EFTA01255056.pdf

Form W-9 law. December 2011) Request for Taxpayer Certification Give Form to the requester. Do not p el bTarry Identification Number and ut to the IRS. send Stn.FtwertueSeivks Name (ssehown on your name tax ream) TE 6I, ..r—s&C • csi Saiwass nthstederegerdad nay nomad,Mont from above t Check targetless box for federal tax deteaketiors / 0 Indindualieole rxcerletor 0 C Corporation rgrtCorporstko CI Pannerthp 0 TessUrerate ,a CI Untied lebility earroeny. Enter ate too ellseallostkn (CaC capontkn. 8=8 oceporsticn nnmernentup) is ...---..—________. .. 0 Elena Meg 1 ! In COW ONISIMInX,DOM)fr 1 (P nwiter oo rof uy, am..*xi ZIP code d WrOvt4.4, , g .0 name and edctessireakno0 57- Titan4-$ 115v/ 0001-- Lot eccout nunixelentere 0400 4 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 I Segel **maw natter to avoid backup withholding. For individude, this is your social security number (SSN). However, for a resident alien, sole proprietor. or disregarded entity, see lho Pal I hsbuctions on pipe 3. For other entities, It is your employer Identification number (EIN). If you do not have • number, see How to get a TIN on page 3. Note. If the amount is in more than one name, see the chart on page 4 for guidelines on whose Employer Identification number number to enter. Part Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I Mn 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 am subject to backup withholding as a result of a failure to report all interest or dividends. or (c) the RS has notified me that I arn no longer subject to backup withholding. and 3. I am a U.S. citizen or other U.S. person (defined belay). Certification instrucbons. You must cross out item 2 above if you have been notified by the IRS that you ore amenity subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions. hem 2 does not apply. For mortgage interest paid, acquisition or abandonment of property. cancelathan of debt, contributions to an individual retirement arrangement PRY. and generally. payments other than intoning and d , you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign lignenure et Here U.S. person le Date a 9/403 General Instructions . If a requester gives you a form other than Form 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 Fore W-9. noted. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.& person if you are: A person who Is required to file an information return with the IRS must • An individual venal* • U.S. citizen or U.S. resident alien, obtain your correct taxpayer Identification number (TIN) to report, for • A partnership, corporation, company, or negotiation 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 *state). or of debt, or contrtutions you made to an IRA. • A domestic trust (as defined in Regulations section 301.7701.7). Uee Form W-9 only if you are a U.S. person (Including a resident alien), to provide your correct TIN to the person requesting it (the Special mks for partnerships. Partnerships that conduct a trade or requester) and, when applicable, to business in the United States are generally required to pay a withholdng tax on any foreign partners' share of income from such bulness. 1. Certify that the TIN you we giving is correct (or you are waiting for a Further. in certain taus 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 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 are a U.S. exempt partner in a partnership 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. ailocalge share of any partnwsNp Income from a U.S. trade or business status and avoid withholding on your share of partnership income. is not sutact to the withholding tax on foreign partners' share of effective& connected income. Cat No. 10231X Form W-9 (Rsv. 12-2011) SDNY_GM_00053689 CONFIDENTIAL - PURSUANT TO FED R.QP . AIE IDENTIAL DB-SDNY-0016513 EFTA_00164270 EFTA01255056