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<br />(Rev. October 2018)
<br />Department of the Treasury
<br />lnternal Revenuo Service
<br />Request for Taxpayer
<br />ldentification Number and Gertification
<br />Give Form to the
<br />requester. Do not
<br />send to the lRS.
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<br />)Goto for instructions and the latest information,
<br />shown on your income tax on not line blank.
<br />LAN T tNc.
<br />name/disregarded entity name, if ditferent from
<br />4 Exemptions (codes apply only to
<br />certain entities, not individuals; see
<br />instructions on page 3):
<br />Exompt pay€€ code (if any)
<br />Exemption from FATCA reporting
<br />code (if any)
<br />Wplids to accounts mainlained outside th6 U.S)
<br />Requester's name
<br />7 List account
<br />Number
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
<br />backup withholding. For individuals, this is generally your social security number (SSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Part l, later. For other
<br />entities, it is your employer identification number (ElN). lf you do not have a number, see How to get a
<br />I/N, later.
<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 Give the Requester lot 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); and
<br />2' I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the lnternal Revenue
<br />Service (lRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
<br />no longer subiect 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 />Certification instructions. You must cross out item 2 above if you have b6€n notified by the IRS that you are currently subject to backup withholding because
<br />you have failed to report all interest and dividends on your tax retum. For roal estate transactions, item 2 does not apply. For mortgage lnterost paid,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (lRA), and generally, payments
<br />must provide your conect TlN. See the lnstructions for Part ll, later.other than interest and dividends,required to sign the certification, but you
<br />Sign
<br />Here
<br />General lnstru
<br />Section references are to the lnternal Revenue Code unless 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 lo www.irs.govlFormW9.
<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 correct taxpayer
<br />identification number cflN) which may be your social security number
<br />(SSN), individual taxpayer identification number (lTlN), adoption
<br />taxpayer identification number (ATIN), or employer identification number
<br />(ElN), to report on an information return the amount paid to you, or other
<br />amount reportable on an information return. Examples of information
<br />returns include, but are not limited to, the following.
<br />. Form 1 099-lNT (interest earned or paid)
<br />or
<br />Date >
<br />e Form 1099-DlV (dividends, including those from stocks or mutual
<br />funds)
<br />e Form 1099-MISC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />. Form 1 099-8 (stock or mutual fund sales and certain other
<br />transactions by brokers)
<br />. Form 1 099-S (proceeds from real estate transactions)
<br />r Form 1 099-K (merchant card and third party network transactions)
<br />o Form 1098 (home modgage interest), 1098-E (student loan interest),
<br />1098-T (tuition)
<br />. Form 1099-C (canceled debt)
<br />r 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 return Form W-9 to the requester with a TIN, you might
<br />be subject to backup withholding. See What is backup withholding,
<br />later.
<br />3 Check appropriate box for federal tax classification of the person whose name is entered on line 1 . Check only one of the
<br />following seven boxes.
<br />n lndividual/sole proprietor or E C Corporation El S Corporation n Partnership fl TrusVestate
<br />single-member LLC
<br />I t-imiteC liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ]
<br />Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
<br />LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC
<br />another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC
<br />is disregarded from the owner should check the appropriate box for the tax classification of its owner
<br />Other (see
<br />apt. or nstructions.5 Address (number, street,
<br />ND AVE NE
<br />6 City, state, and ZIP
<br />DINVILLE WA 98072
<br />numbEr
<br />Part I
<br />adentification number
<br />I 1 2 1 8 4 1 9 3
<br />Part ll
<br />Signature of
<br />U.S. person )
<br />Cat. No. 10231X rorm W-9 1nev. 10-2018)
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