|
"�
<br />elver-nrm,tothe
<br />Farm
<br />Request for Taxpayer
<br />(ftnv: E7Wamm6ar 014)
<br />L Identification Number and Certification
<br />to th,t
<br />17apanManlatthnrrappausend
<br />Santa! to the IRS,
<br />IRS.
<br />IataMal rimuanan,APrvinn
<br />_. e . Re; a W. 11 , .......
<br />.� NAiYIa rl6aligwn an yatafngoma tax rallilm } Neme is r9quli'ad dn:thl §.Ilnai dtl not tfAVO tfllslinablank,
<br />Mutlpal of.?matte Structured SottiatnantCoronet
<br />2�nuslnosairainMdisrNgaMedohilty name, it eifferaal from anoya
<br />qoP
<br />e hark appropriate box for federal taxalaaaliloatlam chunk omVbftm of the (Wtawingsovon baxoal
<br />4 exomplloos (apduti apply ppnl&
<br />Panels apntiNes, not lnddhllduatelate
<br />D IntlfvidrralZapla proprietor or ( ocorporalion 0 a corporation Pannermi ("� 7Y�uavostate
<br />R
<br />InotivotlOno an Pago 6J1
<br />m o
<br />singla mcmhar ll.tn
<br />[� Urnhod llon.Wty company. War the :lax claasillgation (0•C corporation, See corporation, p>rpannarattip7W
<br />li%ampt payaP Soda pf nay) G
<br />t1qCa. Far asnnyyla•,pWmmaWPi„LU that to dlWratlafdod, do not check 1101 Clinch Ilia- dpprometd box In thalhei above for
<br />Varoptlan from FATCA reporting
<br />NtA
<br />flmtaxoteaa,Ilcatlon othhe aingIwmamborawnar.
<br />code (if any) _
<br />other rte lifalruntfonajb
<br />(M1M+Ym IPUWttNMattngllNWtlpu(iglo NU1A:J
<br />II
<br />6 Ad toss numhar street, and apt aradila no,) Fl. eque9lettiLYmaand.a dresa (apilaliag
<br />8800 mutual or Omaha plaza .,. .
<br />oily, imto, and 2lp aod,3.
<br />Omaha, NEC 60178
<br />T nl"r ours niiwifltfHl
<br />tlSSptTYer darlti cWltitan 3tiumber
<br />I[a
<br />Wer yourTIK In trip appropriate box, Tho7IN prnvlded must match the name giveline,[ an to avold
<br />sa aI saaudryn"uan or _
<br />dualse for a
<br />gaakupwlftimS (page0hlaoroth,l'
<br />lu,poarindWt
<br />ntIor6ganality, seathePalsocurkynumbar
<br />real'cfpnt dl(an, seta proprietor; ordistogardad aritlty, ass the pad 'I lnatn,ol(ana MI page 1, Far o'tYiaP
<br />eni9dsa, ttla your omPloyer ldanklribattan number (Glt�. IP you da net have a numbor, ere blow W.gata
<br />VN on pegs S.
<br />Mato, If the wootnitin In more than one name, we the Instructions for line f and the ohart on page 4 for
<br />guldelinaa on whaae number to enter.
<br />'I. The number shown on this Parrs Is my aameat taxpayer ldengftcntlon nurnber (or I am waiting tar a number to be Issued tome):; and
<br />2, .I ant notsubleat to backup wlthholding.baaau ia; fay I amexernpt fwm backup Withholding, or tbl i naive not been mongod b the Informal Revenue
<br />Service (IP18) that I ern subjeut(o backup wlthhalding as a result of a failure to report all Interest or dividends, or (o) the IN$ has notified. me :that I am
<br />ndlomquir subject tobabkup' Withholding: and
<br />-
<br />9, 1 Am a With slice" or other Us, person Idellhsd be"; end
<br />-A, The FATCA codes) entered on fire form -(it any) tnddeling that I -am exempt from FATCA reporting Is Garrott:
<br />- Centifloatfon Inatrumthma. You must oress out -Item 2 above It you have been nollffed by the IRS thatyou are currently, wbjeotto.bebkup withholding
<br />booaase you haveiailed to report ail interest and dividends on your tax return, For real estate trallgagtiana, ham 2,toes not apply, Par Mortgage
<br />Interest paid, sgquis)tion or abandgrlmentofassured property, can, callettlort at :debt, mntdbt,)lloba to an Individual retirement amengemant 0RA7, and
<br />generally, payn anb other than Interest and dividends, you am not Wegpirod to alga ilia corRlltcadon, but you must provide your Correct TIN. Son the
<br />General Instruotions
<br />Section:rniorancma arm to the informal navende coda unto" olhorwiso:noted,
<br />Fur Oro dnv&lapmMWt trfapllmlahaboliEdaVeruptYNtlnlU 01actlag I-ann W-9 Inch
<br />ee legla atlanenooted Race we Towson 11) it atru wwdrs.96VIAlo,
<br />Purpose of Farm:
<br />An Individual or Pntity aFonn'N,9 requester), who ($ acquired to Ilia oil Nqui.nQon
<br />return Willi 1110 IRS Met obtainy nurgpfregt tax dgar lilanllfloatlan numbor (TIN)
<br />Writplt mayhdynurp0alal aWOa,ily paml7Pr 9aNl,,(ndtvid
<br />m pal laxpayar ldenllgnatinn
<br />etier (ITINI deopllohCrapaypr.ldantip6ailop numisnr(A71N), or employer
<br />Idmntifaatlan number (EMi, to report an an Information return the amount paid to
<br />Yam = orother amount ioporlab'ie on an Information return, ExamPla6 of Ihfarmallon
<br />returns include, nut are ucttimitedto, the Tolluwfng;
<br />• Form 1009 -INT (mfe est earned Or pale)
<br />•.Form Ia9o•CIV (drvldarde,. Inoluding those, from stocks or mutual tundej
<br />• Pore 1,09- 14*0tvorious]yposof Income, prize$. awards, orgronprappeds)
<br />*.PennI00Y n (stock ormutual fund Palos end certain other tommulldnaby
<br />Molars)
<br />• Form .Imf gds (Prumvearfrom coal estate manaaotfona)
<br />• Porm 1099 -K (movahant: card :"Ind rthird parW nPWJalk.tYanS3a9dnbj
<br />= Form Ines (home mortgaga Intamsf), 10SA -E (a mdom men Interest), lam•T
<br />(1011(x)
<br />Form 1e99- 0 :(canomadtlabt)
<br />• Form 1(rp8 -a (aaqulollion orebdndonm9nt otencumd,properly)
<br />use Porn)Vyo andY If� YYou area U. phreon(imeludina e maidentatiam,,.to
<br />pravtde,yaar: correct TIN,
<br />Ifyog do flat mmm Fbart W-9 to the requeGterwttc a IIN, You might be subject
<br />to backup wrl uY60ag. San yVhni 19 hookup w11001*39 to paga2,
<br />sySigning too flilad -out form, your
<br />L sentry that the TN you are giving Isaarraot(or you are waltlag for a number
<br />to he hotrod),
<br />2. Certify that you as notsubiect le haakup withholding, Or
<br />a, Clatm oxatllptlan iral'n baakuP VrllhhaidinBBttyau run n ll,a, axemptpayoa, it
<br />applluahla ymvro also oarfffyinl' that as a tl 6, femP , your altoaable sham of
<br />anyy ppannatshlp'Ingoma from a: tlJoadoor �ptln na6a 18 flak auateahto1h0
<br />wlthhalding. tax on lfr ign.panneral clues of nilnolIvuly Pomaded Inoamo ,and
<br />A. CndIty thatrATOA aerials entered an mrs form(il say) Indicadm that you ere
<br />o%ampt front the FAVA rppart ego Is carroot, See:Wnat Is PATCA roparring2 on
<br />Pape 2 fur further In(Orma11Ion.
<br />.__.,�..���. root. No, tagatx Form W +S (hbv. tic -2gtA)
<br />
|