EFTA01388758.pdf

kern W i" 9 Request for Taxpayer Give Form to the (Rev. November 2017) Identification Number and Certification requester. Do not Department of theTreasury internal ReremeSewice I. Go to www.irs.gov/Forml1/9 for instructions and the latest information. send to the IRS. i Name (as shown on your tncome lax return). Name is required on this fine: do not leave this line blank, Gratitude America, Ltd 2 Business nameldisreganleid entity name. if different from above See Specific instructions on page 3. 3 Check appropriate box toe federal fax classification or the person whose name is entered on line 1. Chock following seven boxes. only one of the 4 Exemptionsbodes apt* only to certainentities, not indancitiats: see instructions ea Page 3): 0 individual/sole proprietor or senora-member LLC • C Corpomtion 0 5 Corporation 0 panneahip 0 Trustrestate Print or type. Exempt payee code of any) 0 Limited liability company. Enter the tax classification (CuC corporaMon. SeS 00r6OcaliOn, P.PannerS*), Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do check Exemption from FATCA rePonirg LLC it the LW is Classified as a single-member LLC that is disregarded from the owner unless the owner of notLLC the another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member it of ono is disregarded from the owner should check the appropriate box for the tax dassification olds owner. LIZ that 0 Oliwo (see Instructions). Exempt Private Organization Oxen 10JOC “na“<sec P.ti3) 5 Address (rlumber, street, and apt or suite no.) See instructions. Requester's rame and address (opener) 9100 Poart of Sale Mall, Ste 15 6 City, stale, and ZIP code St. Thomas, USVI 00802 7 List account number(s) here (optionae 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, a disregarded entity, see the Instructions for Part I, later. For other entities. it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. Or Note: If the account is in more than one name, see the instructions for ine 1. Also see That Name and Employer klendfleation member Number To Give the Requester for guidelines on whose number to enter. l i agl Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am walling 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 ratified by the eternal 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 has rue/lied me that I am no longer subject to backup withholding: and 3. I am a U.S. citizen or other U.S. person (defined beitaw); and 4. The FATCA code(s) entered on this town Of any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup yhtholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage intent paid, acquisition or abandonment of secured property. cancellation of debt, contributions to an individual retirement arrangement (IRA), and geneally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions !or Part II, later. Sign Signature of k Here U.S. person a. k t to, N-\2A Date Ilk General Instructions • Form 1099-ON (dividends. including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise noted. • Form 1099-MISC (various types of income, prizes. awards, or gross proceeds) Future developments. For the latest information about developments related to Form W-9 and its Instructions, such as legislation enacted • Form 1099-B (stock or mutual fund sales and certain other after they were published, go to wiinvirs.gov/ForrnW9. transactions by brokers) • Form 1099-S (proceeds from real estate transactions) Purpose of Form • Form 1099-K (merchant card and third party network transactions) An individual or entity (Form W-9 requester) who is required to file an • EOM 1098 (home mortgage interest), 1098-E (student loan Interest), information return with the IRS must obtain your correct taxpayer 1098-T (tuition) Identification number (TIN) which may be your social security number • Form 1099-C (canceled debt) (SSN), Individual taxpayer Identification number (MN), adoption • Form 1099-A (acquisition or abandonment of secured property) taxpayer identification number (ATIN), or employer Identification number (EIN), to report an an Information return the amount paid to you, or other Use Form W-9 only if you are a U.S. person (incksding a resident amount reportable on an information return. Examples of information alien), to provide your correct TIN. returns include, but are not limited to, the following. If you do not return Porn, W-9 to the requester with a TIN, you might • Form 1099-INT (interest earned or paid) be subject to backup withholding. See What is backup withholding. later. Cat. No. 10231x Form W-9 (Rev. 11-2017) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0092499 CONFIDENTIAL SDNY GM_00238883 EFTA01388758