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Form W-9 {Rev. 1 1 -201 7)Page 5
<br />1. lnterest, dividend, and barter exchange accounts opensd
<br />before 1984 and broker accounts considered active during 1993.
<br />You must give your correct TlN, but you do not have to sign the
<br />cenification.
<br />2, lnterest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considered inactive during
<br />1983. You must sign the certification or backup withholding will apply. lf
<br />you are subject 1o backup withholding and you are merely providing
<br />your correct TIN to the request€r, you must cross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate ttansactions. You must sign the certification. you may
<br />cross out item 2 of the certification.
<br />4. Olher paym€nts. You must give your correct TlN, but you do not
<br />have to sign the cerli{ication unless you have been notified that you
<br />have previously given an incorrect TlN. ',Other payments', include
<br />payments made in the course of the roquester's trade or business for
<br />renls, royalties, goods (other than bills for merchandise), medical and
<br />health care services (including paym6nts to corporations), payments to
<br />a nonemployee for services, payments made in settlement of payment
<br />card and third party network transactions, payments 10 certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured proporty, cancellation of debtr qualitied tuition program
<br />payments (under section 529), ABLE accounts (under section S2gA),
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distribuiions, and pension dislributions, you must give your correct
<br />TlN, but you do not have to sign the certification.
<br />14.
<br />For this of account:Give name and EIN of:
<br />The public entity
<br />The trust
<br />Agricultur€ in the name of a public
<br />entlty (such as a slate or looal
<br />government, school district, or
<br />prison) that receives agricultural
<br />program payments
<br />1 5. Grantor trust filing under the Form
<br />1041 Filing Method or the Optional
<br />Form 1099 Filino Method 2 {see
<br />section 1.671 -4(b)(2X|XS))
<br />1 List firs! and circle the name ol ths
<br />lf only one person on a joint accor:nt
<br />musl be furnished.
<br />whose number you lurnish,
<br />SSN, that person's numbar
<br />What Name and Number To Give the Requester
<br />For this type ot account:Give name and SSN ol:
<br />person
<br />has an
<br />2 Crrcle the minor's name and furnish the minor's SSN.
<br />3 You must show your individual name and you may also enter your
<br />business or DBA rrame on the "Business name/disregarded entjty'i
<br />name line. You may use either your SSN or EIN (if you have one), but the
<br />IRS encourages you to use your SSN.
<br />4 List first and circle the name of the trust, estate, or pension trust. (Do
<br />not furnish the TIN of the personal representative or trustee unless the
<br />legal entity itself is not designated in the account title.) Also see Spec/b/
<br />rules for parlnersh,ps, earlier.
<br />*Note: The grantor also must provide a Form W-9 to trustee of trust.
<br />Note: lf no name is circled when more than one name is listed, the
<br />number will be considered lo be that of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someone uses your personal information
<br />such as your name, SSN, or other identifying information, without your
<br />permission, to commit fraud or other crimes. An identity thief may use
<br />your SSN to get a job or may file a tax .eturn using your SSN to receive
<br />a refund.
<br />To reduce your risk;
<br />' Protect your SSN,
<br />. Ensure your employer is protecting your SSN, and
<br />r Be careful when choosing a tax preparer.
<br />lf your tax records are affected by identity theft and you receive a
<br />nolice from the lRS, respond right away to the name and phone number
<br />printed on the IBS notice or letier.
<br />lf your tax records are not currently affected by identity theft but you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activity or credit report, contact the IRS ldentity Theft Hotline
<br />at 1 -800-908-4490 or submit Form 1 4039.
<br />For more in{ormaiion, see Pub. 5027, ldentity Theft lnformation for
<br />Taxpayers.
<br />Victims of identity theft who are experiencing economic harm or a
<br />systemic problem, or are seeking help in resolving tax problems that
<br />have not been resolved through normal channels, may be eligible for
<br />Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
<br />calling the TAS toll-free case intake line at 1-877-7TT-41t8 or ITynDD
<br />1 -800-829-4059.
<br />Protect yourself lrom suspicious emails or phishing schemes.
<br />Phishing is the creation and use of email and websites designed to
<br />mimic legitimate business emails and websites. The most common act
<br />is sending an emailto a user falsely claiming to be an established
<br />lggitimate enterprise in an attempt to scam the user into surrendering
<br />private information that will be used tor ideniity theft.
<br />1. lndividuai
<br />2. Two or more individuals (joint
<br />account) other than an acgount
<br />malntained by an FFI
<br />3. Two or more U.S. persons
<br />0oint account mainlained by an FFI)
<br />4. Custodial account of a minor
<br />(Unilorm Gift to Minors Act)
<br />5. a. The usual revocable savings irust
<br />(grantor is also trust06)
<br />b. So-called trust accornt ihat is not
<br />a legal or valid trust under state Iaw
<br />6. Sole proprietorship or disregarded
<br />enlity owned by an individua{
<br />7. Grantor trust filing under Opiional
<br />Form '1099 Filing Method 1 (see
<br />Regulations seclion 1 .671 -a{bX2Xi)
<br />(A)
<br />For this type of account:
<br />8. Disregarded {inlily not owned by an
<br />jndividual
<br />9- A valid kust, estate, or pension lrust
<br />10. Corporation or LLC electing
<br />corporate slatus on Form 8032 or
<br />Form 2553
<br />1 1. Association, club, religious,
<br />charitable, educational, or other lax-
<br />exempl organization
<br />'12. Partnership or multi-member LLC
<br />1 3, A broker or registered nominee
<br />The individuai
<br />The actual owner ol the account or, if
<br />combined funds, the first individual on
<br />the accountl
<br />Each hoider of the account
<br />The minor'
<br />The grantor-trusteel
<br />The aclual owner'
<br />The owner'
<br />The granior'
<br />Give name and EIN ol:
<br />The owner
<br />Legal entitya
<br />The corporation
<br />The organization
<br />The partnership
<br />The broker or nominee
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