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<br /> Form W®g
<br /> Request for Taxpayer Give Form to the
<br /> (Rev.
<br /> °eCelii°�2014'
<br /> Identification Number and Certification requester.Do not
<br /> Depat.ment of the Trravmy
<br /> Internal Revenue Servicesend to the IRS.
<br /> 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
<br /> smartLINK,Inc.
<br /> N 2 Business name/disregarded entity name,ii different from above
<br /> a
<br /> m
<br /> a
<br /> O.
<br /> 0 3 Check appropriate box for federal tax classification.check only one of the following seven boxes: 4 Exemptions(codes apply to
<br /> no 0 IndividuaVsole proprietor or 0 C Corporation Q S Co0 Trust/estate instructions on certain entities, age 3)Mduals;see
<br /> a c single-member LLC rporation' 0 Partnership
<br /> Page
<br /> ❑limited liability company.Enter the tax classification(C=C corporation.S=S corporation,P_partnership)is Exempt payee code(d arty)
<br /> o 2 Note.Fora single-member LLC that Is disregarded,do not check Lcheck eck the appropriate box in the fine above for Exemption from FATCA reporting
<br /> c e the tax classification of the single-member owner.
<br /> ` , ❑Other(see instructions)D code(ifs any)
<br /> 5 Address(number.street andi o Diane n+ cheers Ow usr
<br /> Z.
<br /> epi,or suite no.) Requester's name and address(optional)
<br /> a
<br /> 16E11THST
<br /> o 6 City,state,and ZIP code
<br /> coco
<br /> Newport,KY 41048
<br /> 7 List account number(s)here(optional)
<br /> CM1 Taxpayer Identification Number(TIN)
<br /> Enter your TIN in the appropriate box.The TiN provided must match the name given on line 1 to avoid I Social security number
<br /> backup withholding.For individuals,this is generally your social security number(SSN).However,for a J
<br /> resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other I I -
<br /> entities;it is your employer Identification number(EIN).If you do not have a number,see How to get a
<br /> TIN on page 3,
<br /> Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for orEmployeridentification number
<br /> guidelines on whose number to enter.
<br /> �
<br /> ip:��a.�..��tw,. 8 1 - 3 7 5 2 6 7 8
<br /> lint Certification
<br /> Under penalties of perjury,I certify that:
<br /> 1. The number shown on this form is my correct taxpayer identification number(or 1 am waiting for a number to be issued to me);and
<br /> 2. I am not subject to backup withholding because:(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. I 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 Z�
<br /> Here U.S.person is /'jCL �1 ' ....-- ...../2
<br /> Dater. 9/rj;4
<br /> General Instructiosia •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T
<br /> Section references are to the Internal Revenue Code unless otherwise noted. (tuition)
<br /> Future developments.Information about developments affecting Form W9(such •Form 1099-C(canceled debt) i
<br /> as legislation enacted after we release it)is at www.fs.gov/hv9, ;•Form 1099 A(acquisition or abandonment of secured property)
<br /> rp Use Form W-9 onlyyoug )
<br /> Purpose of Forth if are a VS.person(including a resident alien),to
<br /> provide your correct TIN, I
<br /> An individual or entity(Form W-9 requester)who is required to file an information
<br /> //you do not return Form W-9 to the
<br /> return with the IRS must obtain your correct taxpayerrequester with a 71N,you might be subject
<br /> which may be your social r identification number mM to backup withholding,See What is backup withholding?on page 2.
<br /> number rmM,adoption taxpayer number
<br /> (SSN),individual taxpayer identification By signing the filled out form,you:
<br /> identificationbeerOIN,number payer identification number(MIN).or employer1
<br /> (Elly),torert on an information return the amount paid to 1.Certify that the TIN you are giving Is correct(or you are waiting for a number
<br /> you,or other amount reportable on an information return_Examples of information to be issued). I
<br /> returns include,but are not limited to.the following: 2.Certify that you are not subjectlto backup withholding,or
<br /> •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup ivithtmotd¢n9 if
<br /> •Form 1099-DN(dividends,including those from stocks or mutual funds) you are a U.S.exempt payee.II
<br /> applicable,you are also certifying that as a U.S.person,your allocable share of
<br /> •Form 1099-MISC(various types of Income,prizes.awards or gross proceeds) any partnership Income from a Urs'share
<br /> de or effectively
<br /> business is not subject to the
<br /> •Form 109948(stock or mutual fund sales and certain other transactions withholding taxon foreign partners'share of connected inn-oma,and
<br /> brokers) b' 4.Certify that FATCA code(s)entered on this form(f any)indicating that you are
<br /> •Form 10995exempt from the FATCA reporting, correct.See What is FATCA reporting?on
<br /> (proceeds from real estate transactions) page 2 for further information,
<br /> •Form 1099-K(merchant card and third party network transactions)
<br /> Cat.No.10231X Form W-9(Rev,12-2014)
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