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Form W-9 (Rev.10-2018)Page 5
<br />1. lnterest, dividend, and barter exchange accounts opened
<br />before 1984 and broker accounts considered active during 1983'
<br />You must give your correct TlN, but you do not have to sign the
<br />certification.
<br />2. lnterest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considered inactive during
<br />1983. You must sign the certification or backup withholding will apply. lf
<br />you are subject to backup withholding and you are merely providing
<br />your correct TIN to the requester, you must cross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the certification. You may
<br />cross out item 2 of the cedification.
<br />4. Other payments. You must give your correct TlN, but you do not
<br />have to sign the certification unless you have been notified thai you
<br />have previously given an incorrect TlN. "Other payments" include
<br />payments made in the course of the requester's trade or business for
<br />rents, royalties, goods (other than bills for merchandise), medical and
<br />health care services (including payments to corporations), payments to
<br />a nonemployee for services, payments made in settlement of payment
<br />card and third party network transactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualified tuition program
<br />payments (under section 529), ABLE accounts (under section 529A)'
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your correct
<br />TlN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this type of account:Give name and SSN of:
<br />For this type of account:Give name and EIN of:
<br />14. Accouni with of The public entity
<br />Agriculture in the name of a public
<br />entity (such as a state or local
<br />government, school district, or
<br />prison) that receives agricultural
<br />program payments
<br />1 5. Grantor trust filing under the Form
<br />1041 Filing Method or the Optional
<br />Form 1099 Filing Method 2 (see
<br />section 1.671-4(bX2)(iXB)
<br />1 List first and circle the name of the person whose number you furnish.
<br />lf only one person on a ioint account has an SSN, that person's number
<br />must be furnished.
<br />2 Circle the minor's name and furnish the minor's SSN.
<br />3 You must show your individual name and you may also enter your
<br />business or DBA name on the "Business name/disregarded entity"
<br />name line. You may use either your SSN or EIN (if you have one), but the
<br />IRS encourages you to use your SSN.
<br />a List first and circle the name of the trust, estate, or pension trust. (Do
<br />not furnish the TIN of the personal representative or trustee unless the
<br />legal entity itself is not designated in the account title.) Also see Specra/
<br />rules for parlnershps, earlier.
<br />*Note: The grantor also must provide a Form W-9 to trustee of trust.
<br />Note: lf no name is circled when more than one name is listed, the
<br />number will be considered to be that of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someone uses your personal information
<br />such as your name, SSN, or other identifying information, without your
<br />permission, to commit fraud or other crimes. An identity thief may use
<br />your SSN to get a job or may file a tax return using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />r Protect your SSN,
<br />r Ensure your employer is protecting your SSN, and
<br />e Be careful when choosing a tax preparer.
<br />lf your tax records are affected by identity theft and you receive a
<br />notice from the lRS, respond right away to the name and phone number
<br />printed on the IRS notice or letter.
<br />lf your tax records are not currently affected by identity theft but you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activity or credit report, contact the IRS ldentity Theft Hotline
<br />at 1 -800-908-4490 or submit Form 1 4039.
<br />For more information, see Pub. 5027, ldentity Theft lnformation for
<br />Taxpayers.
<br />Victims of identity theft who are experiencing economic harm or a
<br />systemic problem, or are seeking help in resolving tax problems that
<br />have not been resolved through normal channels, may be eligible for
<br />TaxpayerAdvocate Service [IAS) assistance. You can reach TAS by
<br />calling the TAS toll-free case intake line al 1-877-777-4778 or ITYIIDD
<br />1 -800-829-4059.
<br />Protect yourself from suspicious emails or phishing schemes.
<br />Phishing is the creation and use of email and websites designed to
<br />mimic legiiimate business emails and websites. The most common act
<br />is sending an email to a user falsely claiming to be an established
<br />legitimate enterprise in an attempt to scam the user into surrendering
<br />private information that will be used for identity theft.
<br />The trust
<br />1. lndividual
<br />2. Two or more individuals (oint
<br />account) other than an account
<br />maintained by an FFI
<br />3. Two or more U.S. persons
<br />(oint account maintained by an FFI)
<br />4. Custodial account of a minor
<br />(Uniform Gift to Mlnors Act)
<br />5. a. The usual revocable savings trust
<br />(grantor is also trustee)
<br />b. So-called trust account that is not
<br />a legal or valid trust under state law
<br />6. Sole proprietorship or disregarded
<br />entity owned by an individual
<br />7. Grantor trust filing under Optional
<br />Form 1099 Filing Method 1 (see
<br />Regulations section 1.671 -4(bX2Xi)
<br />(A))
<br />For this of accountl
<br />8.not owned by an The owner
<br />individual
<br />9. A valid trust, estate, or pension trust
<br />10. Corporation or LLC electing
<br />corporate status on Form 8832 or
<br />Form 2553
<br />The individual
<br />The actual owner of the account or, if
<br />combined funds, the lirst individual on
<br />the accountl
<br />Each holder of the account
<br />The minor2
<br />The grantor-trusteel
<br />The actual ownerl
<br />-,3I ne owner
<br />The grantor"
<br />Give name and EIN of:
<br />Legal entitya
<br />The corporation
<br />The organization
<br />The partnership
<br />11. Association, club, religious,
<br />charitable, educational, or other tax-
<br />exempt organization
<br />12. Partnership or multi-member LLC
<br />1 3. A broker or registered nominee The broker or nominee
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