EFTA01255548.pdf

Form W m (Rev. Decomber 20t4) 9 Request for Taxpayer ORIelisiA Give Form to the requester. Do not Deportment o4 the Treasuy Identification Number and Certification send to tho IRS. internal Revenue Se'Ace I Name (as Mown on your income tax Muri). Name a required cn thls the: do not haw Ire, inn bank. Southern Trust Company, Inc. 2 Oiliness fientekliNeterded entity name, V dinerem from above See Specific Instructions on page 2. 3 Check appropriate box for federal tax ciasslficaten Check only one of the Wowing seven boxes: I 4 Exemptions NCidekh aProhly to civ El rndoidualhOle VOOttettit or 0. C Corporation 0 s Corporation 0 Partnership 0 Trustkvalo I a c :(4,:tieoni fhleg on'po rece l 3): • see single-member LLC Print or type 0 Urneed lability company. Ente• the tax classecalion paCcorparellon. SaS corcoralien, Picanneisno) a Exemp t payee code Pf any) Note. For a shoe member LL that is disregarded. do not check Lla check the aP0, 09elat• DCA in thq ine *On — Exemption Imo FATCA reporting fa the lax classiest:an of the singtrymembra owner. code fit and 0 Oilier (see Instructions)... prow„• most werawyonys es tew 5 Address (number, street, and apt. or stile r.o Requesters name and addrcre (optionie 6100 Red Hook Quarter 53 a City. alete end 2IP code St Thomas USIA ,00802 7 fist account number(s) here (optional Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. Te TIN provided must match the name given on the 1 to avoid I Social security number backup withnotcang. For individuals, this Is generally your social security number ISSN). However. fo• a resident alien, sole proprietor, or disregarded entity, see the Pan I instructions on Page 3. For ether entities, it is your employer Identification number (EIN). If you do not have a number, see How to ger 2 TIM on page 3. or Note. If the account is in more than one name. see the instrucfrons for Hie 1 and the chart on page 4 for I Imp/Dyer Identification number guidelines on whose number to enter. katpenaltiesCertification of that: Under perjury, I certify 1. The number shown on this form Is my correct taxpayer identification number Or t am wailing let a number lo be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding. or 04 I have not been notified by the Internal Revenue Service ORS) that I am subject to backup withholding as a result of a failure to report ell interest or dividends. of (C) the IRS has notifed me that I am no longer subject to backup withholding: and 3. 1 am a U.S. citizen or other U.S. person (defined below): and 4. The FATCA code(s) entered on this form el any) indicating that I am exempt Udell FATCA reporting is ccrrect. Certification instructions. You nwet cross out Item 2 above if you have been Wei .by the IRS that you are currently subject to backup withholding because you have fared to report a ' dividends on your tax rent a. real estate transactions. item 2 does not apply. For mortgage interest paid, acquisition or ab onrnant of ed property, contributions to an Individual retirement arrangement (1Rfg, and generally, payments other th Merest and et' 1 . you required to n the certification, but you must provide your correct TIN. See the insUuctions on page 3. Sign max.& :2O/2011 Signature of /7\ Here U.S. person Oaf • Farm 1039 meow mortgage attrese. 1098-E (student loan imeas0. I090-1 General Instructions thrwtto) SectIon referencia are to the Internal Revenue Code unleSS Otnen.n90 noted. • Form 1099.c icanceed debt/ Future developments. Iniormation abort developments electing Form Vii9 (such .Fuon 1099-A (acquisition or abandonment of secured propert9 as latalsiellon enacted anti we release Ida at ninwusgoe/hr9 U30 Firm W-9 only d you area V.S. person Snoorelog a residers silent to Purpose of Form parade your erect TIN. It you Co nor Mum Form avig to the inuoster wort o 7W youmignr be subject An Individual Of entity (Form W9 requester) who is rorehred to filo an infrernation return with the IRS must obtain your correct taxpayer akentalciatIOn number aim ro onlurp ytiratioldeng. See filial is OeCAuP wahrtokrio97 on era 2. which may be your social seaway number ISSN). Individual taxpayer !dentine/am By sigring the laS-out form, you: numberPIA. iderNlon (payer Identification /lumbar (ATIN). or employer 1. Cowley that the Tel you are pin% is erect for you are wallop for a number SentIcallon number (Eoe. to report on on WOrmafion return the amount pale to to be Issueol. you. a Ow amount reportable on an faceination return. Examines of Informafion returns Include, but are not limited to, the Wowing: 2. Genii,/ met you we net subject to backup mentioiding. or • Form 1099•INT (interest earned ce head) 3. Cum exemption from backup witithotoing If you are a U.S. exempt payee. if appeciable. you are sae certaying that es a U S. person, your allocable meteor • Form 1099•DIV (airecencia bokafing those from stocks or mows, funds) any pelmet Sane boo a U.S. vac* or business to not subject to try • Form 109941CSC (serious typeset Income, paces, awards, or gloss proceeds) frithfrotdieff lek on foreign Canners' Share of effectively connected acorn., and • Form 1099-B (stock or mutual fund sales end certain 0016/ tromactions by a. Cathy that FATCA codels1entered on this loon Ot any) inolcating that you are brokers/ exempt from the FATCA waren. is coney. See awe k FATCA reporting? on • Form 10994 (proceeds from real estate transactions) par 2 for higher inforniatIon. • Form 1099-K (merchant am and third Party fietrififii Cal. No. 10231X SDNY_Gail_00063067 CONFIDENTIAL - PURSUANT TO FED. R.QQN(F IDENTIAL DB-SDNY-0025892 EFTA_00173575 EFTA01255548