|
UIJ 5
<br />w-g Request for Taxpayer
<br />ldentification Number and Gertification
<br />) Go to www.irs.govlFomWg lot instructions and the latest information.
<br />tr)
<br />c)ct)(t
<br />o-
<br />co
<br />6tro
<br />l)
<br />=
<br />65
<br />.9
<br />o
<br />o,o.U'
<br />0oa
<br />(,(lb
<br />o
<br />'tr
<br />o-
<br />Form
<br />{Rev. Nov€mber 201 7)
<br />Dspadmonl of the Treasury
<br />lntsmsl Relenue Seruic€
<br />'I Name on your tax return).on llnei do not loavo
<br />LLC
<br />n€ms/disre{|srded name,abova
<br />7 account nuanb{r{s} hars
<br />Enter your TIN in the appropriate box. The
<br />For individuals, this is
<br />TIN provided must match ihe name given on line 1 to avoid
<br />backup withholding.generally your social security number However, for a(ssN).
<br />l, later.resident alien, sole proprietor, or disregarded entity, seo the instluctions for Part For other
<br />entities,it is your employer identilication number (ElN). lf you do not have a nu mber, see How to get a
<br />TIN,later
<br />Note: l1 the account is in more than one name, see the instructions for line 1, Also see What Name and
<br />Number To Give the Requesler for guidelines on whose number to enter.
<br />Under penalties of perjury, I certify that:
<br />Give Form to the
<br />requester. Do not
<br />send to the lRS.
<br />4 Exemptions (codes apply only lo
<br />certain entities, not Individuals; see
<br />instructions on page 3);
<br />Fxempt payee code {if any)
<br />Exemption trom FATCA reponing
<br />code (if any)
<br />lApptes to ac.oinls tnaiatziltd outside the U.S'
<br />name and
<br />or
<br />1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and2' I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the lnternal RevenueService (lRS) that I am subject.to backup wiihholding as a result of a farlure to report all inieresi or dividends, or (c) the IRS
<br />-has
<br />notified me that I amno longer subject to backup withholding; and
<br />3. I am a U.S. citizen or other U.S. person (defined below); and
<br />4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FAToA reporting is correct.
<br />C€rtitication instructions. You must cross out item 2 above if you have been notilied by the IRS that you ars currently subject to backup withholding becauseyou have failed to repod all inierest and dividends on yourtax return. For real estate transactions, itern2 does not apply. For mortgage interest paid,-
<br />acquisilion or abandonment ol secured property, cancellation of debt, contributions to an individual retiremenl arrangement (1R4,;nd generally, payments
<br />other lhan interest and dividends, you are not requiroddgr6b€idhsqgdtfiedipn, but you must provide your correct Tlfi. See the instructi|ns for iart li, later.w&UOnS
<br />Sign
<br />Here
<br />Signalure of
<br />U-S, person )
<br />DNr cn=Johr Dr! Ernst,
<br />o=Dru Bru ou,
<br />T;trs
<br />General lnstruc Datei 2018.01 17 13:Og:14
<br />-08'00'
<br />Section referencos are to the lnteanal Revenue Code unless otherwise
<br />noted,
<br />Fulure developments. For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go to www.irs.govlFormWg.
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who is required to file an
<br />information return with the IRS must obtain your correct taxpayer
<br />rdentification number |flN) which may be your social security number
<br />(SSN), individual taxpayer identification number {lTtN), adopiion
<br />taxpayer identification number (ATIN), or employer identification number
<br />(EiN), to report on an information return the amount paid to you, or other
<br />amount reportable on an inlormation return, Examples of information
<br />returns include, but are not limited to, the following.
<br />. Form 1 099-lNT {interest earned or paid)
<br />Date > 01117119
<br />. Form 1099-DlV (dividends, including those from stocks or mutual
<br />funds)
<br />. Form 1099-MISC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />. Form 1099-8 (stock or mutual fund sales and certain other
<br />transactions by brokers)
<br />. Form 1099-5 (proceeds from real estaletransactions)
<br />r Form 1099-K (merchant card and third party network transactions)
<br />r Form 1098 (home mortgage interest), 1098-E {student loan interest),
<br />1098-T (tuition)
<br />' Form 1099-C (canceled debi)
<br />. Forrn 1 099-4 (acquisition or abandonment of secured property)
<br />Use Form W-9 only if you are a U.S. person (including a resident
<br />alien), to provide your correct TlN.
<br />lf you do nat return Form W-9 to the requester with a TlN, you might
<br />be subject to backup withholding. See What is backup withholding,
<br />later.
<br />3 Check appropriate box for federal tax classificalion of lhe person whose nama is entered on line I . Check only one of thelollowing seven boxes.
<br />f] lndividuallsoleproprietoror I CCorporation fl sCorporation n eartnership f] TrusVestate
<br />single-member LLC
<br />B LimiteO liability company. Enter the tax cJassification (C=C corporalion, S=S corporation, p=padnership) > ! _Note: Check the appropriate box tn the line above for the t* classilication of the single-member owngr" Do not check
<br />LLC if the LLC is classified as a single-member LLC that is disreqarded from the own-er unless the owner of the LLC isanolher LLC that ls not disr€garded irom the owner for U,S. federal tax purposes. Otherwise, a single-membe. LLCis disregarded flom the owner should check the appropriate box for the tu classification of lts own'er.
<br />Other
<br />5 Address , street, and apt. or suite no.)
<br />121
<br />state, and ZIP code
<br />numb€r
<br />Part I
<br />Employer
<br />4 6 0 9 3 5 2 3 9
<br />Part ll
<br />Cat. No. 10231X FormW-9{Rsv. 11-2017)
|