EFTA01412701.pdf

Give Form to the requester. Do not send to the IRS. Request for Taxpayer Identification Number and Certification Fofm (Rw. DKomber 20U) Oepsrtmsm of ihi Treasuiy tnisrnai Rovsnue S«rvico 1 Name (os shown on your Incomo lax reium). Nome is required on ih's line: do nol leave this Urn blank. Southern Trust Company, Inc. 2 Business namo/disregarded entity name. II dillorenl trom above Southern Financial, LLC cv 0 01 a 4 Exemptions (codes opply only 10 certain cn1111es, not iroli^oua3s; see Instructions on page 3): Exempt payee code (U snrf ExampUon from FATCA reporting codefrion^ a Check appropriate box ferfederal Un dassiflcalion: chock only one of the foMovring seven boxes: QindMdual/boloproprieloror 0 CCocporsUon 0 S Corporatlort Q Partnership D Trust/oslato slrtgle-niembef LUC Q UmHed liability company. Entor the lax dassHicatlon (CcC corporation, S>S corporation, Papartnanhlp)> Note. For a sino1D-.mcmber LLC that is disregarded, do not cheek LLC: chock the appr^Niale box In the line above for the tax clossificaiton of the single member owner. 8 II r u Q other (see Instiuctlons) Requester's name and address (opiional) 5 Addross dumber, street, and opt orsuKe no.) I 6100 Red Hook Quarter, B3 EFTA01412701 6 dty, state, and ZIP code St Thomas, USVI 0080Z 7 Ust account numborts) here (optional) I Taxpayer Iderttfficatlon Number (T1" Parti Soctol soouil" number Enter your TIN In Iho appropriate box The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this Is generally your social security number (SSN). However, fora resident aDen, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For olher entities, It is your employer Identification number (EIN). it you do not have a number, see Haw (o get a VN on page 3. or Empleyer tdentifloalten number Note. If the account is In more than one name, see the Insinjcllons for line 1 and the chan on page 4 for guidelines on whose number to enter. 86 0 7 7986 1 [Part II Certification Under penal-ides of penury. I certify that: I. The number shown on this form is my coaect taxpayer identirication number (or 1 am waiUng for a number to be Issued to me); artd 2. I am not suplecc to backup wlihhoidlng because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to baclwp v,nthholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified mo that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (denned below}; and 4. The FATCA code(s) entered on this form (if any) Indicating that I am exempt from FATCA roporling is correct. Cerdfleatlon Inatrucdene. You must cross out Item 2 above if you have been notlHed by the IRS that you are currenily sut"ect to backup vrfthhotdlng because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and generally, payments other than Interest and dividends, you are nol required to sign the certilicailon, but you must provide your correct TIN. See the instructions on page 3. Sign Here signature U.8. pefBon> 1 ^ Ooto> EFTA01412702 A I Fenn 1098 (ttome mortgage imerest), 1098-b laiudent loan tnleresl), 1098'T (lukion] • Fonn 1099*C (cancolod debt) ■ Form 1099<<A (acqulsilion or ebandonrnem of secured property Use Form W*9 only If you are a U.S. poteon "tiding a rosldam alien}, to provtdo your corrodTlN. tf>ou do nor return Form tV-9 fo (he requesierw/tfi a TIN, you mtgfitba sut)toc( (0 Mckirp withholding. See Whet la backup whhhokiing? on page 2. By algrdng the fined-out form, you: 1. Certify that the TIN you are giving Is coned (or you ero wohlrrg for a number to be issued), 2. Cortify that you arc not subject to baclup withholdirtg, or a. Claim exemption from backup withholdirtg If you aro a U.S. exempt payee. It appllc"le, you are also certifying (hat as a U.S. person, your aBocable diare of any oannor"lp Income from a U.S. trade or business Is not subject to the villhhokling lax on foreign partners' share of effectively corrHiCtod Inooms, and 4. Certify that FATCA code(s) entered on this lorm (if any) kxScatlng that you are exempt bom the FATCA reporting, b OorrecL See VAim b FATCA repetiing? on page 2 for further Info.'matiDa General Instructions Sodlon references are to the Inlerrul Revenue Code urtiess othenvtss noted. Future developmenta. Information about devotopments affecting Form W-9 (such as legislation enacted alter we roieass h) b at wwwiugov//W9, Purpose of Form An Individual or entity (Form W-9 requester) who b required lo no an Inlomtaiien return with the IF" must obl" your co-Tect toxp"cr Idemifloaiion number (TIN) which may be your social security number (SSI", hdlvldUB] taxpayer Idenlillcailon number IlT1N). adopUontaxpayE» . Idenlillcailon number (AT1N), or employer kfentilicaUon number (BN), lo repnt on an Inlormatkxi return the amount paid lo you, or other amount reportable on an inlormatlon return. Examples of Information returns Inciudo, but ere not limited lo, the follow^ • Form 1099-INT (interest aarrwd or paid) • Form t099*DIV (dividends. Including those from stocks ormutual funds) • Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mulial fund sales and certain other transactions by brokets) • Form t099'S (proceeds from real estate transactions) • Form I099-K(merchantca(dandlhlrdpartynstworkiran3actlon3) Form W-9 (Rev. 12-2014) CaLNo.10231X EFTA01412703