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Foffr w-g Request fior Taxpayer <br />ldentification Number and Certification(Rev. Ocbber2018) <br />Depanment of the Treasury <br />lnternal Rev€fl ue S€wice <br />Here Signetura of <br />U.$ ncrson) <br />General <br />Give Form tothe <br />r€quester, Do not <br />send to the lRS.for instructiom and the latest irformatbn. <br />{ Name (as on your tax Name <br />ofFame <br />2 Business nam€/disregarded nane, <br />4 Eremptbns (codes apply only to <br />certain entiliqe, nol individuals: see <br />insbuctions on pqge 3): <br />Exempt payeecode (t any) <br />EKemption fiom FATCA reporting <br />code ff any) <br />(A,plk* b etu ddnrat td d6?e rfie U.S:) <br />narne <br />7 account number(s) here <br />Note: lf the account is in moro than one name, see the insfuctions for line 1- Also see What Name and <br />Number To Give ilre Requester for guidelines on whose number to enter, <br />Under penalties of pe{ury, I ccrtify that <br />1. The number shown on this form is my conect taxpayer identiflcadon number (or I am walting for a number to be issued to rtre); and <br />2. I amrot subject to backup withholdirg because: (a) I am e<empt from backup withholding, or @) I have not be€n not?fied by the lnternal Revenue <br />SeMce (lRS) that I am subject to baclop withholding as a result of a failure to repon dl interesi 6r dividends, or (c) the tRS'has notitied me that I am <br />no longer subjectto backup withholding; and <br />3. I am a U.S. cilizen or other U.S. person (defined below); and <br />4. The FATCA code(s) entered on this fom [f any) indicating that I am exempt trom FATCA reporting is conect. <br />>Goto <br />on <br />(Y) <br />olJ)(d <br />o- <br />co.ooccLo>rEri]J <br />o=r- iD <br />d.9 <br />ooa.oo(D <br />v) <br />or <br />nk Date >/2- / /'-]d <br />Section references are to the lntemal Flevenue Code unless otherwise <br />noted. <br />Future deyelopnenb. For the latest information about devetopments <br />related to Form W-9 and its instructions, such as legislation enacted <br />aft€r they were published, go to www.irs.govlFoml /9. <br />Purpose of Form <br />An individual or entity (Forrn W-9 requestar) who is required to lile an <br />information r€fum with the lFlS must obtain your corect tfl(payer <br />identincation number [flN) which may be your social secudty iumber <br />(SSN), lndlvldual taxpayer identifcation number (lTlN), adoption <br />taxpayer identification number (ATIN), or employer identification number <br />(ElN), to report on an information rsfum the amount paid to you, ol other <br />amount reportable on an information retum. Examples of infbmation <br />retums include, but are not fmited to, the following. <br />. Folm 10S,{NT (ntercst eam6d or paid) <br />. Form l0SFDlV (dividend$, including those from stocks or mutual <br />tunds) <br />. Form 1099M|SC {vartou$ typos of income, prizes, awards, or gro6s <br />proceeds) <br />. Form 109*g (stock or mutualfund sales and certain other <br />transactions by brokers) <br />o Form 1099-5 (proceeds from real estate transactions) <br />. Fom 1099-K {merchant card and third party network tanmctions) <br />. Form 1098 (home mortgage interesg, 1098-E (student toan interest), <br />1098-T (tuiton) <br />. Form 1099-C (canceled debt) <br />. Form 'l GlgrA (acquisition or abandonment of s€cured property) <br />-Use Form W-9 only if you are a U.S. person {including a resident <br />alien), to provide your con€ct TlN. <br />lf you da rle,t retum Form W-9 to the requeste(with aTlN, you might <br />be ilbjec:tto bectup withholcting. Se€ \ that is backup withhotding, <br />later. <br />3 Ghmk appropiate box for foderal tax classifiGation of the person whose neme is ent€red on lirE 1 , Check only one of the <br />f ollowir€ ssr/efl boxes. <br />E hoiuid*y"olepmprietoror E] ccotpon"tion n scorporation D partnersnip I r*"y""t t" <br />single-rnember LLC <br />I t-imiteOtialilitycompany.Enterlhetaxclassification(C=Ccorporation,s=Scorporation,P=Partnership)]_ <br />Note| Check the appropriate box in the line above lor the tax classmcation of the single-member ourner. Do not check <br />LLC if the LIC is classified as a singlq member LLC that is disregarded ftorn the owner urleos ths owner of the LLG is <br />another LLC lhat is not distegatded fiorn tlE owner for U.S. fedml ta purposes. Otherwbe, a single-member LLC <br />is disregarded from the own€r should check the approFiate box for the tax classificatbn of its owrer. <br />Other instructions) > <br />Ave. Box 374 <br />(r <br />I w <br />6 state, and <br />wA 98926 <br />NumberPart I <br />I 1 1 8 I 3 8 4 o <br />Part ll <br />Cat. No- 1023tX rorm W-9 Fev. 10-2018)