|
cncar your I nv m me appropriate pox. Ina nN provided must match the name given on Ilse 1 to avoid � Social security number j �
<br />backup withholding. For individuals, this is generally your social security number (SSN). However, fora � — m _
<br />resident alien, sole pl•oprietor, or disregarded entity, see the Instructions for Pan I, later. For other
<br />ontities, it is your employer identification number (EIN). IF you do not have a number, seo How to get a
<br />'PIN, later.
<br />or
<br />Note: If the account is in more than one name, see the instructions (or (ins i. Also see What Narne arld Employer Identillcatlon number
<br />Number To Givo the Requesterfor guidelines on whose number to enter, (�__I
<br />8�1�—�1�8�0�2�3�2�8
<br />Under penalties of perjury, I certify that:
<br />i. The number shown on this form is my correct taxpayer idendflcatlon number (or 1 am walling for a number to be Issued to me); and
<br />2, I am not aubJect to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
<br />Sewice (IRS) that i am sub)ect to backup withholding as a result o(a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
<br />no longer sub)ect to backup withholding; and
<br />3. I am a U.S. citizen or other U.S, person (defined below); end
<br />4. The FATCA rode(s) entered on this form (If any) Indicathig that I am exempt from FAl-CA mporting Is correct.
<br />Certification instructions, You must cross out item 2 above if you have bean notified by the IRS that you are currently sub)ect to backup wlthhoiding because
<br />you have failed to report all interest and dividends on your lax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and genoraliy, payments
<br />other than iiderest and dividends, you are not required to sign the cerllfication, but you must provide your correct TIN. See the instructions far Part II, later.
<br />ti Cl ICI QI II IS LI UGU(Jf15
<br />Section references are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Future developments, Far the latest information about developments
<br />related to Fdrm W-9 and Its instructions, such as legislation enacted
<br />after they were published, go to www.irs.gov/FormW9.
<br />Purpose of Form
<br />An Individual or entity (form W-9 requester) who is required to file an
<br />informatlon return with the IRS must obta6t your correct taxpayer
<br />idenilfication number (TIN) which may bo your racial security number
<br />(SSN), individual taxpayer identification number (ITIN), adoption
<br />taxpayer identification number (ATIN), or employer identitication number
<br />(EIN), to report on an information return the amount paid to you, or other
<br />amount reportable on an informetlon return. Examples of information
<br />returns include, but are not limited to, the following,
<br />• Form 1099 -INT (interest earned or paid)
<br />- i i Vaa-uiV tUIVIQanUs, mcwamg mole Irom stocks or mutual
<br />funds)
<br />• Form 1099-MISC (various types of Income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1099-B (stock or mutual fund sales and cenaln other
<br />transactions by brokers)
<br />• Form 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third parry network transactions)
<br />•Form 1098 (home mortgage Interest), 1098-E (student loan interest),
<br />1098-T (tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acqulsltlon or abandonment of secured property)
<br />Use Form W-9 only iF you aro a U.S, person (Indluding a resident
<br />alien), to provide your correct T1N.
<br />Il you do riot return Form W-9 to the requester with a T/N, you might
<br />be subject to backup wlthhoiding. See What Is backup withholding,
<br />later.
<br />cal No. iozatx Form W-9 {Rev, io-zeta)
<br />®
<br />Request for Taxpayer
<br />Form
<br />Give Form to the
<br />(Rov.Ocloher 201G)
<br />Identification Number and Certification
<br />requester. Do not
<br />Oepanment
<br />of the Treasury
<br />send to the IRS.
<br />IntemtJ
<br />Revenue Service
<br />► Go to www.irs.gov/FormW9 for instructions and the latest information.
<br />t Name (as shown on your Income tax return). Nome is required on this line; do not leave this line blank.
<br />FLORIDA CDI, LLC
<br />2 Business name/disregarded emity name, If dlllerent Irom above
<br />m
<br />3 Check appropriate box for federal tax classilicatlon of the parson whose name Is entered on line 1, Check only one of the
<br />4 Exemptions {codes apply only to^
<br />�
<br />following seven boxes.
<br />cortnln ontities, not intlivitluals; seo
<br />a
<br />p✓
<br />❑ IndlviduaVsole ro rletor or potation m Q Partnership � TrusVestate
<br />p p' � C Cor � S Co oration
<br />Instructions on page 3):
<br />H
<br />oingle-member LLC
<br />a o
<br />Exempt payee coda (If nny).,_
<br />�'�
<br />❑Limited liability company. Enter the lax elassillealion (G=C corporation, S=S corporation, P=Pndnorship) ►
<br />`o °
<br />�
<br />Note: Check the npproprlale box In the Ilna above for the tax classilicatlon of the shrgle-member owner, Do not chock
<br />Exemption from FATCA reporting
<br />�
<br />LLC if the LLC Is classifletl as a single -member LLC that is diaregardad from the owner unless the owner of the LLC is
<br />'e 5
<br />C
<br />another LLC that la not disregarded from the owner for U,S. federal rex purposes, Olhorwiae, osingle-member LLC that
<br />code (If any)
<br />�
<br />fs disregarded from the owner should check the appropNate hox (or thefax classilicatlon of Its owner.
<br />�
<br />a
<br />� Other (see instrucllons)►
<br />rMas•, to.mw,enc mmmwme«,nrao m•usf
<br />y
<br />G Address (number, street, and apt. or suite noJ See Instructions,
<br />Roquoster's name and address (optional)
<br />in
<br />3124 NW 16TH TERRACE
<br />G City, state, and ZIP code
<br />POMPANO BEACH, FL 33064
<br />7 List account number(sj horn (optional)
<br />Tax oyer Identification Number
<br />(TIN
<br />cncar your I nv m me appropriate pox. Ina nN provided must match the name given on Ilse 1 to avoid � Social security number j �
<br />backup withholding. For individuals, this is generally your social security number (SSN). However, fora � — m _
<br />resident alien, sole pl•oprietor, or disregarded entity, see the Instructions for Pan I, later. For other
<br />ontities, it is your employer identification number (EIN). IF you do not have a number, seo How to get a
<br />'PIN, later.
<br />or
<br />Note: If the account is in more than one name, see the instructions (or (ins i. Also see What Narne arld Employer Identillcatlon number
<br />Number To Givo the Requesterfor guidelines on whose number to enter, (�__I
<br />8�1�—�1�8�0�2�3�2�8
<br />Under penalties of perjury, I certify that:
<br />i. The number shown on this form is my correct taxpayer idendflcatlon number (or 1 am walling for a number to be Issued to me); and
<br />2, I am not aubJect to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
<br />Sewice (IRS) that i am sub)ect to backup withholding as a result o(a failure to report all Interest or dividends, or (c) the IRS has notified me that I am
<br />no longer sub)ect to backup withholding; and
<br />3. I am a U.S. citizen or other U.S, person (defined below); end
<br />4. The FATCA rode(s) entered on this form (If any) Indicathig that I am exempt from FAl-CA mporting Is correct.
<br />Certification instructions, You must cross out item 2 above if you have bean notified by the IRS that you are currently sub)ect to backup wlthhoiding because
<br />you have failed to report all interest and dividends on your lax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and genoraliy, payments
<br />other than iiderest and dividends, you are not required to sign the cerllfication, but you must provide your correct TIN. See the instructions far Part II, later.
<br />ti Cl ICI QI II IS LI UGU(Jf15
<br />Section references are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Future developments, Far the latest information about developments
<br />related to Fdrm W-9 and Its instructions, such as legislation enacted
<br />after they were published, go to www.irs.gov/FormW9.
<br />Purpose of Form
<br />An Individual or entity (form W-9 requester) who is required to file an
<br />informatlon return with the IRS must obta6t your correct taxpayer
<br />idenilfication number (TIN) which may bo your racial security number
<br />(SSN), individual taxpayer identification number (ITIN), adoption
<br />taxpayer identification number (ATIN), or employer identitication number
<br />(EIN), to report on an information return the amount paid to you, or other
<br />amount reportable on an informetlon return. Examples of information
<br />returns include, but are not limited to, the following,
<br />• Form 1099 -INT (interest earned or paid)
<br />- i i Vaa-uiV tUIVIQanUs, mcwamg mole Irom stocks or mutual
<br />funds)
<br />• Form 1099-MISC (various types of Income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1099-B (stock or mutual fund sales and cenaln other
<br />transactions by brokers)
<br />• Form 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third parry network transactions)
<br />•Form 1098 (home mortgage Interest), 1098-E (student loan interest),
<br />1098-T (tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acqulsltlon or abandonment of secured property)
<br />Use Form W-9 only iF you aro a U.S, person (Indluding a resident
<br />alien), to provide your correct T1N.
<br />Il you do riot return Form W-9 to the requester with a T/N, you might
<br />be subject to backup wlthhoiding. See What Is backup withholding,
<br />later.
<br />cal No. iozatx Form W-9 {Rev, io-zeta)
<br />
|