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Form W-9 (Rev. 12-2014)
<br />Line 2
<br />If you have a bualness name, trade name, DBA name, or disregarded entlty name,
<br />you may enter it on line 2.
<br />Line 3
<br />Chock file appropriate box in line 3 fol'the U.S. federal taxclassificatlon of the
<br />person whose name Is entered on line 1. Check only one box in line 3.
<br />Limited Liabillly Company (LLC). If the name on line 1 is an LLC treated as a
<br />partnership for U.S. federal tax purposes, check the "Limited Liability Company"
<br />box and enter "P" In the space provided, If the LLC has filed Form 8032 or 2553 to
<br />be taxed as a corporation, check the "Limited Uabillty Company" box and In the
<br />space provided enter "C" for C corporation or "S" far 5 corporation. If it is a
<br />aingle-member LLC that Is adisregard ad entity, do not check the "Limited Liability
<br />Company" box; instead check the first box In line 3 "IndvIduallsole proprietor or
<br />single-memIder LLC:'
<br />Line 4, Exemptions
<br />If you are exempt from backup withholding and/or FATCA reporting, enter In the
<br />appropriate space in line 4 any cadets) that may apply to you.
<br />Exempt payee code.
<br />P Generally, individuals (Including sole proprietors) aro not exempt from backup
<br />withholding.
<br />a Except as provided below, corporations are exempt from backup withholding
<br />for certain payments, including interest and dividends.
<br />• Corporations are not exempt from backup withholding for payments made in
<br />settlement of payment card or third party network transactions.
<br />e Corporations are riot exempt from backup withholding with respect to attorneys'
<br />fees or gross proceeds paid to attorneys, and corporations that provide medical or
<br />health care Services are not exempt wlth respect to payments reportable on Form
<br />1099-MISC.
<br />The following codes identify payees that are exempt from backup withholding.
<br />Enter the appropriate code in the space In line 4.
<br />1—An organization exempt from tax under section 501(a), any IRA, or a
<br />custodial account under section 401 If the account satisfies the requirements
<br />of section 401(1)(2)
<br />2—The UNted Stales or any of Its agencies or instrumentalities
<br />3—A slate, the District of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivisions as Instrumentalities
<br />4—A foreign government or any of Its political subdivisions, agencies, or
<br />Inatru armsdires
<br />5—A corporation
<br />6—A dealer In securities or commodities required to register in the United
<br />Steres, the District of Columbia, or a U.S. commonwealth or possession
<br />7—A futures commission merchant registered with the Commodity Futures
<br />Trading Commission
<br />8—A real estate Investment trust
<br />9—An entity registered at all times during the tax year under the Investment
<br />Company Act of 1940
<br />10—A common trust fund operated by a bank under section 584(x)
<br />11 —A financial Institution
<br />12—A middleman known In the Investment community as a nominee or
<br />custodian
<br />13—A trust exempt from tax under section 664 or described In section 4947
<br />The following chart shows types of payments that may be exempt from backup
<br />withholding. The chart applies to the exempt payees listed above, t through 13,
<br />IF the payment is for,..
<br />THEN the payment is exempt for, ..
<br />Interest and dividend payments
<br />All exempt payees except
<br />for 7
<br />Braker transactions
<br />Exempt payees 1 through 4 and e
<br />through 11 and all D corporations. S
<br />corporations must not enter an exempt
<br />payee code because they are exempt
<br />only for sales of noncovefed securities
<br />acquired prior to 2012.
<br />Barter exchange transactions and
<br />Exempt payees 1 through 4
<br />patronage dividends
<br />Payments over $600 required to be
<br />Generally, exempt payees
<br />reported and direct sales over $5,0001
<br />1 through 5e
<br />Payments made In settlement of
<br />Exempt payees 1 through 4
<br />payment card or third party network
<br />transactions
<br />I Sae Farm 1099-MISC, Miscalsmeoua Income, and Its instructions.
<br />' However, the following payments made to a corporation and reportable on Form
<br />1099-MISC are not exempt from backup withholding: medical and health care
<br />payments, attorneys' fees, gross proceeds paid to an attorney reportable under
<br />section 80450, and payments for services paid by afederal executive agency.
<br />Exemption from FATCA reporting code. The following codes identify payees
<br />that are exempt from reporting under FATCA. These codes apply to persons
<br />submitting this form for accounts maintained outside of the UU lted States by
<br />certain foreign financial Institutions. Therefore, if you are only submitting this form
<br />for an account you hold In the United States, you may leave this field blank.
<br />Consult with the person requesting this form if you are uncertain if the financial
<br />institution is subject to these requirements. A requester may Indicate that acode Is
<br />not required by providing you with a Form W-9 with "Not Applicable" (or any
<br />Mother indication) written or printed on the line for a FATCA exemption code.
<br />A—An organization exempt from tax under section 601(a) or any individual
<br />retirement plan as detlned In section 77D7(a)(37)
<br />B—The United States or any of its agencies or instrumentalities
<br />C—A state, the District of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivisions or Instrumentalities
<br />D—A corporation the stock of which Is regularly traded on one or more
<br />established securities markets, as described in Regulations section
<br />1.1472-1(c)(1)(1)
<br />E—A corporation that Is a member of the same expanded affiliated group as a
<br />corporation described In Regulations section 1,1 472-1(c)(1)(0
<br />F --A easier in securities, commodities, or derivative financial Instruments
<br />(Including notional principal contracts, futures, forwards, and options) that is
<br />registered as such under the laws of the United States or any state
<br />G—A real estate Investment trust
<br />H --A regulated Investment company as defined in section 051 or an entity
<br />registered at all times during the tax year under the Investment Company Act of
<br />1940
<br />I—A common trust fund as defined In section 584(a)
<br />J—A bank as defined In section 581
<br />K—A broker
<br />L—A trust exempt from tax under section 664 or described In section 4947(a)(1)
<br />M—A tax exempt trust Under section 403(b) plan or section 457(8) plan
<br />Note. You may wish to consult with the financial Institution requesting this form to
<br />determine whether the FATCA code and/or exempt payee code should he
<br />completed.
<br />Line 5
<br />Enteryour address (number, street, and apartment orsulte number). This is where
<br />the requester of this Form W-9 will mail your information returns,
<br />Line 6
<br />Enter your city, state, and ZIP code.
<br />Part 1. Taxpayer Identification Number (TIN)
<br />Enteryour TIN In the appropriate box. If you are a resident alien canyon do not
<br />have and comet ellgibla to get an SEN, yourTIN la your IRS individual taxpayer
<br />Idenfifiaatlon number (ITIN). Enter It In the social socurlly number box. If you do not
<br />have an ITIN, see How to get a 7714 below.
<br />Ifyou are a sole proprietor and you have an LIN, you may enter either your SSN
<br />or EN. However, the IRS prefers that you use your SSN,
<br />If you are a single -member LLC that is dlsregarded as an entity separate from Its
<br />owner (sea Limited Liability Company (LLC) on this page), enter the owner's SSN
<br />(or EIN, If the owner has one). Do not enter the disregarded entity's FIN. If the LLC
<br />is classified as a corporation or partnership, enter the entity's FIN.
<br />Note. See the had on page 4 for further clarification of name and TIN
<br />combinations.
<br />How to gat a TW. If you do not have a TIN, apply for one Immedlately. To apply
<br />far an SSN, got Form 88-5, Application for a Social Security Card, from your local
<br />SSA office or get this form online at wwwasa.gov. You may also get this form by
<br />calling 1-880-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
<br />Identification Number, to apply for an ITIN, or Form SS -4, Application for Employer
<br />Identification Number, to apply for an LIN, You can apply for an LIN spline by
<br />accessing the IAS wabaite at www,irs,gov/bustnesses and clicking on Employer
<br />Identification Number (EIN) under Starting a Business. You can get Forms W-7 and
<br />SS -4 from the IRS by visiting IRS.gov or by calling 1 -800 -TAX -FORM
<br />(1-000-820-3676).
<br />It you are asked to complete Form W-9 but do not have a TIN, apply far a TIN
<br />and write "Applied For" In the space for the TIN, sign and data the form, and give It
<br />to the requester, For Interest and dividend payments, and certain payments made
<br />with respect to readily tradable Instruments, generally you will have 60 days to get
<br />a TIN and give It to the requester before you are subject is bacll withholding on
<br />payments, The 60 -day rule does not apply to other types of payments. You will be
<br />subject to backup withholding on all such payments until you provide your TIN to
<br />the requester,
<br />Nota, Entering "Applied Far" means that you have already applied for a TIN or that
<br />you Intend to apply for one soon.
<br />Caution: A disregarded U.S. entity that has a foreign owner must use the
<br />appropriate Fond Ms.
<br />751-45
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