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Form
<br />(Rev. Ocbber20l8)
<br />Depanment of the Treasury
<br />lntanal RwenueS€rvice
<br />Enter yourTlN in the appropriate box- The TIN provided must match the
<br />backup withholding. For individuats, ihi$ is generally your social security
<br />r€sident alien, sole propnretor, or disregarded entity, see the instuctions
<br />Sign
<br />Here Signeturo of
<br />U.9 pcrson >nz?-
<br />General ns
<br />Section reference$ are to the lntemal Revenue Code unless otherwise
<br />noted.
<br />Fufurc developnEnts. For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />aftor they wer€ published, goTo www.irs.govlFormW9.
<br />Purpose of Form
<br />An individual or enlity (Fom W-9 requester) who is required to file an
<br />information refum with the IRS must obtain your corect taxpayer
<br />idenffication number filN) which may be your social security riumber
<br />(SSl$, lndividual taxpayer identification number (fflN), adoption
<br />taxpayer identification number (ATIN), or employer identification number
<br />(ElN), to report on an information retrm the amount paid to you, of other
<br />amount reporhble on an in{onnation retum- Examples ol information
<br />retums include, but are not [mited to, the following.
<br />. Folm 1099-lNT 0nterest eamed or paid)
<br />Request fior Taxpayer
<br />ldentification Number and Certification
<br />> Go to Bryrv.ri's. go|ilFotmnig la insilruclions and the tatest innormatbn.
<br />Give Form tothe
<br />requester, Do not
<br />send to the lRS.
<br />4 E<empti:ns (codes apply only to
<br />certain entitiqe, not individuals: see
<br />instsuctions on page 3):
<br />Exempt payeecode 0f any)
<br />EKe mpti on from FATCA reporti n g
<br />code ffany)
<br />@tb b @fr ddhM d6'rto $e U.sl
<br />narne and address
<br />or
<br />currently subject to backup withholding b€caus€
<br />not apply- For mortgage interest paid,
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<br />rt
<br />oct)(0
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<br />tro
<br />.6ocCLO>iEfi)
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<br />1 shown on yot{is reqired on
<br />enlity nane, it dtbr€nt ftom abov€
<br />accounl here
<br />name given on line 1 to avold
<br />number (SSN). Horever, for a
<br />for Part I, later. For other
<br />qntitiee, it 16 your employ€r identificatlon number {ElN). lf you do not have a number, see Holy to get aTlN,lalq.
<br />Note: lf the account is in more than one name, see the instructions for line 1. Also see What Name and
<br />Number To Giye the Reg.Jester for guidelines on whose number to enter.
<br />Under penalties periury, I oedify that
<br />1 ' The number shown on lhis form is my conect talqrayer ldentiffcadon number (or I am waiting for a numb€r to be issued to fie); and
<br />2. I affnot lu-bjg-ct to backup withholdirg because: (a) I am er<empt fom backup withholding, or (b) I have not been notited by the Intemal R€venue
<br />Service (lRS) that I €rfl subject to baclop withholding as a result of a failure to report all interesi or dividends, or (c) the tRsiras notitiect me that I am
<br />no longer srrhject to baelep withholding; and
<br />3- I am a U.S. citizen or other U.S. person (de{ined below); and
<br />4. The FATCA code(s) entered on this forn $l any) indicating that I am exempt lrorn FATCA reporting is conect.
<br />Gertifcallon instructbn$. You must cross out item 2 above ifyou have been notified bythe IRS that you are
<br />you hav€ tailed to report all interest and
<br />acquisition or abandonment of seanred
<br />dividefids on your tax retum. For real estate lransactions, item 2 does
<br />property, cancellation of debt, contrlbutons to
<br />other than interest and dividends, you a€ not to sign the certification, but you
<br />an individual retirement arangement (1R4, and generdly, payments
<br />must provi@ your coriect TlN, See the instructions for Part ll, lat€r.
<br />on> /J'//-;a
<br />. Farm 109$DlV (dividends, including those from stoc*s or mutual
<br />tunds)
<br />. Form 109!}-MISC {various types of income, prizes, awards, or gro€s
<br />proceeds)
<br />. Form 109+8 {stock or mutualfund sales and certain other
<br />transactions by brokers)
<br />. Form 1099-5 (proceeds from real estate tsansactions)
<br />. Fom 1099-K (merchant card and lhird party network fransactions)
<br />. Form 1098 (horne mortgage interest), 109&E (student loan intvest),
<br />I098-T (tuiflon)
<br />. Form 1099-C (canceled debt)
<br />. Form 1 099-A (acquisition or abandonment of secured propedy)
<br />Use Form W-9 only if you arc a U-S. person (including a resident
<br />alien), to provide your con€ct TlN.
<br />If yw do rrplt retum Form W-9 to the reqwsterwith aTlN, you might
<br />be $llbjecf, to beclup withhotcling- See What is backup withholding,
<br />later-
<br />3 Check appropiate box for Heral tax classification of the peEon vrhose rrame is entered ofl line 1, Check only one of ihe
<br />following saren box€s.
<br />E hoiuid*y"ole proprietor or EI c corporation fl s corporation U partnersnip f] tr"t/uttrtu
<br />single-member LLC
<br />I t-imitd tialility company. Enter the tax claEsification {C=C corporation, S=S corporation, P=Partnership) }
<br />Other iostructions) >
<br />5
<br />row
<br />stest, and spt. or suite no-) See
<br />374
<br />codestato, and
<br />WA
<br />number
<br />Part I
<br />I I 7 8 I 3 I 4 o
<br />Part ll
<br />Cat No.10231X rorm W-9 Fev. 10-2018)
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