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<br /> F�, W�9 Request for 7axpayer c�Y�Fom,e�me ;
<br /> �."�°�'�01> Identification Number and Certification n9uester.Donot ;
<br /> D�partmom olthe7reasury Send to the IRS. j
<br /> Intemal fleveiue Service I
<br /> Name(as eMwn on your Mcorne la rtWm)
<br /> .3r�`1 'YMtlMAJ �✓EnTtir0.MDCr(r j
<br /> N &nlnessnamc/disrepartfetlonldynamn,lidiflerentiromabove i
<br /> �
<br /> a CTeckapD�P�atelroxlorledxralteaclasslfwUon: ExempUons(scelnsUUUfonag j
<br /> �a ,py I
<br /> � {yvindiv'duaVsWeproprlola ❑ CCorporetlan ❑SCorporation ❑ Pertnerdnp ❑TrusViulate �
<br /> �� Etuxnpt P��ee COAe(M eny) E
<br /> � LknkeC IiaOilitV�Pany.EntBr lAe taz clecsilicellon(C=C corparalan,5=5 coiporelbn,P=paM1nvship�► ExempOon Irom FATCA repMing I
<br /> � cafe(d any) �
<br /> a� ❑ OthOf�sOl1054ucllon5)► �
<br /> 8 u Atltlress(num6or,clreel,ondapt.oreuNeno� Repueclx'enarneentledtlress(oplionxq �
<br /> 43 `1�4' l�rer+.a v�s ,>t 2 , I
<br /> m Clly,stata,atM ZIF code
<br /> � E�:2� ,,�A � �63 I
<br /> List eccoum numCer(s)hem(opfionap
<br /> • Taxpayer ldentlflcation Number IN) '
<br /> Enter your TN In the appropnete boz.The TiN proviAetl must matM the neme given on the"Name"Ilne ��lai aaeurlry num6er j
<br /> to avoid backup withholding.For Indlviduals,this is your soclal security number(SSN�.However,lor a
<br /> resldent alien,sole proPrletor,or disregartled enlity,see t�e PaA I Instructions on page 3.For other S' 3 '� �
<br /> entitles,R is your employer ldentificalion number(EIN).If you do not have a number,see How lo gef a � - � G - C� 3 6 i
<br /> TIN on pege 3. �
<br /> Note.ll l�e eccount Is in more than one name,see 1�e chart on page a for guidelines on whose Employe�IdmHMcaMon m�mber
<br /> num6er to enter.
<br /> Certificetion �
<br /> Under penaflies o1 perjury,I cedify 1haF. �
<br /> 1. The number snown on this form Is my corrett tazpeyer iden!ilicalion rimber(or I am walting tor a number to be issued to me�,end
<br /> 2. 1 em not subjecl to backup wflh�olding because:(a)I em exempt Iram backup withholding,a@)I have not!�een notlfied by the Internal Revenue
<br /> Service pRS)Ihat I em sub�ect to backup wiMlrolding as a resun ot a lailure to repoA ell interest or dlvideno:,,or(c)thn IRS has nntlfied me that I am f
<br /> no lorger sub�ect to backap withholding,end �
<br /> 3. 1 am a U.S.cltizan or other U.S.person�delined betow),end �
<br /> 4.The FATCA cade(s)entered on this torm(if any)intllceting that I em exempt from FA7CA repoAing is cortect �
<br /> Certificalion InstrucUons.You must cross out item 2 above If you hava been nofrfied by the IRS lhal you are eurrenUy sub�ect to baekup withholtling �
<br /> becnuse you heve teiled to report ell interest end dividends on your t�retum.For real estate Imnsadions,item 2 dces not appty.Fa moAgage f�
<br /> iMerest paid,acquisition or ehandonment ol sewred propeAy,cancellatton ol tlebt,contdbutlons to an Individ�al retlrement artangement(IRA),anA i
<br /> gennaly,payments other lhan Interesf and divldends,you are not required to sign the certlficatWn,but you must provitle your correc[i1N.See lhe �
<br /> Instvctlons on page 3. / (
<br /> $19� SlBnalure 1
<br /> Here usvns�? - ot ► 1 ! �G � ��' — �
<br /> General Instruetions wllnnoNi�gtex�nlorelgnDarincrs'slareoletlecEvelyconnecteClncane,entl �
<br /> SecHonreferencesoratot�alntertWReverueCatleunlessothmxlsenotea. 4•�°��y�e1FATCAwde�s�enteredonWSWrmQlan�ind:wHngl�alyoueie i
<br /> eeempl fram I�e i'ATCA rtpoMnq,k conect. j
<br /> Fu�uredewlopmenlc.TAeIRShaoctmledapageonlRS.gavbrinlo�malion Na1e.Ilyouare.+U.S.perSonaaOezQuaslerpWnyouebrnothnlMnFum �
<br /> eboul Form W-9,al www.irs.gav/w9.Inlamalbn ahout�ry W1vre tlevebpmenL^ W.9 b raquest your TIN,you musl asr lhe�aquasWr'a lorm if It is sWvlantlaly .
<br /> aXectNgFormW�9(sucha�IegiyalbnenacletleM1erwarMeaselqwlilbepastetl simllartoNhFortnW-9, �
<br /> on Mat�ge.
<br /> �eMlnon ol e US.person.Fa tatlerel leK purposea,you ere cons�dered e U.S. �
<br /> Purpose ot Form �150"'�ti'°"•,"
<br /> A perecn wno Is reW irod to lilo an InlonnaUon relum with tho IRS musl obtain your 'A^InONMuoI whu Is o U.S.cPozen or U.S.rcaldent alle�i, .
<br /> carrecltupayaiidentif¢albnnumbrQlN�lo�epoA.toraxnmpie.inrnmoW��o •ApaM1ners�ip,00rporetlon,compeny,otesaor:utloncmeteCororgenizMlnl�e �
<br /> you,paymaMsmaOetoyoulnsedlemontolpaymenicardnndlMrOpa�t,�nehvotk Uni�edStelo-iaund¢rlhalewsotllroUnilcOSlatm, i
<br /> Iransacllone,realestalelrensactions,mOrlgegeNlereslynupef0.eequlsllana .pngy�ete(otherthanataeignestete),ar
<br /> abanOonment ol secureE pmpaty,cencellation ol EnM,ar wntfitW lons yw meEe i
<br /> to an IRA. �A domaslk Irust(es deGned in Repulatiam saclon 301.79014�. ,
<br /> 5 eclelmleclorpaMas�bs.FeMervMGs��a�cw�ducinlraMorLusltw,aln '
<br /> UseFortnW-9onyNyouarcaU.S.penon(mcludirgnrcslEenla4e��,to P �
<br /> Ihe Un!ted Slstes are gona�ally reQuireO lo pay e vnthhe�di�taa undar eec6on
<br /> proNde your carrect 71N io the person mquesttiq It(the requestar�nnC,when I
<br /> app��da �o: 'dA6onenyforelgnpartnme'shereolelleMlvalyconnncteCtaKa6leincanalmm
<br /> such Wfines:.FuMx,ln cMain casr,where a Foim WA hes nol bem recdved, �
<br /> 1.C�NyMlan�eTlNyaueregivi�iscmat(oryoure�vnBlfqloranumMr �hprulosuMlttleCllan1448rtQulroOpiMOrihlp�pprltuTethatepartnt�150 j
<br /> to be lasued�, lorclgn permn,nnd pay Ihe secthn 71r6 Mthholtling tn�.Therelore,II you ere e
<br /> 2.Cetlily Nal you era nol cubJxUo bacAup wAhholding,or U.: person t�at Is e patlnw In o pertnonhip tontluCUnp n treCe or FUNness M IAe �
<br /> 3.Glalm eacmption Irom Dackup�vithhotdiug X you ero e U.S.exempt payea.II Unled Steta,pmvAe Form W-9 to Ne pertnenhip lo establl�yp:r U.S.stalus �
<br /> epplicebb,you ere elso certllybg that aa a U.S.person,your�Aocabk shore of �evoi�t eection 11�6 wNhnokinq an ynur share of parhershlp Incoma. f
<br /> any paMeMip Income Imm e U.S.Irede or busness Is not auqat lo I�e �
<br /> Ca1.No.10t31% Form w-9(Pev.e-1013) �
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