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�,,.,, W�9 Request for Taxpayer Give�orm to ihc
<br /> °: "°°�^�°�,'°°�, Identification Number and Certification requester. Oo not
<br /> „i ,T,�,. send lo lhc IRS.
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<br /> � L��st account num�cr�s)hne lo�trowq
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<br /> Taxpayer ldentitication Number(TIN) ___
<br /> 6rter your TItJ in the apP�aP����e boz.The TIN provided musl match the name yiven on Line 1 to avoid Saclal security number
<br /> uackup wl,hholtling. For intlivitluaL,Ih�s i5 your social Securiry number(SSN�.However,lor a residenl
<br /> aimn,Solrz proprietor,or tl�sregarded entity,seo lha Part I inslructions on page 3. For olher enlities,it i5
<br /> yom emG'oyo�idcn�ificntimi numbcr(EIM� II you do not have a numbcr,:ce How fo gef a TIN on page 3. of
<br /> Nole.II the account is in mo�e Ihan one name,see the chart on page 4 lor guidelines on whose Employer I�Nlliwtion number
<br /> numbcrtoenter. f� ���� ��� ��.,�����
<br /> � Certi(ication _
<br /> Undcr pen�llie;ol perjury, I ecrtity lhat:
<br /> 7. The number shown on 1M5 form is my correct�aepayer itlentification number(or I am waiting lor a nwnber to be issued to me),ar,d
<br /> 2. I ain nat subject to backup withholdmg because:(a)I am exempt lram backup withholding,or(6)I hare not been noli(ied by Ihe Internal
<br /> Revenue Senice�IRS)that I am subject to backup withholding as a result ol a I�ilure to report all inte�est or div�dends,or(c)1he IRS has
<br /> noldmd me Ihai I am no Innger subject lo backuU�+'dhho!ding,antl
<br /> 3. I am a U.S.person�including a U.S.residenl alien�.
<br /> Certiliwlion inslruclions.You must cross out item 2 above il you havo been notified by Ihe IRS thal you are wrtently subject to backup
<br /> ��i�hhoitling becawe you have failetl lo repoh all interesl and dividends on your taz reWm. For real es!ate transactions.item 2 does not apply.
<br /> Por mor�gage in;erest pa��d,acquisilion or abandonmenl of securod pmperty,cancellalion ol debl,contribulions lo an individuz��el�rement
<br /> arrangement pRA),and generally,p.rymenls othw than interest and dividends,you are not mn,�„ired to sign lhe Ceridication,but you must
<br /> provide your correct TIN. �See the insiructions an paga A.)
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<br /> Signalureof �A �, � � // � ���� / } ���//'.�
<br /> Here u s.n��o� ► i�,W��� lL lY-1/� Da�e► � <C' '�G-
<br /> Purpose of Form �•��'�� who is�citizen or resident ol Ihe United
<br /> A person who is required to file an information reWrn�vith Ihe States,
<br /> IRS, must obtain your conecl laxpayer identilicaiion number • �partnership, corporation, company,or association
<br /> (TiN)to reporf, lor example, income paid to you, roal estate aealed or organized in lhe Uniled Stales or under Ihe laws
<br /> t�ansaclions, morlgage inierest you paid, acquisilion or of lhe United Slates, or
<br /> abandonment of secured property, cancellation of debt, or • Any estale(uther than a foreign estale)or irust. See
<br /> contributions ynu made to an IAA. Regulations sections 301.7701-6(al and 7(a)tor additional
<br /> U.S. person.Use Form W-9 only il you are a U.S. person infannation.
<br /> Qr,cludiny a residenl alien), lo provide your correcl TW lo ihe Special rules lor partnerships.Partnerships thal conduct a
<br /> p�rson requesting it(ihe requester)and, wiien applicabie, to: irade or business in ihe United States are generally required
<br /> 1. Certify that lhe TIN you are giving is covect (o�you are to pay a withholding tax on any foreign pariners' share o�
<br /> maning lor a number to 6e issued), income lrom such business. Further, ui certain cases where a
<br /> 2. Certify that you are not subjecl to backup wilhholding,or Form W-9 has not been received, a partnership is requi�ed to
<br /> presume that a partner is a loreign person, and pay the
<br /> a. Claim ezemption trom backup withholding il you are a �vithholding tax.Therufore, it you are a U.S. person Ihal is a
<br /> U.S. exempt payee. partner in a partnership conducting a trade or business in the
<br /> � In 3 above, if applicable, you are also ceilifying that as a United States, provide Porm W-9 to the partnership to
<br /> U.S. person, your allocable share of any partnership income establish your U.S. status and avoid wilhholding on your
<br /> I�orn a U.S. trade or business is not subject to the share o1 partnership income.
<br /> �vdhholding taz on foieign pariners' share ol etfeclively
<br /> connecled income. The person who gives Porm W-9 to the partnership for
<br /> purposes of establishing its U.S. staWs and avoiding
<br /> Note.If a requester give,you a brm other than Fomi W-9 to Withholding on its allocable share ol net income Irom lhe
<br /> rcGuest your TIN, you must use the requester's lorm if it is partnership conducting a t�ade or business in the United
<br /> �,ubstanliaily similar to Ihis Form W-9. Stales is in ihe lollowing cases:
<br /> For fedcral tax pwposes,you are considered a person if you • Th�•U.S. owner ol a disregarded entily and not ihe entity,
<br /> ,:r e:
<br /> c:n.r:o. ��o.���z Fo,,,, W-9 0°.�,�. +�.aoas��
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