|
Confidential
<br />e, W -9 Request for Taxpayer Give For, to the
<br />t" "r,l °- i2nli} Identification Number and Certification requester. I not
<br />I)rt>artrt olrrtth <1,r <,�a. -y sand to the IRS,
<br />oar,rrr� tlrr,,�rxx� a«,r•: e r,
<br />hl.nr.r {ar; t .ri <xz'rou rx,rxne HUe r<N.ienj
<br />ca
<br />lain Hens n.u,x tr..n. 3ank,d rvrhtr tuns .a,t,n�r <r�t thou anrr<r
<br />a,
<br />rn
<br />n' Ch-k appwjxraw b,u 1,x I"I"al lax 1 r�setiadu,¢ _..
<br />�) tn4,+. "JrtullzxiL <Ixryxie=i,x CCwpcxatuxz ; Sr: oYpq.atrrxY P.ar lrrwvhip f Tm.i.r r;tntr=
<br />L krtin �t 6. +dfiD; c <xm.Fx,ar
<br />Iwr i In" t.m wxs wtu .tnw g' t' x Li tnta pa}o -a
<br />"r < txnadrxp .`+. mp,antf <xr i.pxnvw °r±My,;,►
<br />C p
<br />dC Oth,, r .•v rnSar Ul:.tr<x 19)► '..
<br />o . _...
<br />fF Add,, •.+ {r,umin r, .ir«9, armor .zpL <x ,,,M, r n ±...
<br />u I , c�><rircxud,
<br />1 ,,t --Al "t Hirsh v,'? Ix r
<br />Taxpayer identification Number (TIN)
<br />Enler your TIN in the appropriate box The TIN provided most match the name given an the "Name' line Soeuaf somnty number _
<br />to auoltl backup wltivholdtng. For individuals. this is your socmai sacotrityrnmmber (SSN Hove
<br />ever, Hovvar, for s
<br />nrridenl alien sole proprietor, or disregarded entity, sea the part t instructions or page 3 For athe3
<br />entities, 0 is your employer Identification number (EIN! It you do not have a number, sae Nov.° to got a
<br />TtN on page 3. ._...
<br />Note. If the account is an more than one name, see the chart on page 4 to guidelines on whose Employer ,denbNaation number
<br />number to enter.
<br />Under penalties of perjury, I certify, that
<br />1. The number shown on this form is my correct taxpayer identification number (or I am walling for a number to be issued to me), and
<br />2 1 am not subject to backup withholding because (a) I am exempt from backup avthholding, er €bi i have not been notified by the internal Revenue
<br />Service (IRS) that i am subject to backup withholding as a result of a failure to report all interest or dividends, or mcj the IRS has notified me that I anon
<br />rho longer subject to backup withholding, and
<br />3 1 am a U S citizen or olher U S person (defined below)
<br />Certification instructions. You must cross out item 2 above it you have been notified by the :RS that you are currently subject to backup vMhholdirg
<br />because you have tatted to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply_ For mortgage
<br />interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA). and
<br />generally. payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN See the
<br />instructions on page 4.
<br />Sign signature of
<br />Here US. P.M.. 0, }Date►
<br />General Instructions
<br />Section referances are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Purpose of Form
<br />A person who is required to file an information return with the IRS must
<br />obtain your correct taxpayer identification number (TIN) to report, for
<br />example, income paid to you, real estate transactions, mortgage interest
<br />you paid, acquisition or abandonment of secured property, cancellation
<br />of debt, or camtributions you made to an IRA.
<br />Use Form VV-9 only if you are a U.S person (including a resident
<br />alien), to provide your correct TIN to the person requesting it (the
<br />requester) and, when applicable, to
<br />1 Certify that the TIN you are giving is correct (or you are waiting for a.
<br />number to be issued).
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt
<br />payee. If applicable, you are also certifying that as a U.S. person, your
<br />allocable share of any partnership income from a U.S. trade or business
<br />is not subject to the withholding tax on foreign partners' share of
<br />effectively connected income
<br />r:at
<br />Note. If a requester gives you a form other than Form W-9 to request
<br />your TIN, you must use the requester's form if it is substantially similar
<br />to thus Form W -9
<br />Definition of a U.S. person. For federal tax purposes. you are
<br />considered a U.S. perish if you are
<br />• An individual who is a U.S- citizen or U.S- resident alien.
<br />• A partnership, corporation, company. or association created or
<br />organized in the United States or under the laws of the United States.
<br />• An estate (other than a foreign estate), or
<br />• A domestic trust (as defined in Regulations section 301.7701 -7�
<br />Special rules for partnerships. partnerships that conduct a trade or
<br />business in the United States are generally required to pay a withholding
<br />tax an any foregn partners' share of income from such business.
<br />Funnel, in certain cases where a Form W -9 has not been received, a
<br />partnership is required to presume that a partner is a foreign person,
<br />and pay the withholding tax. Therefore, if you are a U.S. person that is a
<br />partner in a partnership conducting a trade or business in the Ur"ted
<br />States, provide Form W -9 to the partnership to establish your U.S.
<br />status and avoid withholding on your share of partnership incase,
<br />Nr, in?JIx r,xn, W -9f a 12 "i u
<br />
|