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FoJf, r W-S (tle!. I S?il r8J Pae3
<br />Crltnlnsl Feiialrylor felrlttlng lrilormsrlon, \lillfully falsifyih€
<br />osrtiticaticft$ or Afi irmat ions may subject you to c ri minal po nslt i€s
<br />including filss and/or imprEonment.
<br />MEll*eolTlNt. lf lhg rsqu€st€rdiecloss$or us€sTlNs in v'tolatlonaf
<br />{sdarel hw. the Fquest€r msy be subj+rcr tobivila0d €rlminat pen4ftins-
<br />Specitic lnstructions
<br />Line I
<br />Yo! rilust €nt€r ofii of rh€ follc\#ing on this lifi'€i do nor l€avlr this lin€
<br />btank"'lhe nems should netch lh€ nem€ sn ytur.to< return,
<br />ff thir Form.W:9 ls for e jgint accou nt [olh€r than en accqunt
<br />fiaintained by a lor€ign financAl ilEtituthn IFFl]]. fEr first, end th€ n
<br />circle, tha nams of lhs p€r,so.n or sntity' whoe€ num!er you snt€r€d ln
<br />Pen I of Forrn W.g. lf tiou ers providiig Forn W-g to er FFI lo docum€nt
<br />a Joint accounr. €ech holdsr ot th€ acccunt thatii a U.$. p*rson must
<br />praviJe a Fornr V{.8.
<br />a. lndlrlduel, Gene rally. gnt€i ths nams shoujn on your tax r€turn. lf
<br />lou hew cheng€d your last name rvithout informing th€ Sc4hlS€cljrity
<br />Admlninration [$SAl ot tfE namc ctrange. €ntsr yout iirst nam€. th€ hst
<br />nsm€ a*sh{ylvn ot yOur.sCcial.securifycard, andyour ner,v lest namg,
<br />time; ltlN appllcami Entsr laur indivldual name as itwes sntersd on
<br />lour Form W.7 sFplicatlon. lins 1s. Thls sh6ub sl.so b6 rhd Eem€ e.s th€
<br />nsms.you €ntsr.€don tha Form 104{/1{4,0A.{04.{EZ you filsdr,rrith your
<br />epplhdtion.
<br />b. 60l€ proprtetoror *ll6le.member LLC, Ent€r your individual
<br />nerrre ae shd!#n on )(}!r 10.4.0f104.0A./1oq{EZ on lin€ 1. You fiey snt€r
<br />your buslness, tracki. of "tlsing busin€sg as" pBAJ nemd on line 2.
<br />c. Peff*lrshlp, LLC rhfl l€ ndt e rlngl€;msfibor LLC. C
<br />rorporellon, or S.corporstlon, Entsr ths €ntity'€ nEm€ ai shown on th€
<br />€ntityls te{ r€turn on ling 1 and any hUsinsss, fteds, or DBA neme on
<br />lin€ 2,
<br />d. Other endtlec, Ent€r your n€ms as shovn on.requimd U.$, lodsrel
<br />lex documsnts on line L -This nems should mElch th€ n€rili .shotvn on th€
<br />cherter or other hgildocument cmaiinE ths soti.ty. You may aniJrany
<br />bu.slnsss, tisds, or DBA n€me on lin{i 2.
<br />e Qlqrs6erdad 4mlv, F<ir U..S, fsdsrEltax purpos€s, en sntity thet te
<br />drsr€gardad es en €nt it/.es farat€ f rom its fl/n€r is tr€at€d es a
<br />'disngarded entity.!' 8{€ F€g uhtlons sgcticn 301.??01.2tdj[2]tii[. Entsr
<br />fts cA#ner'.s narile on lins J. Tha nems of th€ entitv snter€d on lin€ 1
<br />ehould ns\€r bs E diEr€gardad €ntity. Th€ name on lins 1 should H lhd
<br />nsff€ sho,rrn on th€ incoms tsx rsturn on uJhhh th€ income should'be
<br />lgponed. For€xempl€, fi e tor€ign LLC that is tr€at€d a,s a disr€qerdsd
<br />€nl{ty for U.S. f€dereltsx purposes has a singl€ l}#nsr that h a U.S.
<br />F€ rson, th€ U,g. fi#hsr's nam€ ie fdqulr€d to b€ Frov lCsd on lln€ I . It
<br />th€.diEct or,vn€r ot th€ €nl ity iE elso e dhrsgsrdBi entiiy, enter the first
<br />c$[Fr tha! is not dlsr€gardad for f€d€fql ts pufposis. Ent€t th€
<br />dlsr€gerd€d sfitity's nam€ on.lins 2, 'Bu6in€ss name/dirregarded entity
<br />riAmo." ll th€ d,i/n€i of th€ disregerd€d €ntrty ls a for€ign person. the
<br />(wngr muEtcompl€t€ an epproprisl€ Fstm W.8.inst€ad of e Form W-9,
<br />Thtq bthsce$a b!€n if ths for€iEn p41eon ft.asa U.S.nH.
<br />Line.I.
<br />lf lsu hella 5 busirrg.ss nemq, ttede nam€, DBA nams, or dlsr€gerd€d
<br />€ntlttr nam€, !'oU may snt€r iton |ins 2.
<br />Line S
<br />Ch€ck thg eFpfoFrhte br)l( on lihs 3 lorthe U.S. f€d€relta*
<br />cbBsjtio.ation oJ th€ Fsrson whos€ namq ls €nt€rsd on lln€ I , Check only
<br />one hc'[ on lih€ 3.
<br />Line 4, Exemptions
<br />lf you are exempl irom hackupwhhholding encl/rrr FATCA regntling,
<br />intef in th€ aFproprifia spaad on lihs + sny cod€(sl thal rbay sppv to
<br />you.
<br />Bempt peysa code,
<br />. €ensralty, lndiylduats (includinq sola FropristotEl ar€ nol€x€mFtfrom
<br />bdckuF $ithholdin€.
<br />. Erc€pt e,s provided bslq#. corporetions ar€ bx€ryrFt trom backup
<br />i,/ ithhelding toi i€ rtAin paym€ 0ts, incl uding int€ r€sr and div iCands.
<br />. Corporathns are not €x€ m pt f rom bac kup wlth holding for paym*nts
<br />mad€ in ssttlerddntol F4ymant c+rd or thrd psrlv nsrr,$rk trsn.lactions.
<br />. Colporetbns er€ nnt€isrnptfrdn bahkrp wirhholdlng altfr rsspgct to
<br />ettorn€ys' fis.e.or gross Froc€€ds paiC lo attorn€y$, end cotporations
<br />th.t provld€ mgdicalor h€ahh catd .Edruic€s srs flot €x€rnFl with r€spsct
<br />to Fayim€ntr reporleblr on Fsrm I0SS-M|SC,
<br />Th.e folk:r,vlng ccde.s id€ntify pa.res.s thatere exempl.from backup
<br />withholdlng. Ent€i. th6 epFro$iata coe ih rhe sfac€ in lh€ +,
<br />'l-An organization €x€mft from tEX undar ssction s01[a]. eny IRA, or
<br />e custodrel srcotlnt u[dsr,ssclion 4{3[b][?] if ths eccount satisfies ths
<br />r€qu irsril€ nt6 of ssction 44 1 [it2l
<br />2*Th€ Unit€d Stat€s or qny of.fts eg€nchs oi instrum€ntelit'Es
<br />3-A stits, thd Dlstrict of Colunbh e U,.S. commonvreblth or
<br />possassion, or any of thsir tDlitical eubdiiisions or instrumentelrtlss
<br />4-:A forslgn gor,i€rnm€nt or eny of its political subdiviehnri, eg€nclBs,
<br />or inslrumgnialities
<br />5-A colporslion
<br />6-A deel€r in struriti€.s or comftlcdities requlred to regist€r in th€
<br />LJnit€d Statss, th€ District ot Columbh, ore.U.$. common\$ealth sr
<br />Fggsdssiofi
<br />i-AJutui*s comrn igsion msEhant regisrered with ltfC €oifimodity
<br />Futures Trading Commission
<br />8-A rsele$tats lnv€sim€nt tru,El
<br />g-:An entily regletersdatsll timssduring lh€ tax'yBer undsrlhe
<br />lnwstment Company Act of 194.{l
<br />'l{ -A iomtrron tr!.st tund sperAt€d 4 + bank undar,sBction 584(e}
<br />{ 1 -A finsncial ifistitution
<br />12-A mirCdleman kncrrfh in th€ invcstmontcotrimunlty.e^sa nominss oi.
<br />cuslodhn
<br />1l - A.trust€xsffpt from tax undgr s€ctiorr 6t4 or dq.scnbad ln ssctk)n
<br />49+7
<br />Professional Services Agreement
<br />Page 23
<br />lF r4re emfulpeneon on lln6 1 l€
<br />efn), . ,
<br />THEN check tlte bax.for , , ,
<br />. Corporatbn Corporat'nn
<br />. lodivldual
<br />r Sole Frqpri€tqrship, or
<br />. Singh.msrnb€r limitsd lhbiliry
<br />oompeBy [LLC] ov/n€d bv dn
<br />indtrdui lnd disrflqenk'ator U.e.
<br />hdsreltff purpos€s.
<br />lhdiyiduetfsots propriAtor or singl€.
<br />nEmb€f LLC
<br />. LLC trsetsd a.E a [lAnn€rship for
<br />U.,S, l€d€ rel tex furpqE€.s;. LLC thet haslil€d Fgrn 88f,2 frr'
<br />2551 to b€ ls€d aE e cofForation,
<br />oI'
<br />. LLC thet isdilr€garded a,s en
<br />0ntity s€Feret€ lrom it"g ot./n€r but
<br />hd cl\{ner is arroth€r LLC thai ls
<br />not dlsr€qerd€d bt U.S. f€ds rel tax
<br />pufposs.s.
<br />Limit€d liebility company and ente
<br />fi€ epproprht€ lex ch^ssilicalion.
<br />p= Parlnership; C=C cor:poratlon
<br />s.S=.$ coiporationl
<br />. Penn€r.shlp FennsrshiF
<br />r Trui#egtatc Trusf/sstet€
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