporation ❑ Partnership ❑ TmsVestate
<br />instructions on page 3):
<br />�r C
<br />•
<br />single -member LLC
<br />❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=padnership)►
<br />Exempt payee code Of any)
<br />o` 2
<br />Note. For a single -member LLC that Is disregarded, do not check LLC; check the appropriate box In the Ilne above for
<br />Exemption from FATCA reporting
<br />t
<br />the tax classification of the single -member owner.
<br />code (if any)
<br />1.s
<br />❑ Other ("a Inatruetionsl►
<br />rAupa•w.a bme u.$)
<br />u
<br />5 Address (number, street, and apt or suite no.)
<br />Requester's name a1tl address (optional)
<br />13417 Ventura Blvd
<br />m
<br />ti
<br />e City, state, and ZIP code
<br />Sherman Oaks, CA 91423
<br />7 List account numbers) here (optlonag
<br />Kiel
<br />IT
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number
<br />backup withholding. For Individuals, this is generally your social security number (SSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
<br />entities, it Is your employer identification number (FIN). If you do not have a number, see How to gate
<br />77N on page S. or
<br />Nota. if the account is In more than one name, ase the instructions for line 1 and the chart on page 4 for Employer Went'rfination number
<br />guidelines on whose number to enter.
<br />_
<br />Certification
<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 waiting for a number to be 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 code(s) entered on this form (f 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 certification, but you must provide your correct TIN. See the
<br />Instructions on Page 3. n
<br />HerI Signature of lVW//!/a /liv]• �A/4^'A /7 �/.I®✓%frL%1 /nate► 1-1-2P17 `.2P17
<br />Here 0.S. person► a
<br />General instrudbons V V
<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.gov/hv9.
<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, Morgan taxpayer Identificatlon number (ATIN), or employer
<br />identification number (EIN), 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 (interest earned or paid)
<br />• Form 1099 -DIV (dividends, including those from stocks or mutual funds)
<br />• Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds)
<br />• Form 1099-B (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 cam and third party network transactions)
<br />• Form 1098 ihalne mortgage interest), 1098-E (student loan Interest), 1008-T
<br />(tultion)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only If you are a U.S. person (Including a resident allen), to
<br />provide your correct TW.
<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 withholding? on page 2.
<br />By signing the fllled-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 on foreign partners' share of effectively connected income, and
<br />4. Certify that FATCA cadets) entered on this form (it any) Indicating that you are
<br />exempt from the FATCA reporting, is correct. See What Is FATCA repoding? on
<br />page 2 for further Information.
<br />Cat. No. 10231 X Forrn W-9 (Rev. 12-2014)
<br />
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