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ATTACHMENT
<br />Focnw-91
<br />Request for Taxpayer
<br />"Iva Fern, to the
<br />(Rev, August 2013)
<br />identification Number and Certification
<br />requester. Do not
<br />Send to the IRS.
<br />Copanment
<br />of Iho Treasury
<br />Intenlal
<br />Revenue Service
<br />Name (am shown on your Income tax return)
<br />business name/disregarded entity name, if different from gbove ,
<br />C4
<br />v
<br />°-
<br />Check approprinfe box for federal lax classifications
<br />Exemptions (sea Instructions):
<br />oi]
<br />i] Indidual/sola proprietor C Corporation i] S Corporation El Partnership ❑ TrusVestate
<br />etc
<br />0
<br />P=Partnershi
<br />Exempt payee cads Of any)
<br />from FATCA
<br />`o
<br />imped liability company, Enter the tax classification corporation, corporation,
<br />F1 Lp)>
<br />Exemption reporting
<br />code (if any)
<br />a e
<br />❑ Other (see Instructions) ►
<br />Address (number, street, and apt, or supe no.)
<br />Requester's name and address (options))
<br />d
<br />a
<br />City, state, and 21P code
<br />d
<br />N
<br />List account number(a) here (optional)
<br />Taxpayer Identification Number (TIN)
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on the "Name•' 11171 I:,°°t=' °�°°•r •,u,,,�^
<br />re avoid backup le pr, withholding. torr individuals, this is your social security number n peg However, fora _ m _
<br />resident ellen, sole proprietor, or disregarded entity, see the Part I instructions on pages For other
<br />entitles, it Is your employer Identification number (EIN). If you dr not have a number, see Now to gets FM
<br />TIN on page 3.
<br />Note. firm account In In more than one name, see the chart on page 4 for guidelines on whose E-mpl�oy7�r ldenHgcanon number
<br />number to enter. I I- i I _ F -1—F1 I -F-1 '
<br />der penalties of perjury, I certify that:
<br />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) 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. 1 am a LIS, 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 properly, 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. Sea the
<br />Instructions on page 3.
<br />orgil Signature of
<br />Herm I U.S. person DateP
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Future dovelopments. The IRS has created a page on IRS,goV forinformagon
<br />about For, W-9, at www.lrs.gov/w9, Infonnatlon about any future developments
<br />affecting Form W-9 (such as legislation enacted ager we release it) will be posted
<br />on that page.
<br />Purpose of Farm
<br />A person who Is required to To an Information return with the IRS must obtain your
<br />correct taxpayer fdenilgcation number (TIN) to report, for example, income paid to
<br />you, payments made to you In settlement of payment card and third party network
<br />transactions, real estate transactions, mortgage Interest you paid, acquisition or
<br />abandonment of secured property, cancellation of debt, or contributions you made
<br />to on IRA.
<br />Use Form W-9 only If yet] and a U.S. person (including a resident allen), to
<br />provide you correct 1'IN to the person requesting It (the requester) and, when
<br />applicable, to:
<br />1, Certify that the TIN you are giving Is correct (or you aro waiting for a number
<br />to be issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
<br />applicable, you are also certifying that as a U.S. person, your allocable share of
<br />any pannarehlp Income from a U.S. trade or business Is not subject to the
<br />withholding lax on foreign partnars'sham of effectively connected Income, end
<br />4. Certify that FATCA module) entered on this form (if any) Indicating that you we
<br />exempt from the FATCA reporting, is correct.
<br />Note. It you are a U.s person and a requester gives you a form other than Form
<br />W-9 to request your TIN, you must use the requester's form If it is substantially
<br />similar to this Form W-9.
<br />Definition of a U,S. person. For federal tax purposes, you are considered a U.S.
<br />person If you are:
<br />r An Individual who To a U.S. citizen or U.S. resident alien,
<br />• A partnership, corporation, company, or association created or organized in the
<br />United States or under the laws of the United States,
<br />r An estate (other than a foreign estate), or
<br />.,A domestic trust (as defined In Regulations sectlon 301.7701-7).
<br />Special roles for partnerships. Partnerships that conduct a trade or business In
<br />the United States are generally required to pay a withholding tax under section
<br />1446 on any foreign partners' share of effectively connected taxable Income from
<br />such business. Further, in certain oases where a Form W-9 has not been received,
<br />the rules unear section 1440 require a partnership to presume that a partner Is a
<br />foreign parson, and pay the section 1446 withholding tax. Therefore, If you are a
<br />U.S. person that Is a partner In a partnership conducting a trade or business In the
<br />Untied Slates, provide Form W-9 to the parmorahlp to establish your U.S, statue
<br />and avoid section 1446 withholding on your share of partnership Income.
<br />Cat. No, 10231X
<br />75G-30
<br />(Rev. B-2013)
<br />
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