EFTA01583701.pdf

x iMPORTANT TAX • toREIGIT PARSON NAT /ATE 1O cONFLETt ITS PORN w atm OA PORN TUMMY A 'FORMA PINSON' - INFORMATION MEANS A NOMRSIDOENT ALIEN INDIVIDUAL. • PORTION CO4PONATIONI. • FOREIGN PPPPPPREAM A FOREIGN TRUST, A FOREIGN , AND ANT OTHER PERSON NOT ANTIS PERSON IT ALSO INCLUDES A FOREIGN "MANCH OR OPTICS OF AN U.S. TINAICIAT INITITUTIO• 04 U.S. CLEANING ONCANWATION If THE FOREIGN MUNCH II A QUALIFIED INTIMPIDIART. FOREIGN PERSONS O I AM A FOREIGN .114SON. 1 NNNNNOat 1 ACKNOTWAID4t /PAT YOU ADVISE ME TO READ THE IRS WI TAX STATUS INSTRUCTIONS 'INC/ OM II TRW PACOGEI CAREFUll I AND THAT I NAVE DUN ADVISED TO CONSULT NT. IAA ADVISOR. Please sign end Mut" the attached WI lone(s). u E. etTuaNs AND IF I HAVE NOT CHECKED THE FOREIGv PERSONS TAX STATUS BOX ABOVE. RESIDENT ALIENS UNDER MS OF PERJURY I CIERT1FT. AS nit ACCOWITPOLITE4 IMMO snow. THAT Ii{ THE TAX CERTIFICATION Nulatil SHOWN ON MS APPLICATION II TIT CORRECT ' IDENTIFICATION AMID 40* a AT/ iniTING FON A NOM* TO et ISSUED TO Nil 4%013) THAT IAN NOT SulIJACT TO SUNUP WITIINOLOONG MASSE. (A) I AM Mart FROM RUNUP WITIINOLOING. OR III I HAVE NOT DEIN NONNNN 0 re TNII i NNNNNUll SERVICE III131 THAT I AM SUNJICT TO ITACil•uP WITHHOLDING AS A RESULT OF A FAILURE TO Mt PORT ALL I AND DIVIDENDS. OM ICI Till IRS HAS NOTIFIED MI THAT I AN NO LONGED SUOJECT IC BACEMP WITHHOLDING. 4110 II) I ANA U.S. PINSON (INCLUDING A U.S. RESIDENT ALIEN/ II (ADENNNNNN THAT 0 I HAYS BEEN NOTIFIED Ilw THE MS THAT IAN SUOMI TO SACK-UP ITITNNOLTHITO AS A RESULT OF DIVIDEND ON It/ NNNNN UNDERREPORTING. AND s•AVE NOT RECEIVED A NOTICE PROM THE WS ADVISING TIE THAT BACR.UP WITHNOLOTITO IS - ENS a MUSE SHONA OR CROSS OUT ENS INIONNATION CONTAINED IN OM I IN THE PRIMUS PARAGRAPN I THE MA DOES NOT REQUIRE CONSENT TO ANY PROVISION OF THIS OOCUTIEftf OTNIR /NAN WM CERTIFICATION REQUIRED TO AVOID SACK -UP WiTIONIXIMIIG. •LHOTIO Unlit'? • COMPANIES ONLY • TAT PII•1O1411II THE HAVE CNOSON TO Si CLASSIFIED Al AN ASSOCIATION IS A CORPORATION YOU NAST CHICK ISE 1O1 TO THE LEFT OF THE WORD WW1' TO SE FROM fl ea? Vii(THNOLOTTIO ON INTEREST AND DIVIDEND SSSSSS TS. CEIPWROISE. IAN CLASSIFICATIDA WILL SE DEFAULTED TO A iP OR AS A SINGLE OWNER DISREGARDED AS AN ENTITY SEPARATE FROM ITS 3141all O (CLASSIFIED AS AN ASSOCIATION - WILE AS A 3O4FOAATTON). SIGN HERE CD ALL ACCOUNT RE ARE REQUIRED TO SIGH MELON: 0 . 01 1 / 2 /01 se r6ftli GP-) kr ), b bitlefi t a me A,. .,-f• ,", Pitt Narteindi ,,,, < 'mono.. a' t age Ott 6 hOtt tloo4 G 71e450.0.., :MI ismalde. DD , ..... / law Awftwelailri 031121a Oat HAtig bola. , Seacioal .. ..II ..ass-Tift CD ,„ , A..11:une ......ud.:41e. , MAW ^,w3atieTtle lkµAA Account Ne waft JPIA•iwa (tie Bml. •A mIP tI411 Iowa CaNtimt). ts; A a Oast ENE I'S L. N.A 841 Confidential Treatment Requested by JPMorgan Chase JPM-SDNY-00063412 EFTA01583701