|
Form W•9 (Rev. October 2018) DepMmenl of the Treasury lnlemal Revenue Service
<br />Request for Taxpayer Identification Number and Certification
<br />► Go to www.irs.gov/FormW9 for instructions and the latest information.
<br />2 Business name/disregarded entity name, Ir different from above
<br />� 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 0> following seven boxes. � 8 0 Individual/sole proprietor or D C Corporation S Corporation D Partnership single-member LLC 0 TrusVestate
<br />. ., QI C Q. 0
<br />l;' tl O Limited liability company. Enter the tax classification {C=C corporation, S=S corporation, P=Partnership) ► ___ _ :S 2 Note: Check the appropriate box in the line above tor the tax classification of the single-member owner. Do not check £ � LLC if the LLC is classified as a single•member LLC that is disregarded from the owner unless the owner of the LLC is -. -another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that ll. � is disregarded from the owner should check the appropriate box for the tax classification of its owner.
<br />Give Form to the
<br />requester. Do not
<br />send to the IRS.
<br />4 Exemptions {codes apply only to certain entities. not individuals; see instn.Jclions on page 3): Exempt payee code (,f any) ----Exemption from FATCA reporting code �f any)
<br />[ t-::'D=:c-,-0-:-th_e""'r ,...(s_e_e7in_s _tr_u,...ct _io..,.n_s _) ►....,..----,--.,.,----,--,,--,-----.,---------------,--,c----:---�""-.,--""°..,.· •..,..,_•_· '_'0.,.•n_tt.,,"'_""'_· ...,'�_••_d_rn_m_, .. _,,.,_u_._;; __ , _
<br />] t-c-5��:cd,-d _&_e s _7 _5_m ----cb -::e '.:..-,.,�,..•t _:_e �t L, a_:_�-a -��t �. o_r _s _u �i �•°'-n �o �-�-S �k_�e -i n �s -�_Q �t -i�-"��--....-���-��_,LOO ___ --l R e quester's name and address {opt ionaij
<br />6 City, state, and ZIP code 'J IA � \--
<br />7
<br />Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withl1olding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other entities, it is your employer identification number (EIN). If 'fOU do not have a number, see How to get a
<br />TIN, later.
<br />Social security number CID -[D -I I I I I or
<br />Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
<br />Number To Give the Requester for guidelines on whose rumber to enter. 71
<br />Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number {or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup wit11holding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS llas notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
<br />Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
<br />Sign
<br />Here Signature of
<br />U.S. person ►
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov/FormW9.
<br />Purpose of Form An individual or entity (Form W-9 requester) who is required to file an lnformation return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social secL,rity number (SSN). individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include. but are not limited to. the following. • Form 1099-INT (interest earned or paid)
<br />Cat. No. t0231X
<br />Date► • Form 1099-DIV (dividends, including t11ose from stocks or mutualfunds) • Form 1099-MISC (various types of income, prizes, awards, or grossproceeds} • Form 1099-8 (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1 099-K (merchant card and third party network transactions) • Form 1098 (home mortgage interest). 1098-E (student loan interest). 1098-T (tuition) • Form 1099-C (canceled debt) • Form I 099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.
<br />If you do not return Form W-9 to the requester with a TIN. you might
<br />be subject to backup withholding. See What is backup withholding,
<br />later. Form W-9 (Rev, t0-2018)
|