EFTA01390382.pdf

IV. TAX ELECTION/DECLARATION OF TAX STATUS This Account Agreement la designed for use by both U.S. NOCOS and Non-U.S. Persons. Please check the box next to the applicable dem belcnv. °lent certifies that Client will notify DBSI In writing Immediately If the representation certified to below ceases to be true and correct. 1.0 U.S. Citizen or U.S. Reeklent Allen FormW9 Request for Taxpayer Identification Number and Certification Substitute 4'ACA is., ' Name ore er...3.tytior Income tax 'return) (faerne.e bkr611 ( I% V 3104 AlCi ittiditithl)40,.SAKv guaidas manage ant name, different from aboini Chock oppropdaste box for federal tax classification (roduired)• 3 Individual/sole proprietor ii C Corporation ❑ S Comonstion O Partnership O Tnietiestate • erecnot bliVed O Limited liability company. Eller the tax classification (C-C corporation. S.S corporation. P•pertnershipj 0 Other 0 Address umber, etc 2 r i vill-e r 4 •/ AVA and opt or Tray /0O .0fA 3 City. Stole, and ZIP code .. 57 .7 kor“v,„ 1/5 te; Cola 1.- 3Taxpayer Identification Number (TR u Enter your TIN In the eppropriate box. The TIN provided must match the name given on the "Name" Ikw to avoid baCkup wahhceding. For Individuals. this is your social security number (SSN). Far other entitles. It is your employer identification number (EIN). 1 -00-(1111 mom EMI Certification Under penalties of perjury, I certify that; 1. Tho number shown on des form is my correct taxpayer Identification number (or I am waiting for a number to bo issued to me), and 2. 1 am not subject to backup withholding because: Ie) I am exempt from backup withholding, or (b) i have not been notified by the Internal (revenue Service that lam subject to backup withholding as • result of a failure to report all 01101051 or dividends. or (cline IRS hes notified me that I am no longer subject to backup withholding. end 3. I am a U.S. citizen or other U.S. person (defined In the inalriactionsi. Centlicatkin instructions. You must cross out non) 2 above It yotaisve been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return. ter Sign Here Monate/sof U.S..person Data •S 9/05 2 O Non-U.S. Perron I am not a U.S. person (Including ir U.S. resident alien). I am submating the applicable Form WO with tiff form to certify my foreign status end. If aprilicatire, claim lax treaty benign,. For example: Client Is not a U.S. person (Including a U.S. resident alien). Client agrees to provide DBSI with this application the applicable internal Revenue Service (IRS) Form W-8 to certify the client's foreign status. W-8 forms and Instructions are available on the IRS website at www.Irs.gov. 13.AWM.0196 6 012145.C32813 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0094873 CONFIDENTIAL SDNY_GM_00241057 EFTA01390382