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<br /> Form - Request for Taxpayer (live Form to the
<br /> (Rev.October 2018) Identification Number and Certification requester.Do not
<br /> ==, =11 ►too to wwwJrs gov1FormW9 for instructions and the latest information. send to the iRS.
<br /> 1 (as shown on your income tax return).Name is required on this tine;do not leave this One blank
<br /> 2 Business nimald-miDgardeffentity name,'rf different from above
<br /> co
<br /> 3 Check a box for federal tax classification of the n whose name is entered on One 1.Check on one of the 4 Exemptions codes apply
<br /> followings appropriate
<br /> boxes. certainent�Oies,not Individuals;see
<br /> CL instructions on page 3):
<br /> o ❑ tndividuaysoie proprletor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate
<br /> c single-member LLC Exempt payee code(if any)
<br /> O
<br /> ❑ Umited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)0,
<br /> i; Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
<br /> ULC N the LLC Is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC
<br /> Q another'LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC tis hat code(N any)
<br /> 1i: disregarded from the owner should check the appropriate box for the tax classification of its owner.
<br /> Other(see instructions)► okoon to ewmrue M&%1WW Wisdo ur U.SJ
<br /> B Address(num ,street,and apt.or suite no.)See instructions. Requester's name and address(optionai)
<br /> a ft Y1
<br /> 6 City,state,and ZIP oodel
<br /> Q2523 - IMP
<br /> 7 List account number(s)here(optional)
<br /> •• Tax yer Identification Number
<br /> Enter your TIN in the appropriate box.The TIN provided must match the name given on lime 1 to avoidbackup Social sxurtty number
<br /> resider withholding.ole For individuals,this is d entity,your a Inst security number(SSNr.However,for a FM -M -=
<br /> resident alien,sole propr�tor,or disregarded entity,see the instructions for Part i,lacer.For other
<br /> entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
<br /> TfN,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. 101
<br /> " Q
<br /> lJ
<br /> • �'al flcation
<br /> Under penalties of perjury,1 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)1 am exerript from backup withholding,or(b)I have not been notified by the internal Revenue
<br /> Service(IRS)that 1 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 Of any)indicating that 1 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 ORA),and generally,payments
<br /> other than interest and dividends,YIare not rWrd to sign the certification,but you must provide your correct TIN.See the instructions for Part n,later.
<br /> Sign
<br /> Here t,
<br /> General instructions •Form 1099-DIV(dividends,including those from stocks or mutual
<br /> funds)
<br /> Section references are to the Internal Revenue Code unless otherwise .Form 1099-MISC various of income,
<br /> noted ( types prizes,awards,or gross
<br /> Proceeds)
<br /> Future developments.For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other
<br /> related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
<br /> after they were published,go to wwwJrs.gov1FormW3. •Form 1099-S(proceeds from real estate transactions)
<br /> Purpose of Form •Form 1099-K(merchant card and third party network transactions)
<br /> An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest),
<br /> information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
<br /> identification number(FIN)which may be your social security number •Form 1099-C(canceled debt)
<br /> (SSN),individual taxpayer identification number OTIN) adoption
<br /> taxpayer identification number(ATIN),or employer identification number -Form 1099-A(acquisition or abandonment of secured property)
<br /> (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only If you are a U.S.person(including a resident
<br /> amount reportable on an information retum.Examples of information alien),to provide your correct TIN.
<br /> returns include,but are not limited to,the following. ff you do not return Form W-9 to the requester with a 77N,you might
<br /> •Form 1099-INT(interest earned or paid) be subject to backup wiff holding See What is backup withholding,
<br /> later.
<br /> Cat.No.10231 X Form W-9(Rev.10-2018)
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