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<br />Fo.m w-g Request for Taxpayer
<br />ldentification Number and Certification
<br />> Go to r,vww.r'rs.govlFormWg loi instructions and lhe latest informaiion.
<br />on your income tax rcq cn thrs line;!lot trlonk
<br />lqr federai tax classiiicar.on ol the persofi whcse nams is enl6reJ on; ne 1 check anty one Jl rhe
<br />(R€v. Oclobsr 20181
<br />D{ptrtlrffsnl ol lhe Treasury
<br />lnlornal llsvpr$rd sFrui.e
<br />Give Fotm to the
<br />requester. Do not
<br />send to the lRS.
<br />'I Name
<br />o
<br />oo(to
<br />3 Check 3pflrpriate box
<br />:ollowing sdvon boxes.4 Exemplions {codes appry orrly k)
<br />cedair ertities, nol ndividuals; see
<br />rnslrucljorls on page 3i;
<br />Exempr psyee cooe iif any)
<br />Exerptran lrcm FAICA rsporling
<br />code {jf anyl
<br />co
<br />oc
<br />.9
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<br />IDsg
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<br />E krdrv,duat/sole propr;aior of [- 1 C corpur"t;,rn L-j s corpu,arion lI partnorsl,ip n rrrst€srars
<br />singic-mcalbsr LLCo;d
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<br />ll L inilea iiabilily cgmpany. E,:ter the tax classilcation {C=C corporaiion, S-S corporation, ir=Fsrla€rsh:p) >
<br />Nolo: Chack tho approtlriate box in lirc lilte above ior lirc ts classilicatrof cf tho si.qlc-fnember olvnet. lJo nct checi(LLC:i lhe LLC rs c,issilied as a sinale-rnember LLC that ls o sregarded tlonl th6 olvncf uniess ine.rwner oi the i-LC rsanother LLC that 's not dis.egardod irorn tlre owno- lof tJ .S- lederal tax ourposes. Othgrwise, a single-nternbe. i,a.Cis disregarded laom lh€ovJner shculd chrck the apprapriale ttox for the lsx classtiicalion of ils ovinerI I otner instructions) >
<br />Under of perjury, I cerilfy that:
<br />Certification inslructions. You must cross oul ilem 2 abovs if you have been notified by the
<br />'RS
<br />lhat you are currenlly subled to backup withholding oecause
<br />nol apoly. Fot mortgage interesi paid,you have failed to report all inlgrest ard dividends on your tax roturn, For real estate transactions, jtern 2 doesacquisition or abaooonment of securcd property, cancellation of debl, contributions to
<br />olh€r than interast and dividends, you not required to sign the ce(ification, but you
<br />an indivrdual retirement aruange$enl (lRA), anrj generally, paymcnts
<br />must provide your correct TlN, See the jnstruclions for part ll, later.
<br />1 I he nrmber shown on this torm is nly correct laxpayer ideniification |umber (or I arn \,vaiting for a nunrber to be issucd to flle], and2 l am not.sub,ocl to backut, withholding becatlse: (a) I am exernpt from backup rvilhhokling, or (b) I nave nol heen notified by tho lnternal FlevailUeservice (lns) tnat I am sublect.to.backup withnolding as a resuit of a failu,e to rcp,:ii ail inie*:sr or divrdBn{,$, or {c) the IRS has notifjed nr* thnt larrno longer subjact lo backup withholding; and
<br />3. I am a U.S. citizen o/ other U.S, perscn (defin€d below); and
<br />4' The FATCA code(s) entered on this lorm (if any) indicating that I am excmpt from FATCA reporting is correct.
<br />Sign
<br />Here Signatu,e qt
<br />U.S. psison >
<br />General lnstructions . Form 1099-DlV (dividenos, ,nciuding those trom stocks or mulual
<br />funds)
<br />r Form 1099-MISC (various types ot incom6, prizes, awards, or gross
<br />p/oceeds)
<br />o Form 1099-8 (stock or nrutual ,und sales and csdain other
<br />transaclions by brokers)
<br />. Fo/m 1099 S (proceeds from real estate transactions)
<br />r Form 1099-K (merchant card and third party network transactions)
<br />:lofnl loSq (home mortgage inlerest), i09B-E (srudent loan interest),
<br />1098" I (tu(ion)
<br />. Fofm 1099-C (canceied debt|
<br />o Form '1099-A {acquisition or abandonrnent ot secured properly)
<br />Uso Form W-9 cnly if you are a LJ.S. osrson (inc'uding a resident
<br />alien), to orovide your correct TlN.
<br />lf ydt da nat relurn Farm W"g ta thd ,equestar uriln a flN, you might
<br />be subiact to bBckup wilhhaldirtg. Saa What i$ baf kup wilhholding,
<br />lalcr.
<br />Date >
<br />Section roferenceg are to the lnternal Rsvenuo Code unless otherwise
<br />noted.
<br />Fulure developments. For ths latest information about deveiopments
<br />related to Form W-g and its instructions, such as legislation enacted
<br />afle? th6y wore pUblishcd, go lo www.its.gav/FormWg.
<br />Purpose of Form
<br />An individual or entity (Form W-9 raquast€r) who is required to file an
<br />informfflloil return wlih the IRS llr,$t rlbtaiil your corarl taxpayo.
<br />idsnlificalrqn numbor frlNf which D.|ay bs y$ur social soctllity riumber($$N), individual taxpfiysr idsntif icariin ndrrrber (ll lN), adopiicn
<br />taxpayer ldcnlificalion nunrber (ATIN), or enrployer identification nunrber
<br />(ElN), to raport on an irformation return lhe amount paid to you, or crther
<br />amounl roponable on an iniormation retur.n. Examples of infcrrnation
<br />relufns includB, but are not limited to, the followlng.
<br />r Form .1099-lNT {interosl earoed or paid}
<br />Cdt, No. i0231X Form W-g {Rev. 't0-2010}
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