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Confidential
<br />4, Other Payments, YOt MLIVI t give yotu correct TIN, but you do not
<br />hha,e to saga t0he C901tlCafron unless sou haa6lawn nottflgd that you
<br />have previowy given an incorrect TIN. +Othet payment," i'aatude
<br />payments made in the course Of the requaS;er's trade a business for
<br />rents roya4fies, goods (other than bilis for m9rrhandrsei- m9dlr-ai and
<br />health care services Including payments to corporations!, payments to
<br />a nonemploplo for services, payments In conaln fishing boat crew
<br />members and fishermen and gross proceeds paid to altont9•¢s
<br />(including pay<m"s to corporations;
<br />S. Mortgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualtlted tuition program
<br />payments (under section 529), IRA, Ooverdeil ESA, Archer MSA or
<br />WSA contributions or distributions, and pension distributions. You
<br />must give your correct TIN, but you do not have to sign the, certificatio).
<br />What Name and Number To hive the Requester
<br />For this type of *"i It Giw namr and SSN of:
<br />7 q•9 i;! 0 ❑ 1 18.x1
<br />1 rorrfr, in t Idud , I,jarrt Ttl m Lid ,. .d VId
<br />s� xxxr.q It. rd xnf hxrS°. Pl i� ke�t��
<br />,nit rrnlx r If,
<br />ink I xr 4irn ia+til¢ISr,. t.,I)
<br />S n. ti Ic u�u o�: ti,�nwa.nq� u, ir,rnlrr trrx -.6e..
<br />trU'i ±,Irrynl�Nt� it �ttU^.t,*,�i
<br />it �.rl•i. - -i UU •i ,. z:rwxa Thar .... IRar .l rfi a; *.erg;!.
<br />t 'll ilo— iv : dl�.a.•,L „.t „ :r ItI >, 1 „,
<br />r;leit u..irt <IU Y l'A"14la4
<br />t Ciesrt<f 11Int f.h 7 ,1 -ky C.lpl -,0 ill qra -dr.,
<br />rcaro 1 "sYgtdrrnl M�4tx,uif Ba:r
<br />Po. ldetxr +:o�cf xlI!tY1.rtTz7fai:yg
<br />Poi this type of account G.- rtwma and EIN of
<br />1. (71 wNU,11 -1 <•ra 9F >t Ih;xa =,: Ln +.rl It1 -11 1„v
<br />In.i3,lehi.rt
<br />y' A nhdnrl ,l . a,, 1,i I.-, -li-t tf,)al nierliy"
<br />!+ [, i. �hnh<ai .+i z ,i,•. -7. ni itw + *Ixx ahcrl .
<br />I0. rk la §za1, -Art, 1,- Upx>'l” it, y,.ra,rehcs,
<br />t; ?k �� %,Mnlxt fMn ru.'AtICN?
<br />17. }yarn •A-IIFrnh Ili �rl�r�rin•.i l�.� Itry InlrUr s� @up
<br />1:' A t ,4- 1. -q ,t y,. *i n.rirth +. lh • ix��k,r n 1 ranm.,.,.
<br />t: ±. xk x11 ,. :<tt., irr tri ::arrnr,xll isi `. lbl,- Ir @dw'. treltlt,-
<br />AIx vile „ut ti• .- :r t+.d.d,:.
<br />IC
<br />fide!
<br />pr x, ih it vr.w -p1 �dhn<d
<br />ptt'eM lH1* pea'rttl tlry
<br />tS o.taYtRx t—,i Rllilq —hw fill, i sits Ina- tnn9
<br />t i;.ti !Axel M„dual"In-
<br />All, W11-1 l-,
<br />Y un r 1:7 f Air I'frt�,Nifii
<br />4
<br />Note- if no name is circled 4vh6,n shore than one name is ilcted, the
<br />number ,v,l' be corrslderoci to be that of the first name listed.
<br />Secure Your Tax Records from Identity Theft
<br />Iderl4ry theft occurs; when eorneone uses your personal information
<br />such as yo,;, name seel-rily number {SSW or other toentifyrng
<br />information. without your permission to commit fraud of other crimes.
<br />An identity thief, tray use your SSN to get a too or may file a tax return
<br />ustny your SSN to'9ce :e a refund
<br />TO reduce your r; 3k
<br />• ProteO y” SSN,
<br />• Ensure your employer is protecting your Grz>N, and
<br />•
<br />E311. careful when choosing a tax preparet .
<br />if your tax records ar9 affected by Identity theft and °y(x) receive a
<br />notice from the IRS. respond right away to the name and phone number
<br />printed on the IRS nov,.e or lettef .
<br />if p'r)uf tax record-, are not curren8y affected by identity theft but ycxl
<br />think you are at risk due to a lost of stcoen purse or wallet . questionable
<br />crr,.drt card act:.ity or ceedt report. contact the IRS Identity Thefl ttotiine
<br />at 1 -8(0 (}3- 4490 of si.dtrrnt Form 14D39
<br />For maze informator._ see PutNl,:ahon 413` diWity ThOl Pre•,*nlion
<br />and Victim Assistance.
<br />Victims of identity theft veho are experiencing economic harm cr a
<br />system protdem, or are seeking hoip in resolving tax problems that have
<br />not been r9sola9d thfo gh normal channels, may be eligible for
<br />Taxpayer Adracate Sevoce {TAS'; ass istance You can reach TAS by
<br />calling the TAS tall -tree case intake tine at 1,877 777-478 or TTVI DID
<br />1- 0n0- 8M4059.
<br />Protect yourself from suspicious entails or phistttng schemes.
<br />PNshing is She creation and use of eviaid and websdes designed to
<br />mlrnlr_ legilima:9 business 9mwis and miebsdes The most common act
<br />is send, g an email to a user falsely claiming to be an ostabashed
<br />le91l"ute enterprise In an attempt to scam the user into 6urte ndering
<br />Innate Informatics that wdlb9 Used lot I06rltity theft
<br />Tire IRS doses not initra -ta contacts with taxpayers via wnails. A; ^,o . till,
<br />iRS does not reryuast persona: detailed Intorrration through email or asi,
<br />taxpayers for the FIN numbers- passwords, of similar socret access
<br />inforrnaho) to the;r crgrtit Card, bank< of other financial accounts.
<br />If you roc`fnxb an unsoiclted email cjaimtng to be from ' t -he IRS,
<br />forward this message to pnSivn9kV os gov.. You may also rapOn misuse
<br />of the IR`S name- logo, or other IRS property to the Treasvny Inspector
<br />Geneva,, for Tax A,dmlru5tratioy at 1-806- 366-44S4 You can foulard
<br />suspiadAS ema1L> to iris P9d9ra1 Trade Comm! an at sparmftoo,gov
<br />orcontact the% at roves *.ftr,govAdane,"2 or 1477-IDTHE'FT
<br />,1,877-438433a5
<br />Visit IRS go, to learn more about rdi lity Ih6h and hoar to reduce
<br />you, risk,
<br />Privacy Act Notice
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