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e; - W mr Iace 0 ® Farm W-9 Request for Taxpayer Give Form to tho ® tee,•_December 2014) Identification Number and Certification rogerostor•Do not Deoe iwht of he Trey send to tho IRS. ® t nter:dr Re n.it Strew* 1 Name(as shown on rout income tet(ennui)_Name is required on this ine:do rot Neve this the Wank. ® 1MIAMI SARAH ETHAN BUSINESS LLC 2 Business ram/disregarded entity name if diderert from above ® Np 3 Check appropriate bolt for federal tax ctasslcaten:Meds only one 01 the b3o'wing seen boxes: 1 Exemptions(codes apply aunty b ® D ❑Ndneb/ oo sde ppeeta a ❑ C Carpozlior: ❑S Corporation. IDPartneahap ❑TesveslIDe canon i 'td N entlitnotiidr:ffiY see first esus on page 3): ® sh embert1C pithy) S. y ❑United babcSty company.Enter the tax class/cation(C- corporation.S=S corporation.P=pstnerstip)la Exempt payee code r11 a1 Note.Fa a shtek-member LLC that a darepasled do rot check tLC check the appropriate Dox in the Fre above for ��'ort tram FATCA reporting • ? the tat eeitstruc or:01 the s'rglmember owner, code(deny) ❑Other(see its suctions)► Mea(o a earn aa.re:t•deutta a.it 5,) z 5 Address(ntanbet suet,and act or slate no Receeslei s name and address(optiono) 1. 2160 NE 191 DRIVE ® WS 8 City.state and ZIP code l8 NORTH MIAMI BEACH,FLORIDA,33179 t7 List account numDerts)here(optional) ® Part I Taxpayer Identification Number(T1 N) ® Enter your TIN in the appropriate box.The TIN provided must match the name givers on me 1 to avoid I Social security number backup withholding. c socialg.Findividuals.this is generally your social searity number(SS N).However.for a e resident amen.sole proprietor.or kisregarded entity.see the Part I instructions an page 3.For other - - entities.it is your employer identification number(EIN).If you do not have a number,see How to get a O TiN on page 3. or Note.If the account is in more than one name.see the instructions for fine 1 and the dart on page 4 fa °Teir'eenLacat'm numb° guidelines on whose number to enter. ® 2 7 - 3 5 1 9 2 5 81 O liMill Certification Under penalties of perjury.I certify that: ® 1. The number shore,on this farm is my correct taxpayer identification number(a 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 withhokfrng,a(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a faiure to report all interest or dividends.or(c)the IRS has notified me that I am no longer subject to backup withholding:and O 3. I am a US.citizen or other US.pawn(defined below):and ® 4.The FATCA codes)entered on this tam Of arty)indicating that I am exempt from FATCA reporting is correct. Certification lnstnrctions.You must suss mut item 2 abcwe if you have been notified by the IFS that you are currently subject to backup withhdding because you have failed to report allinterest and dividends an your tax return.For real estate transactions,item 2 dam not apply.For mortgage COinterest paid.acquisition a abandonment of secured property.cancellation of debt.contrieutic ns to an individual retirement arrangement QRA).and generally.payments other than interest and dividends,you we not metered to sign the certification.but you must provide your correct TIN.See the ® instructions on page 3. Sign Signature of ® Here U.S.person Date► ® General Instructions •Form 1098(home mortgage fir•serest),1093-E(student ban interest).1C98-7 (tuition) Section references ere to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canoed debt) ® Future developments Mtamalion about deidopmerts etlectng Form W-9(suchFarm 1094 A quoits don ea alfandormen1 of source!properly)legitation enacted atter we release it)is at wwwirs.povfw9. •® Purpose of Form Use Form W-9 oily i1 you are a U.S.peeton QndudAtg a resaleet der.),b pic itle tarn cared TPN. An individual or entity(Fawn W-9 requester)who is requi ed at be an information It you de not return Form W-9 to tie requesbr wet a TdN,you might be subect ® return with ate itS must oblaa:you correct taxpayer iderttilaxtior.number(TIN) to coo wdhAoedYrr.See What is backup wd/Mofdrp?or page 2 which may be your sadal security number(3S7Vj.individual taxpayer identificationBy signing Rte tiled-out toast tau: ® number Q71NN,adoption taxpayer identdicalion murder WT178.a employer the amount p irfasna identifit.Gerrity the the TIN war are oiling is meed(a you are waiting a number rafion number(> I)•b repel on antior:return b to be issued). you,or other amount reportable on ar.intonation return._Examples el irtornatont O returns include but are rot imbed to the totoveng: 2.Certify that you are not sde(,eel b rMot backup wdsg,or •Form 10•99-INT(u nreel earned a paikQ 3.Ctamrt exemption tam badcup wdMoicting id you area U.S.exempt payee_If ID •Form 1099-DNaApac>�e.you are abo certityitg Bat as a U.S.person.Kau a ble rhos of (deidends,including those Irom states a mutual hinds) any partnership income from a U.S.trade or tartness is not subect b the •Farm 1099-MSC(various types of income,prizes.aNards.a gross pweeeds) wittetot ung tax on tore*pertness'share of ertatbely corrected income,and ® •Form 10448(suck a rrutust fund srlles and cartairt other barsad;bns Dy 4.Certify that FATCA code(s)entered on Pas form(ii any)ind ealing Merl you ere Form exempt tom The FATCA repealing,is correct.See Wird ft FA ICM reporting?or. ® •Form 1099-S(proceeds tom reel estate transactions) page 2 la'wire nianatior. •Form 1099-K(merchant card end turd lowly rework transactions) ® Cat No.10231X Form W-9(Rea.12-2014) • SYNERGLACE USA I Request for Proposal No. 17-10-02 Page 58 on 60 411 .