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<br />W-9 Request for Taxpayer
<br />ldentificatlon Number and Certification
<br />Give Form to the
<br />leqre$ter. Oo not
<br />send to the lRS.
<br />.1 Fxetnplirrls (ci)il{js sflp}y (nl} tr}
<br />.crl8rn ealillag- not lntlivrdrfil$: seo
<br />in::tflictio0s on p3{Jc 3):
<br />Elc,nor psye0 code {il an},1
<br />fx3orption iron FAICA reporlincl
<br />ctd{r li any)
<br />Forr
<br />(Flev. Oeiernber 2(11 4l
<br />Oepsrtmfill Ol ths ltea6u.y
<br />hlornal Flwmuo Ssruim
<br />aio
<br />6a
<br />co
<br />a6aE:oEA
<br />-- i;.=cco
<br />IF'o
<br />o0 volr lax folu.Il.is nt*,k€d on $ils llna;n0t lhk
<br />'h6Colleclive
<br />2 riameldisre{Jarde<j srlity aame.lrom
<br />3 Chsk appropriale box tor tederal tax clffiiticationi chcck of jy on€ ot the lotlow{I9 seve,r boxe:j.
<br />! in<liviciuat,'sole o()prletor or I C t)orptrratiorr f] I i)orporatioa I Parirerslrip f] I rLjsf/r$tai{7
<br />si$gltr.nlenltier LLC
<br />fl f imiteC liaoili(y conrpany. F,ri€r tht tax clNilicaiiorr (C--'C corptrratioil, S-S co.lrorati.rr, lr=parhersh'p) > P
<br />Nolg, Fo, a sinElgilarrbtr LLC that is riisrcqorded, alo rol cijc(:h I LC; check llre itpt).oprlal" bGX l,r dre |ne abov* l.)t
<br />lhe lax {la*sificillio,l oi tlre sinslFmefltber o*nsr
<br />OLher
<br />rro lor'rgei subi€cl to backup wilhholding; Gl(l
<br />3. I arn a \.J.S. titizen o( other Ll.S. persorr idetinad below): and
<br />.X. lhe FATCA codeisj enlere(j on lhis forrn {if any) indicating lhat I a6r exempl fronr FAICA repoding ls correct
<br />Certlfication inslructio.rs. You ftusl cross out itern 2 urbove il you have been notilied by the lliS tl'tat you are crlffenlly suhje{:t to backup withholdinaj
<br />becatrso you have failed tc, rsport all ini€.66t and dividenda ort your tax r€turn. ior real o8tate tranuctions, it€rn 2 doci lot ilpply For rrDilgaga
<br />rnlerest paid, acqtlisition or ab.rndonfnent ol cecurerl oroperly, cancellation of deDt, contributions ic an indiviclual retireneni arrangemant (lFA),arrd
<br />throiher tbarr int€resl ancl dividends, yori are hot required to $ign the ceililication, bui you nrusl froriide y.rur correct TlN. See
<br />Here
<br />General !nstructions
<br />tjection rtfgrc|tes are t0 tlte :ntcnral lievenr-te Coae u.rles otltorwise nolcd.
<br />Futu16 developmts. lntortiarion Jboui devsloprnents af{actlng iorm }V-9 isuchs legislaljon macte.d atler rs reieasr) :,lj is at vr\yw.irs.govlFflq
<br />Purpose of Form
<br />An inCiv;dtral or eirliry (Fom W-9 reqr.,ester) who is eriirirerJ k) lile an iiJonlatii-xl
<br />retBm with lhe IFS musi oili.tit yoU. r'crrect taxpayer identdicatiorr arrnber fIlNiyrhi(Jr n^V bt? you. social security numbar {$3N!, indivi.iual iaxtayc. idsnt,,ticalion
<br />aunrber {J ilN}, afiaption laxpayer idenlitrjatiotr numlxr {AflN). or enployer
<br />idenli?icalior iutrlllct {F,N}, lo.epqrt on ar} iltoilltatiorr relur{r lil6 atnount p}id ti)
<br />vCu, or odl€r dlourll relprlabie oI i]n intarrtaaion teluafi, Exatitpies of infa{rraticrl
<br />.sturE ireiude. bul ars irrll lirlrilec trJ. ihR i.rll{Jwirl!}:
<br />. ae!r 109!] INI {;rttera.;i earnod or uaid}
<br />" Fo.trr 109$-DlV ldividends, irl{:iudi.t(, tl{}se tror:r slocks or nlutrai lt,r}ds)
<br />. f:o.m lO99-MISC lvarious typs ol irrcclre, prizes, awards. or groes proc€d$l
<br />e fsrn 109$-FJ {stock or qruiual fund sales
<br />"tt{J
<br />csdain 0lb6r trilnsacliri rs hy
<br />brokersJ
<br />' t'om 1 099-5 iprcc#ds tram reai estRte fransactbns]
<br />' Fo..n lOgSt-K (nrBrchant c€rrj afrd third parly netq/o/k lairrE?rcliqlrs)
<br />F.qu.s{er's lart.i anrJ addrF-Js {oi]lionail
<br />O3ts >ic'lt1 lf7
<br />o Forni 1008 (llofirc rnof,gage;r{eriJsi;. lCgil-f islridert krafl interostl, 109i1-i
<br />lauition]
<br />. Fgrfi! 1099 C icancei(l drt-}|]
<br />' i!'r{r 1099-A (i\caluisitio| ot nbandoniietil cl:tccu.crJ tiltFe.ly)
<br />ijse Fom W-9 ffrl./ il yos ae :r LJ.l;, pelson iincludiirg a rsidgrrt alien), ts
<br />ilrovide,r,0{f s,Y,0cl TiN.
<br />ll y(ltt do tlet eltr1 Foort V!-9 at ilre- .?qiieskr-t w;tlt a T{N, vailt uilghl bc subii',ct
<br />to backup wilhholdittg. SeeWha! is ba..ktp vlithhalding? an pag| 2.
<br />Bv signing llre llllecl-ou{ io,qr, yc!.
<br />i. C€nlry4 that the llN you are ilivnq is corrcot {{)r Vou arc wajlinq ior a ru'liter
<br />to ho llsried],
<br />2. CerUiy that you 3.e nct suoircr t. backrip fithholdinq, or
<br />3. Claim axemption fron bacl(up wilhhokiinlJ il you 3re a LJ.S- exetrrpi piiye(,'. :t
<br />rpPlicai:le, '/cu are ais' oerlilying lha! s .i lJ.S tletson. yar/r ali€able.share ol
<br />nny palnershif) irrcome frori a lJ.S. tradeor busifls is not subject lo ahc
<br />withholdiog lax so fo!eilyl !-larlniirs'9i1a.c ol rliecl;'/elV conrroctgj inco{n{r. 3rxl
<br />4. Oerlify that InTOA {x(jei$l cirtere{i m thir ifirm {ii ar)y) indjcsiina thai you are
<br />sxernpt lro(r tho |-A1-QA reponkrg, is correct. 5oe w'ria l$ FAfCI reptrti4<1'1 <t:
<br />page 2 {or iurth€r infotrnatior)
<br />>
<br />3.
<br />slrf.ci nnd;rpt or nt-)
<br />$ignature ot
<br />U.$- pormn )
<br />Cal. No. 10231X Fonlr W-g {tisv. l2-2{}1.!:
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