EFTA01459359.pdf

Form W-9 (Rev. December 2014) Request for Taxpayer Give Form to the requester. Do not Dims:men: of the Treasury Identification Number and Certification send to the IRS. Internal F-wcrib Sante Name (as shown on your income lax return') Nun' is rowirud. on IF. Co not leave :nine Mans. Gratitude America, Ltd. 2 Business nanehlaregarded entity name 1offire-it her above 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exempcons (modes app// only to certain entities. not indsriduals; sea 0 Individual/sole propdabor or 0 C Corporation 0 S Corporation 0 Partnership 0 TrusVestate nstrocarvis on page 3): angler ember LLC 1 ❑ ;bated liability company. Enter the tax classification (C=C corporation, S4 corporation, Papartnership) ► Exempt payee code any) Note. For a ansis-mombior tic that is risregardec. do not check LLC; check the appropriate box in the line above for Exemption from FATCA rePorbrig the tax Massificatkin dim sirme.menbor owner. code (of any) A Other (see .nstruoticnie► Non-Profit Corporation Softly gonna Reesswgi *root nous! 2 5 Address (number, *Meet, end apt. or stale no.) Requester's name and address (optional 9100 Port of Sale Mall Suite 15 6 City, gaitandZIP code A St. Thomas, USVI 00802 List account number(s) here (optional Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social Security number backup withholding. For individuals. this is generally your social security number (SSN). However. for a resident alien, sole proprietor, or disregarded entity. see the Part I instructions on page 3. For other I I _ entities, it is your employer identification number (GIN). If you do not have a number, see How to get a T/N on page 3. or Note. If the account Is in more than ore name, see the instructions for line 1 and the Chart on page 4 for Eirmtoyer ideates-at on number guidelines on whose number to enter. Part II Certification Under penalties of perjury. I certify that: 1. The manber shown on tits form Is my correct taxpayer identification number (or I am 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 'Memel Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends. or (c) the IRS nas noticed me that tarn no longer subject to backup withholding: and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA ccde(s) entered on this form Of any) indicating that I am exempt from MICA reporting is correct. Certification Instructions. You I ust cross out item 2 above If have been notified by the IRS that you are currently subject to backup withholding because you have failed tax return. For real estate transactions, Item 2 does not apply. For mortgage interest paid, acquisition attrition of debt, contributions to an Individual retirement arrangement (IRA), and generally. payments o required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Signstuna of Here U.S. person a betel. b Cecilia tAr Dolt .)os General Instruc • Form 1095 (home mortgage Interest), 1096-E (student loan interest), 1096-T (tuition) Section references am to the Internal Revenue Code unless otherwise noted. • Form 1099-C (canceled debt) Future developments. Inkamation about developments affecting Form W-9 (such • Form 1099-A (acquiaition or abandonment of secured properly) as legislation enacted after we release it) is at www.kagovitiv9. Use Form W-9 only if you en a U.S. person (including a resident alien). to Purpose of Form provide your correct TN. An trwirndual or entity (Form W4 requested who it •eCtincl to file en intonnatlon Myou do not Tatum Fenn W-9 to the requester with e TIN, you might be subject return with the IRS must obtain your correct tartoayer a:ramification number ;PM to backup withholding. See What is backup wIchhotding7 on page 2. *No may be your social sear ty number (SSW). micrividact taxpayer identification By signing the Wed-out form, you, number (ITN, adoption taxpayer danaffration number (ATIN), or employer 1. Certify that the 11N you are giving Is correct (or you are wading for a number der Acetic, number (13e1), to report on an information return the amount paid to to be issued), you, or other amount wettable on an inlormation retum. Samples of information realms include. but am not ranked to, the following: 2. Certify that you are riot subject to backup withholding. or • Form 1099-IM (interest earned or paid) 3. Claim exemption from backup withholding if you are a U.S. OXIteltal payee. If • Form 1099.CW (dividends, including those from stooks or mutual funds) aPPINable, you are also certifying that as a J.S. person. your aaotable share of arty partnership Income from a U.S. Dote or business is not subject to the • Form 1099•MISC (venous types of income, order*, awards, or gross proceeds) witnholding tax on foreign partners' share of effectively Comities' income, and • Form 109943 (stock or mutual fund War, and certain other transactions by 4. Certify that FATCA corbel entered on this farm (if any; indicating that y00 are brokers) exempt from the FATCA reporting, le correct. See' m: is FATCA reignite" on • Form 10a9-S (proceeds from rats *state Vans/it:tons) page 2 for further information • Form 1099.K (mothant card and third party nietwun transactions) Cat. No. 10231X Forrn W-9 (Rev. 12-2014) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0119710 CONFIDENTIAL SONY GM_00265894 EFTA01459359