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Form W-9 (Rev. 1 1-2017)Paqe 5
<br />1. lnlerest, dividend, and barter exchange accounts opened
<br />before 19&4 and broker accounb considered active during 1903.
<br />You must give your correct TlN, but you do not have to sign the
<br />certification.
<br />2. lnterest, dividend, broker, and barter exchango accounts
<br />opened after 1983 and broker accounts considered inactive during
<br />1983. You.must sign the certification or backup withholding will appty. lf
<br />you are subject lo backup withholdlng and you are merely providing
<br />your coffect TIN to the requester, you must cross out item 2 in the
<br />certlfication before signing the form.
<br />3. Real estate transactions. You must sign the certification. you may
<br />cross out item 2 of the certification.
<br />4. Other payments. You must give your correct TlN, but you do not
<br />have to sign the cerlification unless you hav6 been notified that you
<br />have previously given an incorrect TlN. ''Other payments,' include
<br />payments made in the course of the requester's trade or business for
<br />renls, royalties, goods (other than bills for merchandise), medical and
<br />health cara services (including payments to corporations), paymenis to
<br />a nonemployee for services, payments made in settlement of payment
<br />card and third party network transactions, payments to certain fishing
<br />boat crew members and fishermen, and gtoss proceeds paid to
<br />attorn€ys (including payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured prop€rty, cancellation ol debt, qualified tuition program
<br />payments (under section 529), ABLE accounts (under section 529At,
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions, You must give your correct
<br />TlN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this of account:Give name and SSN of:
<br />For this of account:Give name and EIN of:
<br />wilh the Department of The
<br />Agricujture in the name of a public
<br />entity (such as a slate or looal
<br />governm€nt, school district, or
<br />prison) that receives agricultural
<br />program payments
<br />1 5. Grantor trust filing under the Form
<br />1 04 1 Filing Method or the Opiional
<br />Form 1099 Filino lvethod 2 (see
<br />Regulations seclion 1.671 -4(b){2XiXB))
<br />The trust
<br />1 List fir$t and circle the name ol the person whose number you fumish,
<br />lf only ona person on ajoint accounl has an SSN, that pors6n's nurnber
<br />must be furnished.
<br />2 Grrcle the minor's name and furnish the minor's SSN.
<br />3 You must show youf individual name and vorr mav also enter vour
<br />business or DBA name on the "Business name/disregarded ent'ity"
<br />name line. You may use either your SSN or EIN (if you have one), but the
<br />IRS encourages you to use your SSN.
<br />4 Lisl first and circle the name of the trust, estate, or pension trust. (Do
<br />not furnish the TIN of the personal representative or trustee unless the
<br />legal entity itself is nol desjgnated in the account title.) Also see Specla/
<br />rules for padnerchrps, earlier.
<br />*Note; The grantor also must provide a Form W-9 to trustee of trust.
<br />Note: lf no name is circled when more than one name is iisted, the
<br />number will be considered to be that of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someone uses your personal information
<br />such as your name, SSN, or other identifying information, without your
<br />permission, to commit fraud or other crimes. An identity thief may use
<br />your SSN to get a job or may file a tax return using your SSN to receive
<br />a rofund.
<br />To reduce your risk:
<br />. Protect your SSN,
<br />. Ensure your employer is protecting your SSN, and
<br />. Be careful when choosing a tax preparer.
<br />lf your tax records are affected by identity theft and you receive a
<br />notice from the lRS, respond right away to the name and phone number
<br />printed on the iRS notice or letter.
<br />lf your tax records are not curently affected by identity theft but you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activity or credit report, contact the IRS ldentity Theft Hotline
<br />at 1 -800-908-4490 or submit Form 1 4039.
<br />For more information, see Pub. 5027, ldentity Theft lntormation tor
<br />Taxpayers.
<br />Victims of identity theft who are experiencing economic harm or a
<br />systemic problem, or are seeking help in resolving tax problems that
<br />have not been resolved through normal channels, may be eligible for
<br />Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
<br />calling the TAS toll-free case intake line at 1-877-777-4tzg or TTyiDD
<br />1 -800-829-4059.
<br />Protect yourself lrom suspicious emails or phishing schemes.
<br />Phishing is the creation and use of email and websites designed to
<br />mimic legitimate business emails and websites. The most common act
<br />is sending an emailto a user falsely claiming to be an established
<br />legitimate enterprise in an attempt to scam the user into surrendering
<br />private information that will be used for identity theft.
<br />1. lndividual
<br />2. Two or more individuals Uoint
<br />account) other than an account
<br />maintained by an FFI
<br />3. Two or more U.S. persons
<br />0oint accounl maintained by an FFI)
<br />4. Custodial account of a minor
<br />(Uniiorm Gilt to Minors Act)
<br />5. a. The usual revocable savings trust
<br />(grantor is also trusles)
<br />b. So-called trust account lhat is not
<br />a leqal or valid trust under state law
<br />6. Sole proprietorship or disregarded
<br />enlity owned by an individual
<br />7- Grantor lrust filing under Optional
<br />Form 1099 Filing Method 'l (see
<br />Regulations section 1.671 - (b)(2)(i)
<br />(A))
<br />For this typ6 of account:
<br />8.P.nlity not an
<br />individual
<br />9. A valid trust, estate, ot pension trust
<br />'10. Corporalion or LLC electing
<br />corporate status on Form 8032 or
<br />Form 2553
<br />1 1. Association, club, religious,
<br />charitable, educational, or olher lax-
<br />exempl organization
<br />12. Partnership or multi-member LLC
<br />1 3, A broker or registered nom nee
<br />The individua,
<br />The actual owner ol the account or, if
<br />combined funds, the first individual on
<br />the accountl
<br />Each holder of the account
<br />I ne mrnor
<br />The grantortrusteel
<br />The actual ownerl
<br />The owner'
<br />The grantor'
<br />Give name and EIN ol:
<br />owner
<br />Legai eniitya
<br />The corporation
<br />The organization
<br />The partnership
<br />The broker or nominee
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