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Form we 9
<br />(Rev. December 2014)
<br />Department of the Treasury
<br />Internal Revenue Service
<br />Request for TaxpayerI Give Form to the
<br />Identification Number and Certification requester. Do not
<br />send to the IRS.
<br />I Name (as shown on your Income tax retu
<br />The Amusement Source LLC
<br />2 Business name/disregarded entity name,
<br />Amusement Source
<br />on
<br />aoove
<br />3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to
<br />❑ EJC Corporation F -1S Corporation certain ons oa, not Individuals; see
<br />Individual/sole proprietor or
<br />❑ Partnership ❑ TrusUestate Instructions on pegs 3):
<br />single -member LLC Exempt payee code (If any)
<br />❑✓ limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnershlp) ► C
<br />Note. For a single -member LLC that is disregarded, do not check LLC; check the appropriate box In the line above for Exemption from FATCA reporting
<br />the tax classification of the single -member owner. code (if any)
<br />❑ Other (see instructions) ► Wplies to acccunts malatalned outWda the U.S.)
<br />5 Address (number, street, and apt, or s
<br />859 Tyler Street
<br />e City, state, and ZIP coda
<br />Hollywood, FL 33019
<br />7 List account numbers) here (optional)
<br />Requester's name
<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 generally your social security number (SSN). However, fora _ m _
<br />resident ellen, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other
<br />entities, it is your employer Identification number (EIN). If you do not have a number, see How to get a
<br />77N on page 3, or
<br />Note. if the account Is In more than one name, see the Instructions for line 1 and the chart on page 4 for Employer identification number
<br />guidelines on whose number to enter.
<br />8 1- 2 1 0 1 7 1 9 0 2 3
<br />Certification
<br />Under penalties of perjury, I certify that:
<br />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
<br />2. 1 am not subject to backup withholding because: (a) l am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
<br />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 has notified me that I am
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below); and
<br />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
<br />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
<br />Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and
<br />generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
<br />instructions on page 3.
<br />Sign Signature of
<br />Here I U.S. person►1%.`��,�✓ Date)-
<br />General
<br />ate►
<br />General I
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release it) is at www.lrs.gov/fw9.
<br />Purpose of Form
<br />An Individual or entity (Form W-9 requester) who is required to file an information
<br />return with the IRS must obtain your correct taxpayer identification number (iIN)
<br />which may be your social security number (SSN), Individual taxpayer Identification
<br />number (ITIN), adoption taxpayer Identification number (ATIN), or employer
<br />Identification number (EIN), to report on an Information return the amount paid to
<br />you, or other amount reportable on an information return, Examples of Information
<br />returns include, but are not limited to, the following:
<br />• Form 1099 -INT (Interest earned or paid)
<br />• Form 1099 -DIV (dividends, Including those from stocks or mutual funds)
<br />• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
<br />• Form 1099-B (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Form 1099-5 (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 (home mortgage Interest), 1098-E (student loan Interest), 1098-T
<br />(tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only If you are a U.S. person (Including a resident alien), to
<br />provide your correct TIN.
<br />If you do not return Form W-9 to the requester with a TIN, you might be subject
<br />to backup withholding. See What is backup withholding? on page 2.
<br />By signing the filled -out form, you:
<br />1. Certify that the TIN you are giving is correct (or you are waiting for a number
<br />to be Issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt payee. 11
<br />applicable, you are also certifying that as a U.S. person, your allocable share of
<br />any partnership Income from a U.S. trade or business Is not subject to the
<br />withholding tax on foreign partners' share of effectively connected Income, and
<br />4. Certify that FATCA code(s) entered on this form (if any) Indicating that you are
<br />exempt from the FATCA reporting, Is correct. See What is FATCA reporting? on
<br />page 2 for further Information.
<br />Cat. No. 10231X Form W-9 (Rev. 12-2014)
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