EFTA01298552.pdf

Form W-9 pet. Dearrber 2011) Request for Taxpayer Certification Give Form to the requester. Do not Sepriews d the Tansy Identification Number and send to the IRS. Nand Revenue Swim Namegeshown on vow hearse tax ream) Tear(' Xit-C • ei Saimaa ne7perdeveatined erdlyre, if Mont from above I Check appropriate box for federal tax deseiketors 0 hdindatreole proprietor 0 C Con:canon QiConsoration 0 Wirtnirshb 0 Trusuretate 0 Event Pelee 0 tinted nary cortanny. Enter tie tex deaselostkn (C=C energise. ItbS esrporetke, eertnenino ic me ............________. I iii t 0 Ottw bee InstrictIonsia 1 s Ackfr71(nwthw eio /gi ld wrGv44.4, 133 name and addesskolioneil Tkopas u5v, ocitol..-- City. state, erxl ZIP cods .1 57- Let eccowinurrintsiltere (cfaion4 Rag I Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on the •Name• fine Segel noway number to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I Mtn's-dons on pipe 3. For other entitles, it is your employer Identification number (EIN). If you do not have a number. see How to get a TIN on page 3. Note. If the account is in mare than one name, see the chart on pace 4 for guidelines on whose Employer Identlecation number number to enter. 06 Lai Certification Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer identification number (*clam waiting for a number to be issued to me), and 2. I am 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 an subject to backup withholding re a resuh of a failure to report all interest or dividends, or (c) the RS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined belay). Certifiranion instructions. You must crone out item 2 above if you have been notified by the IRS that you are amenity subject to backup withholding because you have tailed to report at interest and drvidends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of property. tanceletbn of debt, contributions to an individual retirement arrangement DRY. and generally, payments other than intern and d you are not required to sign the certification, but you must provide your contact TIN. See the instructions on page 4. , — Sign Skinature of Here U.S. pinion le lJ Date 9403 General Instructions ate.If a requester gives you a form other than Fenn W-9 to request your TIN, you must use the requester's form if It Is substantially similar Section references are to the Internal Revenue Code unless o to this Rim W-D. noted. Definition of a U.S. person. For federal tax pewees, you are Purpose of Form considered a U.& portion/you are: A person who Is required to file an information return with the IRS must • An individual who Is • U.S. citizen or U.S. resident gen. obtain your correct taxpayer Identification number (TIN) to report, for • A partnership, corporation, company, or aseociation 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 contnbutions you made to an IRA • A domestic trust (as defined in Regulations section 301.7701.7). Uee Form W-9 only/you are a U.S. person (Including a resident alien), to provide your correct TIN to the person requesting it (the Special nibs for partnerships. Partnerships that conduct a trade or requester) and, when applicable, to business in the United States are generally required to pay a withholdrg tax on any foreign partners' shore of income from such business. 1. Certify that the TIN you we giving is correct (or you we waiting for a Further, In certain cases where a Form W-9 has not been received, a number to be keyed), partnership is required to pwaurne that a partner le a foreign person. 2. Certify that you we not subject to backup withholding, or and pay the withholding tax. Therefore, if you are a U.S. person that is a 3. Claim exemption from backup withholding if you we a U.S. exempt partner in a partner hip conducting a trade or buskins in the United payee. If applicable, you are also certifying that as a U.S. person, your Slates, provide Form W-9 to the partnership to establish your U.S. eilocab:e share of any partnership Income from a U.S. trade or business status and avoid withholding on your share of partnership 'orns. is not subject to the withholding tax on foreign partners' share of effectively connected income. Cat No. 10231% Fonn W-9 give. 12-2011) SDNY_Givl_00063405 CONFIDENTIAL - PURSUANT TO FED_ „QC).NEIDENTIAL DB-SDNY-0026230 EFTA_0O1739 I 3 EFTA01298552