EFTA01137278.pdf

Form (Rev. December 2011) W-9 Request for Taxpayer Give Form to the requester, Do not Depertmere or de Thesury Identification Number and Certification send to the IRS. Internal Revenue Sernce Nam s shown on your InOOMI tag return) MOUNT SINAI SCHOOL OF MEDICINE &eine= name/dIsregened witty name, if afferent from abase See Specific Instructions on page 2. Chock appropriate cox for federal tax otessireatiox 0 Individual/sole proprietor taCCorlacreson 0 S Collsoraca Dnannotelie I i I rust/erste Print or type 0 Exempt payee • Limited Ilablity company. Enter !no tax classification ( C emaciation, S=S carp:ration e=pannarsn p) e Other (see ire:auctions) v. MI Address (number. street, and act or are no.) Requesters name and edema (optional) 1 Gustave L Levy Place City, state, ad ZIP code New York, NY 10029 List account nurnber(s) here (optional) Part 1 Taxpayer Identification Number (TIN) Enter your 11N In the appropriate box. The TIN provided must match the name given on the "Name" he I &eclat security number to avo d backup withholding. For Individuals, MIS is your social seetilty number (SSN). However, for • resident alien, sole propnetor. or &regarded entity, see the Pat I instructions on page 3. For other entitles, It Is your employer identification number (EN). II you do not have a number. see How to got a TIN on page 3. 1111111110 Note. If the rear Is In more than one name, see the chart on page 4 for guidelines on vinose number to enter. Part Certification Under penalties of putty, I certify that: 1. The number shown on this form b my correct taxpayer Identification number (or I em wailing for a number to be lasted to me), and 2. I am not subject to backup withholeing 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 backup withholding as a result of a failure to wort all interest or dindends, or (c) the IRS has notified me that I an no longer subject to backup withhoking, and 3. I am a U.S. citizen or other U.S. Portion (defined below). Certification instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withnoldirg because you have failed to report al 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 p cancellation of debt, contributions to an individual retrement arrangement OM, and generaty, payments Mbar than Interest and you not required to sign the certification. but you must provide your correct TIN. See the instructions on page 4. Sign asoastic„r Here Date II. 3/14/2012 U.S. person e General Instructions Note. II a requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if a Is substantially similar Section references we ea the Internal Revenue Code Unless dthelwtso to figs Form W-9. 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 la required to fee an information return with the IRS must • M individual who is a U.S. citizen or U.S. resident elan, 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 seared property, cancellation • Ni estate (other than a foreign estate), or of debt, or contribtalons you made to an IRA • A domestic trust (as defined in Regulations section 301.7701.7). Use Form W-9 only if you em a U.S. person (Including a resident alien), to provide your correct TIN to the person requesting It (the Special rules for partnerships. Partnersits that conduct a trade or requester) and. when applicable, to: business in the United States are generally required to pay a withholong tax on any foreign partners' share of Income from such business. 1. Certify that the TIN you are giving b correct (or you aro 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 a foreign person. 2. Certify that you are not subject to backup withholding, at and pay the withholding tax. TherefOre, If you are a U.S. person that Is a 3. Claim exemption from backup wIthnolding if you are a U.S. exempt partner in a partnership conducting a trade or business in the United payee. If applicable, you are also cutting 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 ncome from a U.S. trade or business status and avoid criticizing on your share of partnership ncome. is not &nice! to tee viltnholdng tax on foreign partners share or effectively connected income. Cat. No. 102SIX Form W-9 (Rev. 12-2011) EFTA01137278