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Farm
<br />Social security number
<br />Request for Taxpayer
<br />Give Form to the
<br />(Rev. DIdentification
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<br />Number and Certification
<br />entities, it Is your employer identification number (EIN), If you do not have a number, see How fo get a
<br />requester. Do not
<br />Depadm
<br />TLV on page 3.
<br />Note. If the account Is in more than one name, see the instructions for line 1 and the chart on page 4 for
<br />send to the IRS.
<br />Internal
<br />Revenue Service
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<br />I
<br />II
<br />i Name (as shown on your Income tax return). Name is required on this line; do not leave this line blank.
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<br />2 Business nomdisregnrdod entity name, if different from above
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<br />3 Check appropriate box for federal tau classification; check only one of the following seven boxes:
<br />4 Exemptions (codes apply only to
<br />certain amities, not individuals; are
<br />o
<br />❑ Individuatlsole proprietor or ❑ C Corporation ❑ 5 Corporation ❑ Partnership ❑ Trust/estate
<br />instructions on page S):
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<br />v
<br />single -member LLC
<br />❑ Limped Ilability compary. Enter the tax classification (G_C corporation, S=S corporation, Pnisulnershipl ►
<br />Exempt payee code (if any)
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<br />Note. For a single -member LLC that is disregarded, do not check LLG; check the appropriate box In the line above for
<br />Exemption from FATCA reporting
<br />the inx classification of the single -member owner,
<br />code(Ifany)
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<br />❑ Other(.. Instructions)`
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<br />5 Address (number, street, and apt, or suite no.)
<br />Requester's name and address (optional)
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<br />picky, state, and ZIP code
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<br />OR
<br />7 List account number(s) here (optional)
<br />Taxpayer Identification Number (TIN)
<br />Enter your TIN In the appropriate box. The TIN provided roust match the name given on line i to avoid
<br />Social security number
<br />backup withholding. For individuals, this Is generally your social security number ISSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, sae the Fart I instructions on page 3. For otherFM
<br />[11
<br />entities, it Is your employer identification number (EIN), If you do not have a number, see How fo get a
<br />TLV on page 3.
<br />Note. If the account Is in more than one name, see the instructions for line 1 and the chart on page 4 for
<br />or
<br />Employer identification number,
<br />guidelines an whose number to enter.
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<br />Under pelaaltles of perjury, I 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 tome); and
<br />2. lam 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 are a U.S. 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 crass out Item 2 above If you have been notifled 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 property, 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. See the
<br />Instructions on page 3.
<br />bignI Signature of
<br />Here U.S. person Data
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release It) Is at ivww.h's.gav/lw9.
<br />Purpose of Form
<br />An Individual or entity (Form W-9 requester)who is required to file an information
<br />return wlth the IRS must obtain your correct taxpayer Identification number RIM
<br />which may be your social security number ISSN), Individual taxpayer Identification
<br />number (ITIN), adoption taxpayer Identification number (ATI N), or employer
<br />Identification number (EIN), to report on an Information refer n the amount paid to
<br />you, or other amount reportable on an Information return. Examples of Information
<br />returns include, but are not limited to, the following:
<br />• Form 1099-INT(inlerest earned or paid)
<br />• Form 1099 -DIV (dividends, Including those ram stocks or mutual funds)
<br />• Form 1099-MISC (various types of Income, prizes, awards, or gross proceeds)
<br />• Form 1099-a (stock w mutual fund sales and sedate other transactions by
<br />brokers)
<br />• Form 1099-5 (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />* Form 1098 (home mortgage Interest), logs -E (student loan Interest), toga -T
<br />(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 alien), to
<br />provide your correct TIN.
<br />If you do not return Form W-9 to the requesterwith a TIN, you might be subject
<br />to backup withholding, See What Is backup wlthholdingf on page 2.
<br />ey signing the filled -out form, you:
<br />1. Certify that the TIN you are giving Is correct (or you are welting 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 partnership Income from a U.S. trade or business Is not subject to the
<br />withholding tax on foreign partners' share of effectively connected Income, and
<br />4. Certify that FATCA code(s) entered on this form (If any) Indicating that you are
<br />exempt from the FATCA reporting, Is correct. See What Is FATCA reporting? on
<br />page 2 for further Information.
<br />Cat. No. 10231X
<br />751-43
<br />Form W-9 (Rev. 12-2014)
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