EFTA01594875.pdf

Form W9 Request for Taxpayer Give Form to the (Rev. December 2011) identification Number and Certification requester. Do not Department of the Treasury send to the IRS. Inlernel Revenue Service Name (as shown on your Income tax return) . Business name/disregarded entity name. if different from above & triliZP-A) TPL(51_ (e)A1P/94/vy IA4 a c 1 Check appropriate box for federal tax clessilic at ion: III IndividuaVsole proprietor X C Corporation D S Corporation 0 p.t.mhip 0 Trust/estate g • 3 D Limited liability company. Enter the lax classification (C=C corporation. 5,5 corporation, P..partnership( IP 0 Exempt payee r: E I - 0 Other see instructions)" Addr number, strect inolcpt. 100 orpurto n.ctir) -too , e..) v _..) Requester's name and address (optional) City, state end ZIP ,ode -1' 1 aDots L.)5 VI 00b OR 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 the "Name line I Social security number T - -. to avoid backup withholding. For Individuals, this is 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 _ 111 entities. It is your employer identification number fElNi. If you do not have a number. see How to oat a I TIN on page 3. Note. If the account Is in more than one name, see the chart on page 4 for guidelines on whose number to enter. =I Certification Under penalties of perjury, [ certify that: Employer ideetracetlon number b 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number lobe issued to me). and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have riot been notified by the internal Revenue Service (IRS) that lam subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am EFTA01594875 no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cros t itern 2 above if you have been notified b the that you are currently subject to backup withholding because you have failed to report al rest an dividends on your tax r• • • ;a estate transactions. item 2 does not apply. For mortgage interest paid, acquisition or abs nment of sec ad prope •..eeseeei • debt, contributions to art Individual retirement arrangement (IRA), and nterest and dividdereverfnTh not required to slCerfelee certification, but you must provide your correct TIN. See the generally, payments other tha instructions on page 4 Sign here Signature of U.s. person lb. Ee not required to Big General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file art information return with the IRS must obtain your correct taxpayer Identification number (TIN) to report, for example, Income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made loan IRA Use 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 requester) and, when applicable, to: 1. Certify that the TIN you are giving Is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S, exempt payee. if applicable, you are also certifying that ass U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Date ■ 0 Note. Its requester gives you a form other than Form W-9 to request your TIN, you must use the requester's form if II Is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: • An individual who is a U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, • An estate (other than a foreign estate), or • A domestic dust as defined in Regulations section 301,7701-7) Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding (axon any foreign partners' share of Income from such business. Further, in certain cases where a Form W-9 has nal been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you area U.S. person that is a partner in a partnership conducting a trade or business in the United EFTA01594876 States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income, Cat. No. 10231X Form W-9 (Rev. 12-2011) EFTA01594877