EFTA01295000.pdf

Form W-9 (Rev. Deserrew 2011) Request for Taxpayer Give Form to the requester. Do not Depirtmere d the Terway Identification Number and Certification emend to the IRS. nand Reverse Set Name (es sheen on yew inane we Mune TICE LI,C, NSusinseanameideregirded entity owns a different nom .,how Check exanssiere box for Wenn to ciessacwron • IndividaVeole prooreux ID C Commotion • S Corporetizn 0 pernersho 0 Trust/awn IJilsed liability company. Enter Ow rex dwarfcat ion (C....0 COPOraban. S'S COMOrat al. P.Wartinh 34/ ) ) . 1),.. rei _eect) Dew*MS t 1 •6 0 Other nee instructions/ e E. i Aderrert Zteri r theet lod Writ 0 . ..1 4. _ .t." 1"/ i2., Vi 7-10,10, Li5 v/ t; Qty. ante, end ZIP code os :ir cos t.,,,- Ust wocare matmrfo)hom (aplomb Part I Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on the 'Name line Social ',aunty mat. to avoid backup withholding. For individuals, this is your soda Wocurity number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, is. the Pert I instructions on page 3. For other anti-nee, it is your employer identification number (EIN). If you do not have a numbs; see How to get 71ht on page 3. Note. 11 the account is in more than one name. see the that on page 4 for guidelines on whose Employer identlfication number number to enter. Part II Certification NSW Under penalties of perjury, I certify that 1. The nuniber shown on this form is my correct taxpayer identification number (or 1 am waiting for a number to be issued to me), and 2. lam not subject to backup withholding because: (a) I am exempt from backup withholding. or (b) I have not been notified by the Internal Revenue Service (IRS) that I arn subject to backup withholding as a remit of • talon to report all intereet or dividends, or (c) the IRS has notified me that t am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must <roes out Item 2 above if you have boennotifled by the IRS that you we currently subject to backup withholding because you have failed to report all interest end dtvidehds on your's,relLin. For nal estate transactions, Item 2 does not apply. For mortgage Interest paid aoquisiticn or abandonment of secured p watcistarkin of debt. Contributions to an individual retirement arrangement (RA), and generally, payments other than interest and dividends are not required to sign tine certification, but you must provide your correct TIN. See the instructionsCO page 4. Sign sinter. a Here us. Innen► Date e General Instructions Note. If a requester gives you a form other than FOIT1 W-9 to request your TIN, you must oaths requesters form if It is substantially similar Section references ate to the Internal Revenue Code unless otherwise to this Form W4. noted. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.S. person if you are: A person who is required to file an information return with the IRS must • An individual who Is a U.S. citizen or U.S. resident alien. obtain your correct taxpayer identification number (TIN) to report, for • A partnership, corporation, company. or association created or example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation • An estate (other than a foreign estate). or of debt, or contributions you made to an If • A domestic trust (as defined In Regulations section 301.7701.7). Use Fenn W-9 only if you are a V.S. person (Including a resident alien), to provide your correct TIN to the person requesting it (tat SP•olel riles fen partnerships. Partnerships that conduct a trade or requester) and, when applicable. to: business in the United States are generally required to pay a withholding tax on any foreign partners' share of Income from such business. 1. Certify that the TIN you en giving Is correct (or you an waiting for a Further, in certain cases where a Form W-9 has not been received, a number to be issued). partnership is required to presume that a partner Is • foreign person. 2. Certify that you we not subject to backup withholding, or and pay the withholding tax. Therefore, if you are a V.S. person that is a 3. Claim exemption from backup withholding if you we a U.S. exempt partner in a partnership conducting a trade or business in the United payee. If applicable, you are also certifying that as a U.S. person, your States, provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S. trade or business status and avoid withholding on your share of partnership Income. is not subject to the withholding tax on foreign partners' share of effectively connected income. Ca No. 10231% Faro W-9 (Rev. 12-2011) SDNY_GM_00053682 CONFIDENTIAL - PURSUANT TO FED. R.QP AKE IDENTIAL DB-SDNY-0016506 EFTA_00164263 EFTA01295000