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Docusign Envelope ID:ABA0F1AB-1 F56-41 F1-8C93-C2D9991313641A
<br /> Form W-9(Rev.10.2018) page 4
<br /> The following chart shows types of payments that may be exempt M—A tax exempt trust under a section 403(b)plan or section 457(g)
<br /> from backup withholding.The chart applies to the exempt payees listed plan
<br /> above, 1 through 13. Note:You may wish to consult with the financial institution requesting
<br /> IF the payment is for... THEN the payment Is exempt this form to determine whether the FATCA code and/or exempt payee
<br /> for... code should be completed.
<br /> Interest and dividend payments All exempt payees except Line 6
<br /> for 7 Enter your address(number,street,and apartment or suite number).
<br /> Broker transact}ons Exempt payees 1 through 4 and 6 This is where the requester of this Form W-9 will mail your Information
<br /> through 11 and all C corporations, returns.If this address differs from the one the requester already has on
<br /> S corporations must not enter an file,write NEW at the top. If a new address is provided, there is still a
<br /> exempt payee code because they chance the old address will be used until the payor changes your
<br /> are exempt only for sales of address in their recordsr
<br /> noncovered securities acquired Line 6
<br /> prior to 2012.
<br /> Barter exchange transactions and Exempt payees 1 through 4 Enter your city, state, and ZIP code.
<br /> patronage dividends Part I. Taxpayer Identification Number (TIN)
<br /> Payments over$600 required to be Generally,exempt payees Enter your TIN in the appropriate box.If you are a resident alien and
<br /> reported and direct sales over 1 through 52 you do not have and are not eligible to gat an SSN,your TIN is your IRS
<br /> $6,000, individual taxpayer identification number(ITIN).Enter it in the social
<br /> security number box. If you do not have an ITIN,see Now to get a TIN
<br /> Payments made in settlement of Exempt payees 1 through 4 below.
<br /> payment card or third party network transactions If you are a sole proprietor and you have an EIN,you may enter either
<br /> your SSN or EIN.
<br /> 1 See Form 1099-MISC, Miscellaneous Income,and its instructions. If you are a single-member LLC that is disregarded as an entity
<br /> 2 separate from its owner,enter the owner's SSN(or EIN,if the owner has
<br /> However,the following payments made to a corporation and one).Do not enterthe disregarded entity's EIN.If the LLC is classified as
<br /> reportable on Form 1099-MISC are not exempt from backup a corporation or partnership,enter the entity's EIN.
<br /> Withholding: medical and health care payments, attorneys' fees,gross
<br /> proceeds paid to an attorney reportable under section 6045(f),and Note:See What Name and Number To Give the Requester,later,for
<br /> payments for services paid by a federal executive agency. further clarification of name and TIN combinations.
<br /> Exemption from FATCA reporting code.The following codes identify How to get a TIN.If you do not have a TIN,apply for one Immediately.
<br /> payees that are exempt from reporting under FATCA.These codes To apply for an SSN,get Form SS-5,Application for a Social Security
<br /> apply to persons submitting this form for accounts maintained outside Card,from your local SSA office or get this form online at
<br /> of the United States by certain foreign Financial institutions. Therefore,if www.SSA.gov.You may also get this form by calling 1.800-772-1213.
<br /> you are only submitting this form for an account you hold in the United Use Form W-7,Application for IRS Individual'taxpayer Identification
<br /> States,you may leave this field blank. Consult with the person Number,to apply for an ITIN,or Form SS-4,Application for Employer
<br /> requesting this form if you are uncertain if the financial institution is Identification Number,to apply for an EIN.You can apply for an EIN
<br /> subject to these requirements,A requester may indicate that a code Is online by accessing the IRS websita at www.irs.gov/Businesses and
<br /> not required by providing you with a Form W-9 with"Not Applicable" (or clicking on Employer Identification Number(EIN)under Starting a
<br /> any similar Indication)written or printed on the line for a FATCA Business.Go to www.irs.gov/Forms to view,download, or print Form
<br /> exemption code, W-7 and/or Form SS-4. Or,you can go to www.irs.govlOrderForms to
<br /> A—An organization exempt from tax under section 501(a)or any place an order and have Form W-7 andlor SS-4 mailed to you within 10
<br /> business days.
<br /> individual retirement plan as defined in section 7701(a)(37)
<br /> B—The United States or any of its agencies or instrumentalities If you are asked to complete Form but not have TIN,apply
<br /> for a TIN and write"Applied For"in thee space for the TIN,sign and date
<br /> C--A state,the District of Columbia, a U.S.commonwealth or the form,and give it to the requester.For interest and dividend
<br /> possession, or any of their political subdivisions or Instrumentalities payments, and certain payments made with respect to readily tradable
<br /> D—A corporation the stock of which is regularly traded on one or instruments, generally you will have 60 days to get a TIN and give it to
<br /> more established securities markets, as described in Regulations the requester before you are subject to backup withholding on
<br /> section 1,1472-1(c)(1)(1) payments. The 60-day rule does not apply to other types of payments,
<br /> E—A corporation that is a member of the same expanded affiliatedYou will be subject to backup withholding on all such payments until
<br /> you provide your TIN to the requester.
<br /> group as a corporation described in Regulations section 1.1472-1(c)(1)(1)
<br /> Nate: Entering Applied For" means that you have already applied for a
<br /> F—A dealer in securities,commodities, or derivative financial TIN or that you i
<br /> instruments(Including notional principal contracts, futures,forwards, intend to apply for one soon.
<br /> and options)that is registered as such under the laws of the United Caution:A disregarded U.S.entity that has a foreign owner must use
<br /> States or any state the appropriate Form W-8,
<br /> G---A real estate investment trust Part II. Certification
<br /> H—A regulated investment company as defined in section 851 or an To establish to the withholding agent that you are a U.S.person,or
<br /> entity registered at all times during the tax year under the Investment resident alien,sign Form W-9.You may be requested to sign by the
<br /> Company Act of 1940 withholding agent even if item 1,4,or 5 below indicates otherwise.
<br /> I—A common trust fund as defined In section 584(a) For a joint account, only the person whose TIN is shown in Part I
<br /> J—A bank as defined in section 581 should sign(when required).In the case of a disregarded entity, the
<br /> K—A broker person identified on line 1 must sign.Exempt payees,see Exempt
<br /> L---A trust exempt from tax under section 664 or described in section payee code,earlier.
<br /> 4947(a)(1) Signature requirements.Complete the certification as indicated in
<br /> items 1 through 5 below.
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