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Form W-g (Rev. 10-2018)Page 3
<br />Griminal penalty for falsifying information. Wilfully falsifying
<br />certifications or affirmations may subiect you to criminal penalties
<br />including fines and/or imprisonment.
<br />Misuse of TlNs. lf the requester discloses or uses TlNs in violation oi
<br />lederal law, the requester may be subiect to civil and criminal penalties.
<br />Specific lnstructions
<br />Line 1
<br />You must enter one of the following on this line; do not leave this line
<br />blank. The name should match the name on your tax return.
<br />lf this Form W-9 is for a joint account (other lhan an aocount
<br />maintained by a foreign financial institution (FFl)), i'st first, and then
<br />circle, the name of the person or entity whose number you entered in
<br />Part I of Form W-9. lf you are providing Form W-9 to an FFI to document
<br />a joint account, each holder of the account that is a U.S. person must
<br />provide a Form W-9"
<br />a. lndividual. Generally, enter the name shown on your tax return. lf
<br />you have changed your last name without informing the Social Security
<br />Administration (SSA) of the name change, enter your lirst name, the last
<br />name as shown on your social security card, and your new last name.
<br />Note: lTlN applicant: Enter your individual name as it was entered on
<br />your Form W-7 application, ljne 1a. This should also be the same as the
<br />name you entered on the Form 1040/1040A/i04OEZyou filed with your
<br />application.
<br />b, Sole proprietor or single-member LLC. Enter your individual
<br />name as shown on your 1Q4O/104ON1A40EZ on line 1. you may enter
<br />your business, trade, or "doing business as" (DBA) name on line 2.
<br />c. Partnership, LLC that is not a single-member LLC, C
<br />corporation, or S corporation, Enter the entity's name as shown on the
<br />entity's tax return on ljne 1 and any business, trade, or DBA name on
<br />line 2.
<br />d. Otherentities. Enteryourname as shown on required U.S. federal
<br />lax documents on line 1. This name should match the name shown on the
<br />charter or other legal document creating the entity. you may enter any
<br />business, trade, or DBA name on line 2.
<br />e. Disregarded entity. For U.S. federal tax purposes, an entity that is
<br />disregarded as an entity separate from its owner is treated as a
<br />"disregarded entity." See Regulations section S01.7701-2(c)(2)(iii). Enter
<br />the owner's name on line 1. The name of the entity entered on line .l
<br />should never be a disregarded entity. The name on line 1 should be the
<br />name shown on the income tax return on which the income should be
<br />reported. For example, if a foreign LLC that is treated as a disregarded
<br />entity for U.S. lederal tax purposes has a single owner that is a U.S.
<br />person, the U.S. owner's name is required to be provided on line 1. lf
<br />the direct owner of the entity is also a disregarded entity, enter the first
<br />owner that is not disregarded for federal tax purposes, Enter the
<br />disregarded entity's name on line 2, "Business name/disregarded entity
<br />name." lf the owner of the disregarded entity is a foreign person, the
<br />owner must complete an appropriate Form W-8 instead of a Form W-9.
<br />This is the case even if the foreign person has a U.S. TlN.
<br />Line 2
<br />lf you have a business name, trade name, DBA name, or disregarded
<br />entity name, you may enter it on line 2.
<br />Line 3
<br />Check the appropriate box on line 3 for the U.S. federal tax
<br />classification of the person whose name is entered on line 1. Check only
<br />one box on line 3.
<br />Line 4, Exemptions
<br />lf you are exempt from backup withholding and/or FATCA reporting,
<br />enter in the appropriate space on line 4 any code(s) that may apply to
<br />you.
<br />Exempt payee code.
<br />. Generally, individuals (including sole proprietors) are not exempt from
<br />backup withholding.
<br />r Except as provided below, corporations are exempt from backup
<br />withholding for certain payments, including interest and dividends.. Corporalions are not exempt from backup withholding for payments
<br />made in settlement of payment card or third party network transactions,
<br />. Corporations are not exempt from backup withholding with respect to
<br />attorneys' fees or gross proceeds paid to attorneys, and corporations
<br />that provide medical or health care services are not exempt with respect
<br />to payments reportable on Form 1099-M|SC.
<br />The following codes identify payees that are exempt from backup
<br />withholding. Enter the appropriate code in the space in line 4.
<br />1 -An organization exempt trom tax under section 501(a), any lRA, or
<br />a custodial account under section 403(bX7) if the account satislies the
<br />requirements of section 401(D(2)
<br />2-The United Stales or any of its agencies or instrumentalities
<br />3-A state, the District of Columbia, a U.S. commonwealth or
<br />possession, or any of their political subdivisions or instrumentalities
<br />4-A foreign government or any of its political subdivisions, agencles,
<br />or instrumentalities
<br />5-A corporation
<br />6-4 dealer in securities or commodities required to register in the
<br />United States, the Diskict oi Columbia, or a U.S. commonwealth or
<br />possessjon
<br />7-A futures commission merchant registered with the Commodity
<br />Futures Trading Commission
<br />8-A real estate investment trust
<br />9-An eniity registered at all times during the tax year under the
<br />lnvestment Company Act of 1 940
<br />1 0 -A common trust fund operated by a bank under section SB4(a)
<br />11 --A financial institution
<br />12-A middleman known in the investment communily as a nominee or
<br />custodian
<br />1 3 - A trust exempt from tax under section 664 or described in section
<br />4947
<br />lF the entity/person on line 1 is
<br />a(n)...
<br />THEN check the box tor
<br />. Corporation Corporation
<br />. lndividual
<br />. Sole proprietorship, or. Single-member limited liability
<br />company (LLC) owned by an
<br />individual and disregarded for U.S.
<br />federal tax purposes.
<br />lnd ividual/sole proprietor or singie-
<br />member LLC
<br />. LLC treated as a partnership for
<br />U.S. federal tax purposes,
<br />. LLC that has filed Form 8832 or
<br />2553 to be taxed as a corporation,
<br />or
<br />. LLC that is disregarded as an
<br />entity separate from its owner but
<br />the owner is another LLC that is
<br />not disregarded for U.S. federal tax
<br />purposes.
<br />Limited liabilily company and enter
<br />the appropriate tax classification.
<br />{P= Partnership; C= C corporation;
<br />or S= S corporation)
<br />r Partnership Partnership
<br />. Trusyestate Trust/estate
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