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Form W-9 RequestforTaxpayer eive Fw-m to the
<br />(Rev. December 2014) requester. i0o not
<br />DapedmeirtoftheTreaswy Identification Number and Cerdflceteo�a
<br />hrtemal Revenue service toatail$o t91a3 ORS.
<br />your
<br />on this line: do
<br />3 Checic appropriate box farfederal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to
<br />fndividueVsole proprtotoror C Corporation ❑ Partnership ❑ Trustlestate esrtaln entities, not individuals; see
<br />❑ Pa ❑ SCorporation Partnersh hlstructionsonpage3):
<br />single -member LLC
<br />❑ Limited liability company. Enter the tax classification (C=C corporation, S--S corporation, P=partnership)► Exempt payee code (rf any)
<br />Note. Fora single -member LLC that is disregarded, do not chock LLC; check the appropriate box in the line above for Exemption from FATCA reporting
<br />the tax classification of the single -member owner.
<br />coda Of any)
<br />❑ Other (see instructions) ► fy,puos ro uaouubmurdmuudouamo uw us.)
<br />sheet, and
<br />state, anc
<br />333,?�r
<br />name
<br />ust accaum nrmruegsi nere (opuonaq
<br />WMM Taxpayer IPdentafication Numbeir (TIN)
<br />Enter yourTiN in the appropriate box. The TIN provided must match the name given on line 1 to avoid I social security number
<br />backup affen, ale For individuals, this is generally your social security lionsnumber page . ForHowever,other
<br />fora FM-
<br />71AI resident oiler, sofa proprietor, or disregarded erlbly, sea the Part I instructions on page 3. For otherentitles, it is your employer identification number(EIN). if you do not have a numbe, see How to geta 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 I Employer Identification number ^�
<br />guidelines on whose number to enter. 17-7-7
<br />Under penalties of perjury, I certify that
<br />1. The number shown on this form is my correct taxpayer Identlflcation number (or I am waiting for a number to be issued to me); and
<br />2. 1 am not subject to backup withholding becauso: (a) I 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. t am a U.S, citizen or other U.S. person (defined below); and
<br />4. The FATCA code(s) entered on this form Of any) indicating that I am exempt from FATCA reporting is correct.
<br />Certttieation 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. Sea the
<br />(instructions on page 3.
<br />ara3rn I St9neUueof -
<br />Here ua person► ] gate o.
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Futun> developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release it) Is at www.irs gov11W9.
<br />Purpose of Forte
<br />An incividual or entity (Forth W-9 requester) who is required to file an information
<br />return with the IRS must obtain yourcarrect taxpayeridentificatlon number (FIN)
<br />which may be your social security number (SSW). Individual taxpayer identification
<br />number QTit ), adoption taxpayer identification number (A IIM, or employer
<br />Identification number (EIN), to report on an infomiatlon return the amount paid to
<br />you, or other amount reportable on an information return. Eminples of information
<br />returns include, but we not limited to, the following:
<br />• Fore 1099AN i (interest earned or paid)
<br />• Forn f 099•DIV (dividends, Including those from stocks or mutual funds)
<br />• Forn 1099-MISC (vadous types of income; prizes, awards, or gross proceeds)
<br />• Fore 1099-B (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Forcn 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />Form 1098 (home mortgage Interest), 1 090-E (student loan interest),109II T
<br />(tuition)
<br />• Form 1099-0 (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Forth W-9 only if you are a U.S. person (including a resident align), to
<br />provide your comart TIN.
<br />Ifyou do not return Form W-9 to the requester with a 77N, you mkaht be subject
<br />to backup withholding. See What is bactrup 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 me waiting for a number
<br />10 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. exernpt payee. If
<br />applicable, you are also certifying that as a U.S. person, your allocable shire 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 coda(s) entered on this form Qf any) Indicating that you are
<br />exempt from the FATCA reporting, is correct. See What Is FATCA reporting? an
<br />page 2 for further information.
<br />Cat. No.10231x Font-g (Rev.12-2014)
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