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Form W-9 (Rev. 10-2018)Page 4
<br />lnterest and dividend payments All exempt payees except
<br />lor 7
<br />Broker transactions
<br />lF the payment is lor.
<br />Barter exchange transactions and
<br />patronage dividends
<br />Payments over $600 required to be
<br />reported and direct sales over
<br />$5,ooo'
<br />THEN the paym€nt is exemptfor..,
<br />Exempt payees 1 through 4 and 6
<br />through 11 and all C corporaiions.
<br />S corporations must not enter an
<br />exempt payee code because they
<br />are exempt only for sales o{
<br />noncovered securities acquired
<br />prior to 2012.
<br />Exempt payees 1 through 4
<br />Generally, exempt payees
<br />1 through 52
<br />The following chart shows typss of payments that may be exempt
<br />,rom backup withholding. The chart applies to the exempl payeesiisted
<br />above, 1 through 13.
<br />M-A lax exempt trust under a section 403(b) plan or section 457(9)
<br />plan
<br />Note: You may wish to consult with the linancial institution requesting
<br />this form to determin€ whether the FATCA code and/or exempt payee
<br />code should be completed.
<br />Line 5
<br />Enter your address (number, street, and apartm€nt or suite number).
<br />This is where the requester of this Form W-9 will mail your information
<br />returns. lf this address ditfers lrom the one the requester already has on
<br />file, write NEW ai ihe top. lf a new address is provided, there is still a
<br />chance the old address will be used until the payor changes your
<br />address in their records.
<br />Line 6
<br />Entor your city, state, and ZIP code.
<br />Part l. Taxpayer ldentification Number (TlN)
<br />Enter your TIN in the appropriate box. lf you are a resident alien and
<br />you do not have and are not eligible to get an SSN, your TIN is your IRS
<br />individual taxpayer identification number (lTlN). Enter it in the social
<br />security number box. lf you do not have an lTlN, see How to get a TtN
<br />below.
<br />ll you are a sole proprietor and you have an ElN, you may enter either
<br />your SSN or ElN.
<br />lf you are a single-member LLC that is disregarded as an entity
<br />separate from its owner, enter lhe owner's SSN (or ElN, if the owner has
<br />one). Do not enter th6 disregarded entity's ElN. lf the LLC is classified as
<br />a corporation or pannership, enter the entity's ElN.
<br />Note: See What Name and Number To Give the Requestet,later, for
<br />further clarification of name and TIN combinations.
<br />How to get a TlN. lf you do not have a TlN, apply for one immediately.
<br />To apply lor an $SN, get Form SS-5, Application for a Social Security
<br />Card, from your local SSA oftice or get this form online at
<br />www.SSA.gov. You may also get this form by calling 1-900-Tt2-1215.
<br />Use Form W-7, Application for IRS lndividual Taxpayer ldentification
<br />Number, to apply for an lTlN, or Form SS-4, Application for Employer
<br />ldentification Number, to apply for an ElN. You can apply for an EIN
<br />online by accessing the IRS website atwww.ks.gov/B{.,srnesses and
<br />clicking on Employer ldentification Number (ElN) under Starting a
<br />Business. Go to www.lrs.govlForms lo view, download, or prinl Form
<br />W-7 andlor Form SS-4. Or, you can go Io www.its.gov/OrderForms to
<br />place an order and have Form W-7 and/or SS-4 mailed to you within 10
<br />business days.
<br />lf you are asked to complete Form W-9 but do not have a TlN, apply
<br />fora TIN and write "Applied For" in the space for the TlN, sign and date
<br />the form, and give it to the requester. For interest and dividend
<br />paymenls, and certain payments made with respect io readily tradable
<br />instruments, generally you will have 60 days to get a TIN and give it to
<br />the requester before you are subject to backup withholding on
<br />payments. The 60-day rule does not apply to other types of payments.
<br />You will be sub.iect to backup withholding on all such payments until
<br />you provide your TIN to the .equester.
<br />N.ote: Entering "Applied Fol" means lhat you have alroady applied for a
<br />TIN or that you intend to apply for one soon.
<br />Cautioni A disregarded U.S. entity that has a foreign owner must use
<br />the appropriato Form W-8.
<br />Part ll. Certification
<br />To establish to the withholding agent that you are a U.S. p€rson, or
<br />resident alien, sign Form W-9. You may be requested to sign bythe
<br />withholding agent ev€n if item 1, 4, or 5 below indicates otherwise.
<br />For a joint account, only the person whose TIN is shown in part I
<br />should sign (when required). ln the case of a disregarded entity, the
<br />person identitied on line 1 must sign. Exempt payees, see Exempt payee
<br />codg earlier,
<br />Signature requirements, Complete the certification as indicated initemsl throughSbelow.
<br />Payments made in settlement of Exempt payees 1 through 4
<br />payment card or third party
<br />transaclions
<br />I See Form 1099-MlSC, Miscellaneous lncome, and its instructions.
<br />' Howuvur, the following payments made to a corootation andreportable on Form 1 099-MISC are not exempt fiom backup
<br />withholding: medical and health care payments, attorneys, fees, gross
<br />proceeds paid to an attorney reportable under section 6045{f), and
<br />payments for services paid by a federal executive agency.
<br />Exemplion from FATCA reporting code. The following codes identify
<br />payees that are exempt from repoding under FATCA_ These codes
<br />apply to persons submitting this form for accounts maintained outside
<br />of the United States by certain foreign financial instttutions. Therefore, if
<br />you are only submitting this form for an account you hold in the United
<br />States, you may leave this field blank. Consult with the person
<br />requesting this form if you are uncertain if the financial institution is
<br />subject to thes€ requiremenls. A requester may indicate that a code is
<br />not requ,ired by providing you with a Form W-9 with '.Not Applicable" (or
<br />any similar indication) written or printed on the line for a FATCA
<br />exemption code.
<br />A-Ancrganization exsmpt from tax under section 501(a) or any
<br />individual retiremeni plan as defined in section 7701(a\(J7l
<br />B-The United States or any of its agencies or instrumentalities
<br />C-A state, the District of Columbia, a U.S. commonwealth or
<br />possession, or any ol lheir political subdivjsions or instrumentalities
<br />D-A corporation the stock of which is regularly traded on one or
<br />more established securities markets, as described in Regulations
<br />section 1.1 472-1 (c)(1 )(i)
<br />E-A corporation that is a member of the same expanded affiliatedgroup as a corporation described in Regulations section 1 ..,l 472-1 (cX1)(i)
<br />F-A dealer in securities, commodities, or derivative financial
<br />instruments (including notional principal contracts, lutures, forwards,
<br />and options) that is registered as such under the laws of the United
<br />States or any state
<br />G-A real estate investment trust
<br />H-A regulated investment company as defined in section g5.1 or an
<br />entity registered at all times during the tax year under ihe lnvestmsnt
<br />Company Act ol 1 940
<br />l-A common trust fund as defined in section 584(a)
<br />J-A bank as defined in section 581
<br />K*A broker
<br />L-A trust exempt flom tax under section 664 or described in section
<br />4947(a\(1)
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