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-,.._....-•.-• -?-y•?•b•NWfiYkyci?AiYEfi... o! . ....- M?aMifYi?IIlYMY1MmM? <br />44007 5714 P.2 <br />Jan 1S 05 10:11a Ci; of North Olmsted <br />Give facm to Ehe <br />Reguest fot' Taxpayer reQuester. oQ not <br />=:rm V `g Cg{t{?iGa?[Ott secidto the ERS. <br />Rev. Decemcet 20?1 Ic?entifcatian Numb'er and <br />':?y R.vem+? Sernca <br />Name See Speerfic Inz4rucaaa on page 2.i <br />- <br />City af I3orth Olmsted ?c Insi?ueuoes on Da9e 23 <br />ame. Wt[eJenc hotc? eeava l5ee SQ?uf • .. <br />a Buscne5s n d <br />otm _1?c=1.i alit ---• <br />., ?] . c_..._._--------- ----- <br />`o . Q Corpaanan Q PanncshlP , <br />? Check aPpraP-te bmc: ? Ind?MduaUSaie P?O?e10r R?escer s nartic aan aacrrss ldpuo?l <br />N qocress 1??+??. W. ana a0c. or suue na•1 • <br />n 5200 povez Center Road <br />a• . C?ily. suua and LP cocla <br />Nortlt dlmsted Ohio.. 44070 Vsc aeweutt wmoectsl here (apooneA <br />_ , _ _ .5-ke, 1TfN1 <br />Enter yo? ?? in ?he apPmP?? hox. Fbr <br />,r?dn,ichcals, this is your seeiat ="??LY number <br />(55M• However. for ?ed entirl? <br />e?° Ehe Part ! <br />P?cprieiar . oc disrag. <br />innnsccions on pa9a 2 For ather enudes. iC is yauc <br />emgloyer idenuiicauon nuin trer t?«'?1• ?f you da noc <br />have ? numb?• see How ce 9ec a TIN on page 2. <br />Nate:lf the acco 4 d??aOQ ?ase umoe?' <br />uhe ctran on page P for . <br />ta enfer: <br />?? „-,.?;-";? <br />oc <br />EmPbY? idenri?TMMOer <br />3 4,6 0 0(2{D 4 8 ? <br />far U.S. Payees Exempt From <br />BackuR INithholHing (See Uta <br />iasttucu0115 on paae 21 <br />. aY• 1 cer[itY that or 1 am vraiting far a numher to be issued m me). and <br />tlnder 1?atue5 0( Pedidend6cation r?umbec t a (trl I ha?re not heeRt tsatified by the Intund <br />teport atf inte? °C d??dends. or tcl ?? ?? t1°g <br />i. The nufibec sttou?m an this ?fidding ? s? ! m exetnPt (rom trackuP !rrithhofdmq. <br />j• 'ece to bacla?P'M[hh°?+ng as a resulc ot a fai[ure to <br />L Rgyenue 5ern fl?1 t?haC F ( arn su61 <br />et sub'ect to bacscup v?nthhoidng. and <br />nodfierl me that t am no long 1 <br />oufied by the lRS that }fou ara cu?T?'tiy s?? tQ backup <br />? am a atiertl. <br />Ce'rtificntior+ insuuctiocss. ?loa mssst aoss out item z above tt you havE b? r? real estace vansaaions. item 2 does swt aPP?Y• <br />report a res[dent l{ inteces[ and dividends on ya taz recum For <br />;,,,. rirhheid'i?g u.Sbe_ c pecsausean You f?tudi have ng faifaed U.S w U.S. <br />abanaenmenc af secuced ProPe?Y. canceltadan ot de4?t?c to s96n the CeRification, hu[ you ti+usc <br />?d, ??ia 'on or ou are nac req ' <br />FQr moRqage inter?st p a ents other chan enteresc and d'nridende. y . <br />arrangecnen? (lRAl. and generalty- p 7RT? <br />prrndde youc cerrecc TiN. (See t1e i???Ons on ^age 2•1 . ? ' w_._ ? T/. / <br />Sgn signauu0 a' `/# A U f <br />Here t!S Pen«? ? ? ' <br />Purpose of Form <br />p persan wtto i5 RQmed to fie sn irsfomsadao rolm, <br />rew-n ? ?d ?enof? namb? (TiNI ?P? for <br />? cne id w y?. ? ?ts <br />examP?e- inco e iMerest y? Paid, <br />transaarmss. rnor?9 fl <br />a?quisiriort or abandonment of seaaed RraPerY• <br />macie <br />cancelladon ut debt or eoPviheioo? you <br />;p an IRA. <br />Use Focm W.S onty if you ere e US. p`so^ <br />(nduing a resident alien). w gin 1fatir cosrect <br />TIN to the pecson requestin8 rc? r??gy <br />anei. tvhen aPPGcahle} to: <br />1. Cetvly tne TIN you are g'rvi-9 Ls cocrees (or <br />you arc rrsitin9 fa a nurnbec co be issued)• <br />Z CeciifY you are not wbject Ti, badcuP <br />widdtnlcgna. or ??otdng i[ <br />3. Ctai[st exempcion from badcuA <br />you nre a U.S. eiempc PaYL41• <br />tt ypq ace a foreign per$= ? . <br />appropcsace Form ?Y-S. See P?- <br />NfithholdiFlg of Tax on Nanresident N1e"s a"d <br />Faeign Cocpocauons. <br />Hate !f a requester gives you a form ou'er uTan <br />Form W-3 to requesc yaur ilK. !'ou rnusr use [he <br />reqtlesief'S fam7 d It ts Substanvaf/y srmifaf ro thrS <br />Form W-9. <br />W+gt ?2 whmxmbg? ?ersons maldng <br />ee?sam psYm? L4 Y°U _.St wtthhold and pW!Y <br />?,? <br />ca the lRS 31% af such ?? ? ?hhokdic?g.. <br />c?• ? ? ?? baclaiP <br />that maY b, w?a [n . <br />P?i?ng mdode itae?- dmdends. broket ?. <br />and bartrr escher9e U;aTisactions' -nts. <br />?? ?M? ? opepacw-, Real <br />psqpe aansacuons are noc 5ubjed co ba..iNp <br />wichhoidin9• em ' requesmr ? CwBc-t TiN. <br />makayouche p P? cerd?n- and mPorYOW <br />t a taz <br />yucr wxabte intetesL a?? ?, ° bsudlect <br />? ? ??? <br />? tie ?eci ta 6+cYiP s w+??g <br />s, Yau do noc fumtsh Y°'Ir TIM LO the ' <br />requesw, ot <br />'a? <br />2. you d6 not ce?Y Y°? ?H ?n <br />(see the Part ItI insuucA°ns on page Z far <br />dewas). a . <br />, <br />Z, The IRS teiis the requ?ster cha[ you <br />kuntshed an inc:naea T4N. ot <br />4 m ng because you did not ceport <br />oackuP wthhotd iax ra?am <br />ap your in[?est and d'Nidettds on Ya <br />tfor repa?adle incerest ana dividends ontY1• or <br />5. Yon Ca noc certi(y to the rniumter tfWC you <br />ara not sub}ea tO ul ine ce?es? 4 <br />'w'?"d arld abave Ba ?? <br />accouas oPened? 1981 ont?. <br />. <br />e+?-' xYn'e:'ts ?= exer.+P? <br />Sas te PetS't <br />? and the sePatste is+struai-d ta' <br />the ReqU?er of Fomi W-8. <br />penattces <br />FaiFurc tc ?h T?N- If ynu Ead to turt ash yas <br />cocrect 71N to a re4uesrrt yoU am sub1ea sa s <br />• penatcy Ct SSa foc each sueh false unirss your <br />taWe is due w reasanade causa and na w <br />wilUuf negieti. <br />? p-sfey tor faFsa edoet? ? respect <br />to wet-okikiq. U.you maka a taisa ssaw"aK <br />with no rPasonable basts that mstgm 5500 <br />baeKtcp withhdd'an9• you ? 5°? 'to <br />PenatLy' 6sfamatSon. <br />CcimiRal PeTa?Y for talsif?(?rx3 <br />1MKufly fatsdy49 certificaoo? ? a[fmswrienu <br />may subiect you m airrtinal penalties indudin9 <br />fines anulec imPnsonment. <br />Misuse af T1Fts. lf Che requester dEsc(°ses or <br />uy% T7NS ui viofation of Fddecat an thinat <br />cequestet may 6e suh}ect eo civl cntr <br />penatoes. <br />Fam W-9 (Rev, 12•20oo1 <br />Cat. No. 10231X