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Fo.m W-g (Rev. '1 1-201 7)Page 3
<br />Crimlnal p6nalty_lor falsifying information, Willfully falsifyirrg
<br />e€rtillcalions or affirnations may subi€ct you to criminal p6naities
<br />including lines andlor imprisonment.
<br />Misuse ol TlNs. lf the requester discloses or uses TlNs in violation of
<br />federal law, the requester may be subject to civil and criminal penalties.
<br />Specific lnstructions
<br />Line I
<br />You must enter one oi the following on this line; do not leave this line
<br />blank. The name should match the name on your tax return.
<br />lf this Form W-9 is for a joint account (other than an account
<br />maintained by a foreign financial institution (FFl)), list first, and then
<br />circle, the name of the person or entity whose number you entered in
<br />Part I of Form W-9, lf you are providing Form W-9 to an FFI to document
<br />a joint account, each holder of the account that is a U.S. perso. musl
<br />provide a Form W-9.
<br />a. lndividual. Generaily, enter the name shown on your tax return, lf
<br />you lave changed your last nafiro without informing the Social Security
<br />Adminislration (SSA) of the name change, enter your first nanre, the lait
<br />name as shown on your social securily card, and your new last name.
<br />Note: lTlN applicant: Enter your individual name as it was entered on
<br />your Form W-7 application, line 1a. This should also be the same as the
<br />name you entered on the Form 1040/1040N1O40E2 you filed with your
<br />applicalion.
<br />b. Sole proprielor or single-member LLC. Enter your individual
<br />name as shown on your 1040/1D40Nl040EZ on line .1. you may enter
<br />your business, trade, or "doing business as', (DBA) name on line 2.
<br />c, Partnership, LLC that is not a single-member LLG, C
<br />corporation, or S corporation. Enter the ontity's name as shown on the
<br />entity's tax return on line 1 and any business, trade, or DBA name on
<br />line 2.
<br />d, Otherentities. Enteryour name as shown on required U.S. federal
<br />lax documents on line 1. This name should match the name shown on the
<br />charter or olher legai documont creating the entity. you may enter any
<br />business, ttado, or DBA name on line 2.
<br />e. Disregarded eniity. For U.S. ledoral tax purposes, an eniity that is
<br />disregarded as an enlily separate from its owner is tfeat€d as a
<br />"dlstsgarded entity.'' See Regulatlons seclion g0l,T701-2(c)(2)(iii). Enter
<br />tho own6r's name on line 1- The n6me of the entity entered on line 1
<br />should never be a disregarded entity. The name on line 1 should be the
<br />name shown on the income tax return on which the income should be
<br />reported. For oxanrple, if a foreign LLC that is troalsd as a disregarded
<br />entity for U.S. ledoral tax pueo$s$ has a single ownor that is a [.S.
<br />person, the U.S. owner's name is required to be provided on line 1. lf
<br />the direct owner of the entity is also a disregarded entity, enter the first
<br />owner that is not disregarded tor federal tax purposes. Enter the
<br />disregarded entity's nam6 on line !, "Business name/disregard6d entjty
<br />nsmo." li the ownsr of the disrsgarded entity is a foreign person, the
<br />owner must complete an appropriate Form W-g instead of a Form W-9.
<br />This is the case even if the foreign person has a U.S. TlN.
<br />Line 2
<br />lf you have a business name, trade name, DBA name, or disregarded
<br />entity name, you may enter it on line 2,
<br />Line 3
<br />Check the appropriate box on line 3 ior the U.S. federal tax
<br />classification of ths person whose name is entered on line 1. Check only
<br />one box on line 3.
<br />Line 4, Exemptions
<br />lf you are exempt from backup withholding and/or FATCA reporting,
<br />€nter in the appropriate spac€ on line 4 any code(s) that may apply to
<br />you.
<br />Exempt payee code.
<br />. Generally, individuals (including sole proprietors) are not exempt from
<br />backup withholding.
<br />. Except as provided below, corporations are exempt from backup
<br />withholding for certain payments, including interest and dividends.. Corporations are not exempt from backup withholding for payments
<br />made in settlement of payment card or third party network traniactions.. Corporations are not exempt Jrom backup withholding with respect to
<br />attorneys'fees or gross proceeds paid to attorneys, and corporations
<br />that provide medlcal or health care seruices are not exempt with respect
<br />to payments reportable on Form 1099-MISC.
<br />The following codes identify payees that are exempt from backup
<br />withholding. Enler the appropriate code in the space in line 4.
<br />1-An organization exempt from tax under section 501(a), any lRA, or
<br />a custodial account under section 403(bX7) if the account satisfies the
<br />requirements of section 401(0(2)
<br />2-The United States or any of its agencies or instrumentalities
<br />3-A stat€, the District of Columbia, a U.S. commonwealth or
<br />possession, or any of their political subdivisions or instrumentalities
<br />4-A foreign government or any of its political subdivisions, agencies,
<br />or instrumentalities
<br />5-A corporation
<br />6-A dealer in securities or commodities required to register in the
<br />United States, ihe District of Columbia, or a U.S. commonwealth or
<br />possession
<br />7-A futures commission merchant registeted with the Commodity
<br />Futures Trading Commission
<br />8-A real eslate investment trust
<br />9-An entity registered at all times during the tax year under lhe
<br />lnvestment Company Act of 1940
<br />10-A common trust fund operated by a bank under section Sg4(a)
<br />1 1 -A financial institution
<br />12-A middleman known in the investment community as a nominee or
<br />custodian
<br />13-A trust exempt from tax under section 664 or described in section
<br />4947
<br />lF the entity/person on line 1 is
<br />a{n}. . .
<br />THEN check the box for . .
<br />' Corporation Corporation
<br />. lndividual
<br />. Sole proprietolship, or
<br />. Single-member limited liability
<br />company (LLC) owned by an
<br />individual and disregarded for U.S
<br />federal tax purposes,
<br />lndividual/sole proprietor or single.
<br />member LLC
<br />. LLC treated as a partnership for
<br />U.S. federal tax purposes,
<br />r LLC that has filed Form 8832 or
<br />2553 to be taxed as a corporation,
<br />or
<br />. LLC that is disregarded as an
<br />entity separate from its ownor but
<br />the owner is another LLC that is
<br />not disregarded for U.S. federal tax
<br />purposes.
<br />Limited liability company and enter
<br />the approp.iate tax classification.
<br />(P= Padnership; C= C corporation;
<br />or S= S corporation)
<br />. Partnership Partnership. Trustlestat€Trust/eslate
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