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Form W-9 (Rev. 1 1 -201 7)Page 3
<br />Crlmlrul ponalty_for faleifying lnformation. Willfully falsifying
<br />cortilicalions or at{irmations may subiect you to criminal p6naities
<br />includlng lines andlor imprisonment.
<br />Misuse ol TlNs. lf the r€quester discloses or uses TlNs in violation of
<br />federal law, the requester may be subiect to civil and criminal penalties.
<br />Specific lnstructions
<br />Line I
<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 lax return.
<br />lf this Form W-9 is for a joint account (other than an account
<br />maintained by a foreign financial institution (FFl)), list 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-g to an FFI to document
<br />a joint account, each holder of the account that ls a U.S. person must
<br />provide a Form W-9.
<br />a. lndividual, Generally, enler the name shown on yout lax return. lf
<br />yo! lalg changed your last name without Informing the Social Security
<br />Administralion (SSA) of the name change, enler your first nanre, the laii
<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 onyour Form W-7 application, fine 1a. This should also be the same as the
<br />name you entered on the Form 104O/IO40NIO4OEZyou filed with your
<br />applicalion.
<br />b. Sole proprietor or single-member LLC. Enter your individual
<br />name as shown on your 1040/104ON104OEZ 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 line 1 and any business, trade, or DBA name on
<br />line 2.
<br />d, Other entities. Enter your name as shown on required U,S. federal
<br />tax documents on line 1. This name should match the name shown on the
<br />charter or olh€r legal documonl creating the entity. you may enter any
<br />business, trade, or DBA name on line 2.
<br />.. e, Disrcgarded enllty. For U.S. lodsral tax purposes, an entity that is
<br />disregarcled as an enlily separate from lts owner is kealed as a
<br />'?lsregarded entity." See R€gutations section S01.ZZO1 -2\cX2Xiii). Enter
<br />the ownor's name on line L The ngme of the entity entered on lino 1
<br />should never be a dlsregarded entity. The name on line 1 should be the
<br />name shown on the income tax return on which the income should be
<br />repoded. For oxample, if a fofeign LLC that is iroated as a disregarded
<br />entity for U.S. federal tax purpoEes has a singte ownor thal is a 0.S.
<br />person, the U.S. owner's name is required to be provided on llne 1. lf
<br />the direct owner of the entity is also a disregarded entity, enter the first
<br />owner that is not disregarded ior federal tax purposes. inter the
<br />disrogarded entity's name on line p, "Business namB/disregardBd entity
<br />nams." lf lhs owner of the disr€garcted entity is a foroign person, the
<br />owner must complete an appropriate Form W-8 instead of a Form W_9.
<br />This is the case €ven if the foreign person has a U.S. TlN.
<br />Line 2
<br />lfyou have a business name, trade name, DBA name, or disregarded
<br />entiiy name, you may enter it on lins 2,
<br />Line 3
<br />Check the appropriate box on line 3 {or 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 andlor FATCA reporting,
<br />€nter 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 />. Except as provided below, corporations are exempt from backup
<br />withholding for cenain payments, including interest and dividends.. Corporations are not exempt from backup withholding for payments
<br />made in settlem€nt of payment card or third party network transactions.. 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 paymsnts reportable on Form 1099-MlSC.
<br />The following codes identify payees that are exempt from backup
<br />withholding. Enter the appropriate code in lhe space in line 4.
<br />1-An organization exempt from tax under section S01(a), any lRA, or
<br />a custodial account under section 403(b)(7) if the account satisfies the
<br />requiremenls of section 401(0(2)
<br />2-The United States 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, agencies,
<br />or instrumentalities
<br />5-A corporation
<br />6-A dealer in securities or commodities required to register in the
<br />United States, the District of Columbia, or a U.S. commonwealth or
<br />possession
<br />7-A futures commission merchant registered with the Commodity
<br />Futures Trading Commission
<br />8-A real estate investment trust
<br />S-An entity registered at all times during the tax year under the
<br />lnvestment Company Act ot 1940
<br />10-A common trust tund operated by a bank under section 594(a)
<br />1 1 -A financial institution
<br />12-A middleman known in the investment community as a nominee or
<br />cuslodian
<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 for
<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 />lndividual/sole proprietor or single-
<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 thal is disregarded as an
<br />€ntity separate from its owner but
<br />the owner is another LLC that is
<br />not disregarded for U.S. federal tax
<br />purposes.
<br />Limiied liability company and enter
<br />the appropriate tax classification.
<br />(P= Partnershlp; C- C corporation;
<br />or S= S corporation)
<br />. Partnership Partnership
<br />Trust/estate Trustlestate
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