EFTA01386259.pdf

Form W-9 (Rev. 12-2014) Page 4 Part II. Certification 'You oval show your rdMdial name and you may also enter your business or DRA name on the Vuelnosa nernedisregardee entity' roma line. You may use edfw your SSN or EIN el you To establish to the withholding agent that you are a U.S. person. or resident alien. TOM OneetiA the IRS encturegas you to use your SSN. sign Form W-9. You may be requested to sign by the withholding agent evert if ' Up Ant and aide the nuns of the eon, ease. or person twat. (Do not turban the finial the items 1. 4. or 5 below indicate otherwise. pommel represensitive or trustee unless the legal amity melt le not slasiertatee m Ile scant For a Joint account. only the person whose TIN is shown in Part I should sign NW see Specialruns for twowsnos on page 2. (when required). In the case of a disregarded entity, the person identified on line 1 'Note. Groner aloe must provide a Form W-9 to lmstee a/ trust must sign. Exempt payees, see &SWIM'S& 00dr/earlier. Note. If no name is circled when more than one name is listed. the number w11 be Signature requirements. Complete the certification as indicated in items 1 considered to be that of the first name fisted. through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 Secure Your Tax Records from Identity Theft and broker accounts considered active during 1963. You must owe your Identity theft *cars when someone uses your personal information such as your correct TIN, but you do not have to sign the certification. name. SSN, or other identifying information, without your permission, to commit 2. Interest, dividend, broker, and barter exchange accounts opened after fraud or other crimes. An identity thief may use your SSN to get a job or may file a 1983 and broker accounts considered inactive during 1983. You must sign the tax return using you. SSN to receive a refund. certification or backup withholding will apply. If you are subject to backup To reduce your risk: withholding and you are merely providing your correct TIN to the requester. you • Protect your SSN. must cross out item 2 in the certification before signing the form. • Ensure your employer is protecting you SSN. and 3. Real estate transactions. You must sign the certification. You may cross out den 2 of the certification. • Be careful when choosing a tax prepare,. 4. Other payments. You must give your correct TIN, but you do not have to sign If your tax records are affected by identity theft and you receive a notice from the certification unless you have been notified that you have previously given an the IRS. respond right away to the name and phone number printed on the IRS incorrect TiN. -Other payments include payments made in the course of the notice or letter. requester's trade or business for rents, royalties, goods (other than lotus for II your tax records are not currently affected by identity theft but you think you merchandise), medical and heath care services (ndudng payments to we at risk due to a lost or stolen purse or wallet, questionable credit card activity corporations), payments to a nonernployee for services, payments made in or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit settlement of payment card and third party network transacbons, payments to Form 14039. certain fishing boat crew members and fishermen. and gross proceeds paid to For more information, see Publication 4535. Identity Theft Prevention and Victim attorneys (including payments to corporations). Assistance. 5. Mortgage Interest paid by you, acquisition or abandonment of secured Victims of identity theft who are experiencing economic harm or a system property, cancellation of debt, qualified tuition program payments (under problem, or are seeking help in resoMng tax problems that have not been resolved section rash IRA, Covordeil ESA, Archer MSA or NSA contributions or through normal channels, may be eligible ear Taxpayer Advocate Service (TAS) distributions, and pension distributions. You must give your correct TN. but you do not have !o sign the certhica!lon assetance. You can reach TAS by calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD 1.800-829.4059. What Name and Number To Give the Requester Protect yourself from suspicious emails or phishing schemes. Plashing is the creation and use of email and websdes designed to mimic legitimate business For this type of account: Give name and SSN of: emails and websites. The most common act is sending an email to a user falsely claiming to be an established legitimate enterprise man attempt to scam the user ' individual The individual into surrendenng private information that will be used for identity theft. ' Two or more individuals (joint The actual owner of the account or, account) it combined funds. the first The IRS does not initiate contacts with taxpayers via nib. Also, the IRS does not request personal detailed information through emai or ask taxpayers for the individual on the account PIN numbers, passwords, or similar secret access information for their molt card. 3. Custodian account of a minor The minor' bank. or other financial accounts. (Uniform Gift to Minors Act) If you receive an unsolicited email claiming to be from the IRS, forward this 4. a. The usual revocable savings The grantor-trustee' message to phishingein.gov. You may also report misuse of the IRS name, logo, trust (grantor is also trustee) or other IRS property to the Treasury Inspector General for Tax Administration b. So-called trust account that is inGyzg al 1.800.366.4484. You can forward suspicious entails to tho Federal Tice actual owner not a legal or valid trust under Trade Commission at: spemouce.goy or contact them at www.ftc.govirdthelt or state law 1-877-IDTHEFT ft -877-438.4338). 5. Sole proprietorship or disregarded The owner Visit IRS.gov to learn more about identity theft and how to reduce your risk. entity owned by an individual 8. Grantor trust filing under Optional The grantor' Privacy Act Notice Form 1099 Filing Method 1 (see Regulations section 1.671-491X2)0) Section 6109 at the Internal Revenue Code requires you to provide your correct lAi) TIN to presorts (including federal agencies) who are required to fie information returns with the IRS to repot interest, dindends, or certain other income paid to For this type of account Give name and EIN at: you: mortgage interest you paid: the acquisition or abandonment of secured 7. Disregarded entity not owned by an The owner property: the cancelation of debt: or contributions you made to an IRA. Archer indnodual MSA, or HSA. The person collecting this form uses the information on the form to Ale information returns with the IRS, reporting the above information. Routine uses 8. A valid trust, estate, or pension trust Legal eminj of this information include giving it to the Department of Justice for civil and 9. Corporation or LLC electing The corporation criminal litigation and to cities, states. the District of Columbia. and U.S. corporate status on Form 8832 or commonwealths and possessions for use in administering their laws. The Form 2553 information also may be disclosed to other countries under a treaty. to federal and 10. Association, club. religious, The organization state agencies to enforce civil and climatal laws, or to federal law enforcement and charitable, educational, or other tax- intelligence agencies to combat terronsm. You must provide your TIN whether or exempt organization not you are required to file a tax return. Under section 3406. payers must generally withhold a percentage of taxable nterest. dividend. and certain other payments to 11. Partnership or multi- member LLC The partnership a payee who does not give a TIN to the payer. Certain penalties may also aPPIY for 12. A broker or registered nominee The broker or nominee providing false or fraudulent information. 13. Account with the Department of The public entity Agriculture in the name of a pubic entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust fling under the Form The trust 1041 Filing Method or the Optional Form 1099 Fling Method 2 (see Regulations section 1.671.4(b)(2)6) (B)) 'List Thy end circle to named the Minton Mose miter you turrish.11only one POrtiOn on a paint meant Ms an SSN. that person's number mat be furnished. 'Circle the maces mane and *nth the minces SSN. CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0087873 CONFIDENTIAL SDNY GM_00234057 EFTA01386259