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,",, lllf-g
<br />(Rev. Octobor2018)
<br />Department of lhe Treasury
<br />lnternal Revenue Service
<br />of
<br />>Goto
<br />Request for Taxpayer
<br />ldentification Number and Certification
<br />tor instructions and the latest inlormation
<br />Give Form to the
<br />requester. Do not
<br />send to the lRS.
<br />4 Exemptions (codes apply onlyto
<br />certain entilies, not individualsi see
<br />instructlons on page 3):
<br />Exernpt payee code (it any) 3
<br />Exemption from FATCA ieporting
<br />code(ifany) C
<br />(Applies to aeNnts aaintainqd outside ths u.S.!
<br />name and address
<br />(ssN).
<br />l, later.
<br />or
<br />1099-DlV (dividends, including those from stocks or mutual
<br />. Form 1099-MISC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />r Form 1099-8 (stock or mutual fund sales and certain other
<br />transactions by brokers)
<br />. Form 1099-S (proceeds from real estate iransactions)
<br />. Form 1099-K (merchant card and third party network transactions)
<br />. Form 1098 (home mortgage interest), 1098-E (student loan interest),
<br />1098-T (tuition)
<br />r 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
<br />alien), to provide your correct TlN.
<br />lf you do not retutn Form W-9 to the requester with a TlN, you might
<br />be subject to backup withholding. See What is backup withholding,-
<br />lateL
<br />2
<br />shovJn on your tax rolum). Name is on line; do not leave lhis
<br />nam6/dlsregarded entity name,above
<br />AJoo)Goco
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<br />.e
<br />o
<br />65
<br />o
<br />()oo.
<br />at,
<br />ooa
<br />oo
<br />o
<br />c
<br />o.
<br />account number(s) here
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoidbackup withholding. For individuals, this is generally your social security number However, for aresident alien, sole proprietor, or disregarded entiiy, see
<br />ber (ElN). lf
<br />7
<br />the instructions for Part For otherentities, it is your employer rdsntification num you do not have a number, see How to get aI/N, later
<br />Note: lf the account is in more than one name, see the instructions for line 1. Also see What Name andNumber To Give the Requester tor guidelines on whose number to enter.
<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); and2' I am.not..l_u^bject to backup, withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the lnternal RevenueService (lRS) that I am subject'to.backup withholding us u l'esuit oi a failure io report all inleresi or dividends, or (c) the IRS has notified me that I amno longer subject to backup withholding; and
<br />3. I 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 />Sign
<br />Here
<br />General ns
<br />Section references are to the lnternal Revenue Code uniess otherwise
<br />noted.
<br />Future developments, For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go Io www.irs.gov/FormWg.
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who is required to file an
<br />information return with the IRS must obtain your corect taxpayer
<br />identification number [lN) which may be your social security number
<br />(SSN), individual taxpayer identilication number (lTlN), adoption
<br />tqxpayer identification number (ATIN), or employer identjfication number
<br />(ElN), io report on an information return the amount paid to you, or other
<br />amount reporlable on an information return. Examples of information
<br />returns include, but are not limited to, the following.
<br />. Form 1099-lNT (interest earned or paid)
<br />3 check aPpropriate box for federal tax classlflcation ofthe person whose name is entered on line 1. check only one of thefollowing seven box€s.
<br />fl lndividual/soleproprietoror n CCorporation n SCorporation ! Partnership I Trust/estate
<br />single-member LLC
<br />Other
<br />Limited Enter taxthe classificationliabilitycompany c-e(c=c corporatiori,P-Partnership)corporation,
<br />Nots:Chsck Itle lnbox tlreappropriat€line totabove taxthe ofcla$siticatiori tho ownel po checknotsingle-member
<br />LLClh6 clsesi{ied aas LLCsinqls.rnembor l5that f.om ownorthsdisregardo{,theunloss ofo\{naa LLSthBr.tcanothor tsthat not lho{rom forovr'nat u.s.disregardod {adenl lax purposes.Olholwise,LLCsinqle-mBmber
<br />thslrom $houldowner checkis dis169arded tho bor thefor lrxappropriaae ctass,tication itsol owner
<br />5 (number, slreet, and apt. or sults no.l See ing!ruclions.
<br />105
<br />state, and ZIP code6
<br />I Number
<br />Social numbsr
<br />Part I
<br />number
<br />s 1 6 0 0 1 3 4 I
<br />Part ll
<br />Signature of
<br />U.S, person )
<br />Cat. No. 10231X Form W-9 1nev. 10-20ra)
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