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Confidential
<br />I ... �. V, 1t :,iIl 1, 3
<br />Other entities, Enter i,ouv business name as shown on recurred lodern'
<br />tax documents 011 the N,,)me fit* This name should Match the name
<br />shown or the charter (a other legal document Cealrng the ofthly. You
<br />may enter an;= Wsinc- s, trade, of OBA name on the Eusinrssinamoi
<br />disregarded entity name ine
<br />Exempt Payee
<br />It you are exempt from backup -thhold;ng, envier your name as
<br />described above rind sheik the appwolariate box for your status then
<br />check the Exempt payee` box in the line folloving the
<br />disregarded entity name sign and date the iorm,
<br />Generally, indl, rdUaIS finiluding sole propurietors) are not exempt from
<br />backup Withholding Corporations are exempt frOtri b36kUp MMhoiding
<br />lu ciinair payments such as interest and dividends
<br />Note. It you are exempt from backup withholding, 'you Should ShIl
<br />compete Ihis form to avoid posstale efforrocus backup "thholdng
<br />The following payees are exempt from backup w1hholding
<br />I An organization exempt from tax under section 501 (ay smy IRA or a
<br />custodal account uaciiw section 403f b)(7} it the account satisfies IN
<br />requirements of section 401,! 2j
<br />2 The United States or any of Its agencies or instrumentalities.
<br />3 A state, the DsInct of Columbia a possession of the United Stairs
<br />or any of!h&t poilical sundosions or instrumentalities.
<br />4 A I*h,,-rgn goemmenl or any of its polotc-W subdtsom agencies,
<br />of rns1rum4ntairties, or
<br />5 An international organzaron or any of its agencies <X
<br />instrumentalities
<br />Other payers that may be exempt from backup withhordog,ndude
<br />6 Ac"poralion,
<br />7 A foreign nnlraf bank ofissue,
<br />8 A clitaiet in s6curtie6 or commodities trQLVred to t&gJSI0f in the
<br />United Slates the DsMirt of Columbia, or a possession 00 the United
<br />States
<br />9 A futures commission merchant (sg�Owed ENO, the Commodity
<br />Futures Trading Commission
<br />10 A real i in,eslMent trust,
<br />11 An enlily rc-listw6d at all times during the tax year url.def the-
<br />In, estment Company Act of 1940
<br />12 A common truss fund oP6,1trd by a bar* under season 184{a'.
<br />13 A financial inslituron
<br />14 A middleman knovq) in the mvastm6N commonly as a tv,)Mmr* 01
<br />cu"odan, of
<br />IS A thust exempt from lax under selon 664 or described in section
<br />4947
<br />The follomng charl shows types of payments that may be exempt
<br />Itom oaaup wrlhhoichn,) The chart applies to the exempt pay0ar, listed
<br />above, 1 through IS
<br />If this payment is for, THEN the payment is exempt
<br />lot
<br />interest and dividend payments Allaxrmpt payees except
<br />for q
<br />Broker transa–tions Exempt payers I through 5 and
<br />tWough 13 Also, C corporations
<br />Barter exwange transactions arid Exempt payers I through 5
<br />patronage diadends
<br />Payments over $600 teqj,reci to be Generally, exempt payers
<br />reported and direct sales over I through 7
<br />$5000
<br />Part I. Taxpayer Identification Number (TIN)
<br />Enter your TIN in the appropriate box, If you are a resident alien and
<br />you do not ha',& and are not el>qible 1c, gsl arr SSN, Your TIN it, Your tRS
<br />ind,rduaf taxpayer identification number liTiNi Enter it in the social
<br />security number box 11 you do not have an ITIN, see Hov., to got a TN
<br />below
<br />If you are a soda proprietor and You hjce an LIN you may enter either
<br />;(Ar S,,N or E!N H-owover, the IRS peters that you use your SSN
<br />it you are a sinqlr,rr-+.mflet LLC that is disregarded as an entry
<br />separate from its ovmfir fsee Limited L�abvfigy Company (U0 on page 2},
<br />enter In, o"•ney s SSN for EIN it lie o,,iner has one) Do not enter the
<br />disregarded entity s EIN. 0 the LLC is dassr1i,,cl as a corporation or
<br />partnership- enter the entity's EIN
<br />Note - Ser, the chart or page 4 for further clarifirat on of name and I iN
<br />combinations
<br />Now to got a TIN. it you do not have a TIN apply for one immediately
<br />To apply for an SSN, get Form Application for a Social Security
<br />Card, lion', your local Sooal Security Administration office or gel this
<br />tcvffl Will* at VIVM,.ssa gov. You may also get tbic form by calling
<br />T- brg8- 772 -12t 3. Use Form W-7, Applicaimn for IRS lad odual Taxpayer
<br />IdenlitcationNumbef to apply tov art ITIN orForm SSA Application to
<br />Enripojer Identification Number, to apply lot an EIN. Ymi can apply for
<br />all EM online by accessing the IRS Websths at Www, os govIbu'sirtesses
<br />and click" on Employer identrii Number (FIN, under Starling a
<br />Bi.nMilPtS You can get Forms W-7 and SS-4 Irom, the IRS by salting
<br />IRS go, or by calling 1-800-TAX-FORM i1 -800,- 628- 3678f-
<br />t1 you are asked to comploI6 Form VV-9 but W not hate a TIN wife
<br />Applied For in the space for the TIN sign and date the farm and gi, a
<br />it to the requester For interest and dividend payments, and certain
<br />payments Made with respect to readily tradable insitumenIS "tWWJy
<br />you wit! have W days to get a TIN and gite it to tine isquoster palate you
<br />are sut•Iecl to backupwrthholding on payments The 60-day rule does
<br />not apply to other types of payments You will be subject to backup
<br />,vithholding an all such paVm"a until you provide your TIN to the
<br />requester.
<br />Note, Entering, Applied For 'means lhalyou ha,,6alteady applied for a
<br />TIN or that you intend to apply for one soon
<br />Caution: A d?Vagatcrod dotnesic entity that has a foe;ogn ore, nor r7us r
<br />use the Vp,opowo Fora, W-8
<br />Part 11. Certification
<br />To "tsblish to the wilhinoloing agent hat you are a U.S. person or
<br />resident alien, sign Form W-9 You may be requested to sign by The
<br />withholaing agent even if ilen, 1, beltww, aNJ iierns 4 arid $ 0,, page 4
<br />Ind'alf. otheiw�se
<br />For a joint account, only the person whose TIN is shm�,n;r Part I
<br />should sign (when requiredi In the case of a disregarded finlity, the
<br />person identified on lhe'Name line must sign Exempt payers. see
<br />Exempt Payee on page, 3
<br />Signature requirements. CornDletc- the certArcation as indicated in
<br />items I through 3 below, and items 4 and 5 on page 4
<br />1. Interest, dividend, and barter exchange accounts opened
<br />before 1964 and broker accounts considered active during 1983,
<br />You must give your carrot TIN, but you do not have to sign the
<br />,er01catkx,
<br />2. Interest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considered Inactive during
<br />1983- You must sign the c6nificalion or backup withholding will aropl,,, . It
<br />you are 5uhlect to backup withholding and you are merely providing
<br />your conect TIN to the recluester, you must CtoSS out stem 2 I the
<br />certification before sighting the form
<br />3, Real estate transactions. You must sign the certification. You may
<br />cross out itern �of the certification
<br />
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