|
uu I
<br />Forrn w-g Request for Taxpayer
<br />ldentification Number and Certification{Flev. lls:ernber 2014i
<br />D{iJisrlnlo!ll ol (hs llffiilry
<br />htornal tlntruo Seltr
<br />PO Box '11'l
<br />8lour1 o0 vclrr lax rr:w{t N$nie litlft
<br />PUNCH Colleclive
<br />uame/disreajarde<i aaane,
<br />3 Cll€k airprcpriale bo: tot tede.ai ts\ clKcificalioni cnalk oriy one ot llte iollowrlo seve,r birxeill
<br />:l indiviLrual,rsole tK)f)rierar or l] C i)r:rporaticr [f i; {)orporzrrior I par1,,ersni1; fj lr,,sr,r:storr
<br />:jitlq li-. - r rtefi rt;Fj i i-LC
<br />E Linrte.l liaollity oonrpany Entef tha lax cll\ilicaiio'r {C=C cor,Fr.licil,5-S crjfuorati{.rr. i]=rartnAr.lbrpl} |
<br />Nota. Fcr r srngle il)Jtirircr Ll-C iiiai is riisrcqrt.ddj, .lc iloi circ(:k 1..1-.C, :her:k llre:t!)tlroprlaie bcx,n the i{te abc'.,! iorlhe !ar, l.rs\ilr aliur..,{ lr'c sirrlle jn, Itbef c, jlcr
<br />rJlher {sea il!i.iinn:1ior;Ji }
<br />on di nol
<br />Give Form to th€
<br />requester. Oo not
<br />send to the lRS.
<br />4 Fxftrpiio,ri (ci)dris Alp\' r.\nly k)
<br />:criiljn 4nlilkts, nor krflivtdrglst se.l
<br />iri:irirc{iors cn p4qe 3i:
<br />Ir. rrrirrr pricr..odr {rl :llr .-
<br />L.)3nrFihon :rotrr lAi CA rc)po|trnrj
<br />crdo il ani)
<br />N
<br />do
<br />co
<br />o6eft
<br />a';
<br />/b
<br />L0E.G
<br />oo.{n
<br />o
<br />a
<br />itlr;ml r:i ilrFci .ri,l it'l rr s rr'e r,, .r ilt,1r: tri{i !,"ldre-Js {opliouii
<br />trlt sfnte. and ZiP codr{t
<br />wA 98946
<br />i'e.e ioDt;{lCai)
<br />ber
<br />Enter yoLtr Tlf'l in the apfiropriale box. The flN proviced ilust
<br />'nalch
<br />the rrarie given on line .l to ayoicl
<br />backup rvithircidinq For itr,Jividuals, thls is generaliy yorrf social s€cur'ity nur.tbar iSSN). Florver,er, icr,i
<br />r€siaerri alien. sole proprietor or disioljaiijed ellity. seD the Part i irislructiarns on Fage:1. Fc. otier
<br />entili€s, il is your ern6lltya' idonlifi.alion number iElN). lf vou rJn rot htve a nl*nbsr, see l/oyl i{r.lei a
<br />rlN cn page 3.
<br />i'.lote. li rhe 4{tcouDi i5 in rDefc llrair one iralriie. se€ ittc insl{uctiotrs for iir'te i rrtLl lhe c;har1 cn paq+,1 for
<br />itr:itlelinos crrr whose; rrumber to enter.
<br />number
<br />al'
<br />Employer identificatiofi number
<br />I 4 6 o
<br />El![[[_ 9e.t{se!i91,_
<br />lind€r peniilties ci perjury. i re{tilv lhat:
<br />no loilg€r slrbjocl to baci(Jil \yiilti)OldirriJi alld
<br />3 i :ln a rj.3. citi2en c( ctirer i-l 5. person i.i€iinsd bslo,v): ail,j
<br />'1. 'lh€ FATC/r coce(sl enlerei oi'i thrs fc.nr iii'anyi rndicaiing lhat i air s:xtlmpt lrorrr t-Al CP. icponing ts arrrre.:t
<br />becau.s€ you havo failed to relori ali intsrBst and dividcnd$ or your tax.eturn. ior real astate transrctions, ito'r 2 Joes not appli, For rr$rtgztgo
<br />ilslru,ciion:i rrn
<br />$ign
<br />l-lere
<br />General lnstructions
<br />Secli.Jn roielcfic.:s are ic tite !ntetiiai tietJerr.tg Coae ufi'ess otilcjyrise !toied.
<br />Fututo devgioFrerrG. lnfrrtratiofl ifroirr dev!:lopments allscln!.i i.)rri W-9 (such
<br />ac legisiat;on eiacted atter *€ reieas,? lli is ,lt rr\'/w.its.(lovll./rg
<br />Purpese of Fornj
<br />An inCividUal Or e!11i.1, iFofii W-9 reqr.,esl.{) rvtro is retiijired io tile a,r iirlornlatiilrl
<br />,elu.n with lhe lffS ar$t oiliain yo0r {-'.rrreci taxllaye. idertiticeihn lu(nber iIIN}
<br />e;hirl; rnzry be your srcial sKurity nurnba iSStt), irrdividuat laxpayer i.l8niijicatioe
<br />rrimber ijflNi, adoplion iaxpayer idenldication numlxr {nTlN}. or ei:rptoyer
<br />id€nlificalior iuntbu (FlN),ls reporl oit ur inlorrnatio:: rglu,it tit€ arriount prid [r]
<br />,,'0u. oi clirci amoUnt rersrlable ot an ifilot(tatioft ielurl, Exafl]pies of iflfoarylatio,I
<br />rstutrrs inclu(le but ate itol lifi]il€d ta. iile ioliowi|g:
<br />' for rI 1 Ogg INI i;rIerfttt earneci or iraidl
<br />" Fo.or 1O9!,-DlV {ilivkrends. irn:iudin{r tltose lrcril slrr:;t.s ijr nti,tusi iljilds}
<br />r Fqnr 1O99-i\il$C ivaiiorls types of irccrne, prizes. awarfls. or groe:i procedsi
<br />6 ftr'r 1 099-8 (srock or sru:ual lind saies and cs,lair! {)iher frtrs.lctic rs c}
<br />br(Jkersl
<br />. Fom 1 Or9-S iprcc@cjs lrcm rea: esfate fr:t]sactioasi
<br />r Form 1O9!l-K {n}Brr,'hant cafd an{l lhi.d prrty tretvrork trsrr:aclicrrs)
<br />3.
<br />Signatlre ot
<br />U.S- p€rsr >
<br />.-. )lL lt i lt.1oare F
<br />" i:cre! iCIJB illofijp rrorigaqc iflreri?:;':: 1i]-f,8 a {snriient ioitr i.rte.€slj 1{)I]il-T
<br />1l$iti3l)
<br />d F-c.,n 1oqg C ic?nceic{1 {i(t-)ii
<br />, ForrD 1 OL19-A iitxluisrtro't .tt {oandol{t.eitl ol sccttrerJ f)roFer-l},)
<br />rJse Form W-li oniy il yoo are r Li.i-l. peJstr {inclLldiirq a r?sidgrd alien), t!
<br />ir.o!ide ,,cur &x/ilct TiN.
<br />lf ytr| tis 'tol rclat FAin W'9 til iite ,lqiasw.t *-it!: a TlN, vart frilghl be S.ti)jijci
<br />io backtp u:ithhcftli?t1 i;ee Wha! i:; b?t:iup wilhltclcing? cn llagi 2
<br />Bv ii:Jnrrg ll\o iillu(l uL{ irr,n. 1., ..
<br />1 . Cenrya tllat lne llN you Are'givrr)al i:i correct {or ,ioti af c waitifig lot a .ruotiJer
<br />to he isd;ired),
<br />2, Cerlily lhat you 3fe not subject fa i)aay.rp r;iihaoldinrJ. ot
<br />3 alairn exe.Elptios lrorr l)aci(ep ?ithhojrliir!) ii yo! lre s lJ.S- exerirul p,tye,r.. ;t
<br />;tp1:ircable, ycu are i:lsi, *:rlil,vi.g lh?rt as .l i.J.S pers::n. yorrrcIioaabie shtro,t
<br />iviy patnersnip irc:orrre {rcrn a 1.j.3- traije <)r bu$iis is tot subject to lhrr
<br />withlBldi0g iax cl loreigr ltarln.:rrg' sra[: cl L'tiecltyelV coi],irfctgj i,]uonc :t{t{l
<br />4 Certi{y that IATC/i (xxieis) {rilterei on thir Inrft {:i arryJ indicstino tiHi you 4re
<br />ex€lnpt ircrr rlro FAI OA regcrtft r!1, is correct. 3oe Fri)31 ;.! FA|CI *tporioi\? or:
<br />page 2 10t iu(her :r riorrnaiiorl
<br />Fart:l
<br />Cai- No 1a)231X i:onr W-S {iinv. l2-201.1i
|