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Form W-9(Rev.12-2014) Page 3
<br /> Line 2 However,the following payments made to a corporation and reportable on Form
<br /> If you have a business name,trade name,DBA name,or disregarded entity name, 1099-MISC are not exempt from backup withholding:medical and health care
<br /> you may enter it on line 2. payments,attorneys'fees,gross proceeds paid to an attorney reportable under
<br /> section 6045(f),and payments for services paid by a federal executive agency.
<br /> Line 3 Exemption from FATCA reporting code.The following codes identify payees
<br /> Check the appropriate box in line 3 for the U.S.federal tax classification of the that are exempt from reporting under FATCA.These codes apply to persons
<br /> person whose name is entered on line 1.Check only one box in line 3. submitting this form for accounts maintained outside of the United States by
<br /> Limited Liability Company(LLC).If the name on line 1 is an LLC treated as a certain foreign financial institutions.Therefore,if you are only submitting this form
<br /> partnership for U.S.federal tax purposes,check the"Limited Liability Company" for s account you hold inrequestingthe United States,youo may leave thisn if theh blank.
<br /> box and enter"P"in the space provided.If the LLC has filed Form 8832 or 2553 to Coninstitutionsult with the person t se requirements.
<br /> qthismform ifyouare indicate
<br /> if thatanciol
<br /> be taxed as a corporation,check the"Limited Liability Company"box and in the is bysuprovidingot to these rwith a Form A9 with"NotNr may lic ble"( ra code is
<br /> space provided enter"C"for C corporation or"S"for S corporation.If it is a not requiredrindication)written
<br /> you with a Form W-9 or a Applicable" code.any
<br /> single-member LLC that is a disregarded entity,do not check the"Limited Liability similar wr tten or printed on the line for a FATCA exemption
<br /> Company"box;instead check the first box in line 3"IndividuaVsole proprietor or A—An organization exempt from tax under section 501(a)or any individual
<br /> single-member LLC." retirement plan as defined in section 7701(a)(37)
<br /> Line 4,Exemptions B—The United States or any of its agencies or instrumentalities
<br /> If you are exempt from backup withholding and/or FATCA reporting,enter in the C—A state,the District of Columbia,a U.S.commonwealth or possession,or
<br /> any of their political subdivisions or instrumentalities
<br /> appropriate space in line 4 any code(s)that may apply to you.
<br /> Exempt payee code. D—A corporation the stock of which is regularly traded on one or more
<br /> established securities markets,as described in Regulations section
<br /> • Generally,individuals(including sole proprietors)are not exempt from backup 1.1472-1(c)(1)(i)
<br /> withholding. E—A corporation that is a member of the same expanded affiliated group as a
<br /> • Except as provided below,corporations are exempt from backup withholding corporation described in Regulations section 1.1472-1(c)(1)(i)
<br /> for certain payments,including interest and dividends. F—A dealer in securities,commodities,or derivative financial instruments
<br /> • Corporations are not exempt from backup withholding for payments made in (including notional principal contracts,futures,forwards,and options)that is
<br /> settlement of payment card or third party network transactions. registered as such under the laws of the United States or any state
<br /> • Corporations are not exempt from backup withholding with respect to attorneys' G—A real estate investment trust
<br /> fees or gross proceeds paid to attorneys,and corporations that provide medical or H—A regulated investment company as defined in section 851 or an entity
<br /> health care services are not exempt with respect to payments reportable on Form registered at all times during the tax year under the Investment Company Act of
<br /> 1099-MISC. 1940
<br /> The following codes identify payees that are exempt from backup withholding. I—A common trust fund as defined in section 584(a)
<br /> Enter the appropriate code in the space in line 4.
<br /> 1—An organization exempt from tax under section 501(a),any IRA,or a J—A bank as defined in section 581
<br /> custodial account under section 403(b)(7)if the account satisfies the requirements K—A broker
<br /> of section 401(f)(2) L—A trust exempt from tax under section 664 or described in section 4947(a)(1)
<br /> 2—The United States or any of its agencies or instrumentalities M—A tax exempt trust under a section 403(b)plan or section 457(g)plan
<br /> 3—A state,the District of Columbia,a U.S.commonwealth or possession,or Note.You may wish to consult with the financial institution requesting this form to
<br /> any of their political subdivisions or instrumentalities determine whether the FATCA code and/or exempt payee code should be
<br /> 4—A foreign government or any of its political subdivisions,agencies,or completed.
<br /> instrumentalities
<br /> Line 5
<br /> 5—A corporation
<br /> 6—A dealer in securities or commodities required to register in the United Enter your address(number,street,and apartment or suite number).This is where
<br /> States,the District of Columbia,or a U.S.commonwealth or possession the requester of this Form W-9 will mail your information returns.
<br /> 7—A futures commission merchant registered with the Commodity Futures Line 6
<br /> Trading Commission Enter your city,state,and ZIP code.
<br /> 8—A real estate investment trust
<br /> 9—An entity registered at all times during the tax year under the Investment Part I.Taxpayer Identification Number(TIN)
<br /> Company Act of 1940 Enter your TIN in the appropriate box.If you area resident alien and you do not
<br /> 10—A common trust fund operated by a bank under section 584(a) have and are not eligible to get an SSN,your TIN is your IRS individual taxpayer
<br /> identification number(ITIN).Enter it in the social security number box.If you do not
<br /> 11—A financial institution have an ITIN,see How to get a TIN below.
<br /> 12—A middleman known in the investment community as a nominee or If you are a sole proprietor and you have an EIN,you may enter either your SSN
<br /> custodian or EIN.However,the IRS prefers that you use your SSN.
<br /> 13—A trust exempt from tax under section 664 or described in section 4947 If you are a single-member LLC that is disregarded as an entity separate from its
<br /> The following chart shows types of payments that may be exempt from backup owner(see Limited Liability Company(LLC)on this page),enter the owner's SSN
<br /> withholding.The chart applies to the exempt payees listed above,1 through 13. (or EIN,if the owner has one).Do not enter the disregarded entity's EIN.If the LLC
<br /> is classified as a corporation or partnership,enter the entity's EIN.
<br /> IF the payment is for... THEN the payment is exempt for... Note.See the chart on page 4 for further clarification of name and TIN
<br /> combinations.
<br /> Interest and dividend payments All exempt payees except How to get a TIN.If you do not have a TIN,apply for one immediately.To apply
<br /> for 7 for an SSN,get Form SS-5,Application for a Social Security Card,from your local
<br /> SSA office or get this form online at www.ssa.gov.You may also get this form by
<br /> Broker transactions Exempt payees 1 through 4 and 6 calling 1-800-772-1213.Use Form W-7,Application for IRS Individual Taxpayer
<br /> through 11 and all C corporations.S Identification Number,to apply for an ITIN,or Form SS-4,Application for Employer
<br /> corporations must not enter an exempt Identification Number,to apply for an EIN.You can apply for an EIN online by
<br /> payee code because they are exempt accessing the IRS website at www.irs.gov/businesses and clicking on Employer
<br /> only for sales of noncovered securities Identification Number(EIN)under Starting a Business.You can get Forms W-7 and
<br /> acquired prior to 2012. SS-4 from the IRS by visiting IRS.gov or by calling 1-800-TAX-FORM
<br /> (1-800-829-3676).
<br /> Barter exchange transactions and Exempt payees 1 through 4 If you are asked to complete Form W-9 but do not have a TIN,apply for a TIN
<br /> patronage dividends and write"Applied For"in the space for the TIN,sign and date the form,and give it
<br /> to the requester.For interest and dividend payments,and certain payments made
<br /> Payments over$600 required to be Generally,exempt payees
<br /> with respect to readily tradable instruments,generally you will have 60 days to get
<br /> reported and direct sales over$5,0001 1 through 52 a TIN and give it to the requester before you are subject to backup withholding on
<br /> payments.The 60-day rule does not apply to other types of payments.You will be
<br /> Payments made in settlement of Exempt payees 1 through 4 subject to backup withholding on all such payments until you provide your TIN to
<br /> payment card or third party network the requester.
<br /> transactions Note.Entering"Applied For"means that you have already applied for a TIN or that
<br /> See Form 1099-MISC,Miscellaneous Income,and its instructions. you intend to apply for one soon.
<br /> Caution:A disregarded U.S.entity that has a foreign owner must use the
<br /> appropriate Form W-8.
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