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Form W-9 (Rev. 10-2018)Page 4
<br />The following chart shows types of payments that may be exempt
<br />from backup withholding. The chart applies to the exempt payees listed
<br />above, 1 through 13.
<br />Payments made in settlement of Exempt payees 1 through 4
<br />payment card or third party
<br />transactions
<br />1 See Form 1099-M|SC, Mlscellaneous lncome, and its instructions.
<br />'However, the following payments made to a corpotation andreportable on Form 1099-MISC are not exernpt fiom backup
<br />withholding: medical and health care payments, attorneys'fees, gross
<br />proceeds paid to an attorney reportable under section 6045(f), and
<br />payments for services paid by a federal executive agency.
<br />Exemption from FATGA reporting code. The foliowing codes identify
<br />payees that are exempt from reporting under FATCA. These codes
<br />apply to persons submitting this form for accounts maintained outside
<br />of the United States by certain foreign financial institutions. Therefore, if
<br />you are only submitting this form for an account you hold in the United
<br />States, you may leave this field blank. Consult with the person
<br />requesting this form if you are uncertain if the financial jnstitution is
<br />subject to these requirements. A requester may indicate that a code is
<br />not required by providing you with a Form W-9 with .,Not Applicable" (or
<br />any similar indication) written or printed on the line for a FATCA
<br />exemption code.
<br />A-An organization exempt from tax under section S01(a) or any
<br />individual retirement plan as defined in section 7701(a)(S7)
<br />B-The United States or any of its agencies or instrumentalities
<br />C-A siate, the District oi Columbia, a U.S. commonwealth or
<br />possession, or any of their political subdivisions or jnstrumentalities
<br />D-A corporation the stock of which is regularly traded on one or
<br />more established securities markets, as described in Regulations
<br />section 1.1472-t(cXtXi)
<br />E-A corporation that is a member of the same expanded affiliated
<br />group as a corporation described in Regulations section 1 .1 472-1(cX1Xi)
<br />F-A dealer in securities, commodities, or derivative financial
<br />instruments (lncluding notional principal contracts, futures, forwards,
<br />and options) that is registered as such under the laws of the United
<br />States or any state
<br />G-A real estate investment trust
<br />H-A regulated investment company as defined in section g51 or an
<br />entity registered at all times during the tax year under the lnvestment
<br />Company Act of 1940
<br />l-A common trust fund as defined in seciion SB4(a)
<br />J-A bank as defined in section 581
<br />K-A broker
<br />L-A trust exempt from tax under section 664 or described in section
<br />aeaT(a)(1 )
<br />M A tax exempt lrust under a section 403{b) plan or section 457{9)
<br />plan
<br />Not€: You may wish to consult with the financial institution requesting
<br />this form to deiermine whether the FATCA code and/or exempt payee
<br />code should be completed.
<br />Line 5
<br />Enter your address {number, slreet, and apartment or suite number).
<br />This is where the requester of this Form W-9 will mail your inlormation
<br />returns. lt this address differs from the one the requester already has on
<br />file, write NEW at the top. lf a new address is provided, there is stlll a
<br />chance the old address will be used until the payor changes your
<br />address in their records.
<br />Line 6
<br />Enter your city, state, and ZIP code.
<br />Part l. Taxpayer ldentification Number (TlN)
<br />Enter your TIN in the appropriate box. lf you are a resident alien and
<br />you do not have and are not eligible to get an SSN, your TIN is your IRS
<br />individual taxpayer identification number (lTlN). Enter it in the social
<br />security number box. lf you do not have an lTlN, see How to get a TIN
<br />below,
<br />lf you are a sole proprietor and you have an ElN, you may enter either
<br />your SSN or ElN"
<br />lf you are a single-member LLC that is disregarded as an entity
<br />separate from its owner, enter the owner's SSN (or ElN, if the owner has
<br />one). Do not enter the disregarded entity's ElN, lf the LLC is classified as
<br />a corporation or partnership, enter the entity's ElN.
<br />Note: See What Name and Number To Give the Requester, later, for
<br />further clarrfication of name and TIN combinations,
<br />How to get a TlN. lf you do not have a TlN, apply for one immediately.
<br />To apply for an SSN, get Form SS-5, Application for a Social Security
<br />Card, from your local SSA office or get this form online at
<br />www.SSA.gov. You may also get this form by calling 1-BOO-772-1219.
<br />Use Form W-7, Application for IRS lndividual Taxpayer ldentification
<br />Number, to apply for an lTlN, or Form SS-4, Application for Employer
<br />ldentification Number, to apply for an ElN, You can apply for an EIN
<br />online by accessing the IRS website at www.irs.govlBusrnesses and
<br />clicking on Employer ldentification Number {ElN) under Starting a
<br />Business. Golowww.irs.govlForms to view, download, or print Form
<br />W-7 and/or Form SS-4. Or, you can go to www.irs.gav/OrderForms to
<br />place an order and have Form W-7 and/or SS-4 mailed to you within 10
<br />business days.
<br />lf you are asked to complete Form W-9 but do not have a TlN, apply
<br />for a TIN and write "Applied For" in the space for the TlN, sign and date
<br />the form, and give it to the requester. For interest and dividend
<br />payments, and certain payments made with respect to readily kadable
<br />instruments, generally you will have 60 days to get a TIN and give it to
<br />the requester before you are subjecl to backup withholding on
<br />payments. The 60-day rule does not apply to other types of payments.
<br />You will be subject to backup withholding on all such payments until
<br />you provide your TIN to the requester.
<br />Note: Entering "Applied Fof' means that you have atready applied for a
<br />TIN or that you intend to apply for one soon.
<br />Caution: A disregarded U.S. entity that has a foreign owner must use
<br />the appropriate Form W-8.
<br />Part ll. Certification
<br />To establish to the withholding agent that you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requested to sign by the
<br />withholding agent even if item 1, 4, or 5 below indicates otheruise.
<br />For a,joint account, only the person whose TIN is shown in Part I
<br />should sign (when required). ln the case of a disregarded entity, the
<br />person identified on line 't must sign. Exempt payees, see Exempt payee
<br />code, earliet.
<br />Signature requirements. Complete the certification as indicated in
<br />itemslthrough5below.
<br />lF the payment is for. ,
<br />lnterest and dividend payments
<br />Broker transactions
<br />Barter exchange transactions and
<br />patronage dividends
<br />Payments over $600 required to be
<br />reported and direct sales over
<br />$5,0001
<br />THEN the payment is exemptfor...
<br />All exempt payees except
<br />lor 7
<br />Exempt payees 1 through 4 and 6
<br />through 11 and all C corporations.
<br />S corporations must not enter an
<br />exempt payee code because they
<br />are exempt only for sales of
<br />noncovered securities acquired
<br />prior to 2012.
<br />Exempt payees 1 through 4
<br />Generally, exempt payees
<br />1 through 52
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