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4
<br /> Form
<br /> °gig Request for Taxpayer Give form to the
<br /> (Rev:October lSii + requester: Do not
<br /> Id'enti�cati`ari Number and Certification
<br /> send to the IRS.
<br /> oepa<trcc+:nr�tt�'Trett"suit
<br /> kernel Revenue Serilce:
<br /> -Narrt9:(as shown op your insc)me tax,':ttitUrp)
<br /> sv
<br /> m eustness name;If different from above'
<br /> n
<br /> •0 o Check appropriate box:❑ IridividuaVSele proprietor ❑ Corporation ❑ Partnership Exempt
<br /> Z.-- ❑ Limited liability company.Enter the tax classification(D=disregarded entity.C=corporation.P=partnership)► ❑ Rayer.
<br /> t ❑ ?thar{seeinslnx;xar -
<br /> Address(number,street.arld apt.orstiite nos) Requester's naitra and address,(optional)
<br /> fi1. .V
<br /> o City,state,and ZIP code
<br /> a.
<br /> V)
<br /> m List account number(s)here(optional)
<br /> CEM Taxpayer IIdentification Numbar (TIN)
<br /> Enter your TIN in the appropriate boX,The TIN:provided must match the name given on Line 1 to avoid social security number
<br /> backup withholding.For individuals,this is your Social security number(SSW).However,for a resident
<br /> alien,sole proprietoror disregarded entity,see the Part I instructions on page 3.For other entities,it is
<br /> your employer identification number(EIN). If you do not ha'e a number,see How to get a TIN on page 3. or
<br /> Note.If the account is.in more than one name,see the chart on page 4 for guidelines on whose Employer identification number
<br /> number to enter.
<br /> Part II Certification
<br /> Under penalties of perjury, I certify that:
<br /> 1. The number shown on this form is my correcttaxpayer identification number(or I am waiting 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 withholding,or(b)I have not been notified by the Internal
<br /> Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(e)the IRS has
<br /> notified me that I am no longer subject to backup withholding, and
<br /> 3 I am a U.S.citizen or other U.S.person(defined below).
<br /> Certification instructions.You must cross put item 2 above if you have been notified by the IRS that you are currently subject to backup
<br /> withholding because you have failed to report all interest and dividends on your tax return. For.real estate transactions,item 2 does not apply.
<br /> For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement
<br /> arrangement ORA),..and generally,payments other than interest and dividends,you are not required to sign the Certification, but you must
<br /> provide your correct TIN.See the instructions on page 4,
<br /> Sign Signature of
<br /> Here u.s,person ► Date
<br /> General Instructions Definition of a U.S: person. For federal tax purposes, you are
<br /> considered a U.S.person if you are:
<br /> Section references are to the Internal Revenue Code unless •
<br /> • An individual who is a U.S.citizen or U.S.resident alien,
<br /> otherwise noted. • A partnership, corporation,company,or association created or
<br /> Purpose of Form organized in the United States or under the laws of;the United
<br /> A person who is required to file an information return with the States,
<br /> IRS.must.obtainyour correct taxpayer identification number(TIN) • An estate(other than a foreign:estate), or •
<br /> to:report,for example, income paid to you,real estate • A domestic trust(as defined in Regulations section
<br /> transactions,mortgage interest you paid,acquisition or 301.7701-7).
<br /> abandonment of secured property, cancellation of debt,or Special rules for partnerships.Partnerships that conduct a
<br /> centributipns you made to an IRA, trade or business in the United States are generally required to
<br /> Use Form W-9 only if you are a U.S. person(including.a pay a withholding tax on any foreign partners'share of income
<br /> residentalien),toprovide-your correct TIN to the person front such blithest. Further,in certain bases where a Form W-9
<br /> requesting it(the requester)and, when applicable, to: has not been received,a partnership is required to presume that
<br /> 1.Certify that the TIN yogi are giving is correct_(or you are a partner is a foreign person,and pay the withholding:tax.
<br /> waiting fora number to be:Issued), Therefore, if you area U.S.person that is a•partner in a
<br /> 2. Certify that you are not subject to backup withholding; or •partnership conducting a trade or Business in the United States,
<br /> pro'vihe Form W-9 to the partnership td establish your U.S.
<br /> 3. Claim exemption from backup withholding if.you are a U.S. status and avoid withholding on your there of partnership
<br /> exempt payee. If applicable,;you are also certifying that as a income.
<br /> U.S person,your allocable share of any partnership income from The person who gives Form W-9 to the partnership for
<br /> a US.trade or business isnot subject to the withholding taxon •purposes of establishing its U.S.status and avoiding Withholding
<br /> foreign partners' share of effectively connected income. on its allocable share of net income front the partnership
<br /> Note.If a requester gives:you a form other than Form W-9 to 'conducting a trade or business in the United States is in the
<br /> request your TIN,you must use the requester's form if it is following eases:
<br /> substantially similar fo this Form W-9. • The U.S. owner of a'disregarded entity and not the entity,
<br /> Cat No.10231X Form W-9 (Rev.10-2007)
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