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W-9
<br />Request for Taxpayer
<br />Give Form to the
<br />-orm
<br />Identification Number and Certification
<br />requester. Do not
<br />Rev. October2018)
<br />send to the IRS.
<br />)apaAmerrt of the Treasury
<br />Memel Revenue Service
<br />► Go to wwwJrsgov/FormlN9 for instructions and the latest information.
<br />t Name (as shown on your income tax return). Name is required on this line; do not leave this ine blank.
<br />2 Business name/disregarded entity name, II different from above
<br />t7
<br />9 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
<br />4 Exemptions (codes apply only to
<br />at
<br />Ca
<br />following seven taxes.
<br />certain entities, not individuals; see
<br />instructions on page 3):
<br />a
<br />C
<br />❑ IndMdualtsole proprietor or El Corporation El Corporation El Partnership ❑ TrusVestate
<br />0
<br />c
<br />single member LLC
<br />Exempt payee code (rf any)
<br />0
<br />❑Limited liability company. Enter the tax classification (C--C corporation, S=S corporation, P=Partnership) ►
<br />p
<br />Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
<br />Exemption from FATCA reporting
<br />is
<br />LLC If the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
<br />LLC
<br />code (rf any)
<br />L 5
<br />another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member that
<br />IL U
<br />Is disregarded from the owner should check the appropriate box for the tax classification of Its owner.
<br />❑ Other (see i nstn ctions) ►
<br />MA'" to «oaxm mwxsvao ouWdo sro u.$)
<br />y
<br />d
<br />5 Address (number, street, and apt. or suite no.) See instructions.
<br />Requesters name and address (optional)
<br />m
<br />6 City, state, and ZIP code
<br />7 Ust account number(s) here (opticnai
<br />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
<br />Social
<br />security
<br />number
<br />_FT
<br />_
<br />backup withholding. For individuals, this is generally your social security number (SSN). However, foractions
<br />resident alien, sole proprietor, or disregarded entity, see the instrufor Part I, later. For other
<br />;. a .,., e..,.,u ,— t,fa.aif,.flnr, n.,mnd fl If vni i rin not have a number. see How to cot a
<br />TIN, later. or
<br />Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and i Employer Identification number
<br />Number To Give the Requester for guidelines on whose number to enter. 1 F-FI—FT
<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 wafting for a number to be issued to me); and
<br />2. 1 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 noted 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 codes) 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 because
<br />you have failed to report all interest and dividends on your tax 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 generally, payments
<br />other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
<br />Sign Signature of
<br />Here us. person ► Date ►
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Future developments. For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go to www.irs.gov/Forml
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who is required to file an
<br />information return with the IRS must obtain your correct taxpayer
<br />ideMification number (TIN) which may be your social security number
<br />(SSN), individual taxpayer identification number (]TIN), adoption
<br />taxpayer identification number (ATIN), or employer identification number
<br />(EIN), to report on an information return the amount paid to you, or other
<br />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
<br />funds)
<br />• Form 1099-Iv11SC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1099-B (stock or mutual fund sales and certain other
<br />transactions by brokers)
<br />• Form 1099-S (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),
<br />1098-T (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
<br />alien), to provide your correct TIN.
<br />ff you do not return Form W-9 to the requester with a TIN, you might
<br />be subject to backup withholding. See What is backup withholding,
<br />later.
<br />Cat. No.1023'X Form VV-`J (Rev.10-2018)
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