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Form W-9 (Rev. 12-2014)
<br />Line 2
<br />Ifyou have a business name, trade name, D13A name, or disregarded entity name,
<br />you may enter it an line 2.
<br />Line 3
<br />Check the appropriate box In line 3 for the U.S, federal tax classification of the
<br />person whose name Is entered on line 1. Check only one box In line 3.
<br />Limited Liability Company (LLC). If the name on line 1 Is an LLQ treated as a
<br />partnership for U.G. federal tax purposes, check the "Limited Liability Company"
<br />box and enter "P" In the space provided. It the LLC ries filed Form 8832 at 2553 to
<br />be taxed as a corporation, check the "Limited Uability, Comryany" box and in the
<br />space provided anter "C" for corporation or "S" for S corporation. If it Is
<br />single -member LLC that Is a disregarded entity, do not check the "Limited Llahlllty
<br />Company" box: instead check the first box In line 3 "Individual/sole proprietor or
<br />single -member LLC:'
<br />Line 4, Exemptions
<br />If you are exempt from backup withholding and/or FATGA reporting, enter in the
<br />appropriate apace in line 4 any coda(s) that may apply to you.
<br />Exempt payee code.
<br />• Generally, individuals (including sole proprietors) are not exempt from backup
<br />withholding.
<br />* 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 matte In
<br />settlement of payment card or third party network transactions.
<br />• Corporailons are not exempt from backup withholding Win respeclto ahomeys'
<br />fees or gross proceeds paid to attorneys, and corporations that provide medical or
<br />health are servloes are not exempt with 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 403(b)(7) If the account satisfies the requirements
<br />of section 48'1(1)(2)
<br />2—The United States or any of Its agencies or Instrumentalities
<br />3—A .fate, the Dlolrlct of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdivisions or Instrumentalities
<br />4—A foreign government or any of its political subdivisions, agencies, or
<br />instrumentalities
<br />5—A corporation
<br />6—A dealer In securities or commodities required to register in the United
<br />States, 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 />0—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 bank under section 584(a)
<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, 1 through 13.
<br />...
<br />THEN the payment is exempt for...
<br />ayments
<br />All exempt payees except
<br />for 7
<br />7Hthmugh
<br />Exempt payees 1 through 4 and 6
<br />through 11 and all C corpnratlons. S
<br />corporations must not enter an exempt
<br />peyes code because they are exempt
<br />only for sales of noncovered as
<br />acquired prior to 2012.
<br />Bader exchange transactions and
<br />Exempt payees 1 through 4
<br />patronage dividends
<br />Payments over$fi0o required to be
<br />Generally, exempt payees
<br />reported and direct.alas over 85,0001
<br />1 through 52
<br />Payments made In settlement of
<br />Exempt payees l through
<br />payment card or third party network
<br />transactions
<br />'See Form 1099-MISC, Miscellaneous Income, and Its Instructions.
<br />'However, the following payments made to a corporatlon and reportable on Form
<br />1099-MISC are not exempt from backup withholding: medical and health care
<br />payments, attorneys' fens, gross proceeds paid to an attorney reportable under
<br />section 6045(1), and payments for services paid by a federal executive agency.
<br />Exemption it am FATCA reporting code. The following codes identify payees
<br />that are exempt from reporting under FATCA. These codes apply to parsons
<br />submilllnq this form for accounts maintained outside of the United States by
<br />certain foreign financial Institutions. Therefore, If you am only submitting this form
<br />far 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 a code is
<br />not required by providing you with a Form W-9 with "Not Applicable" (or any
<br />similar Indication) written or printed on the line for a FATCA exemption code.
<br />A—An organization exempt from tax under eecelon 501(a) or any individual
<br />retirement plan as depend in section 7701(a)(37)
<br />B—The United States or any of its agencies or Instrumentalities
<br />C—A slate, the District of Columbia, a U.S. commonwealth or possession, or
<br />any of their political subdlvistons 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 sectlon
<br />1.1472-1(c)(1)(I)
<br />E—A corporation that is a member of the same expanded affiliated group as a
<br />corporation described in Regulations section 1.1472-1(c)(1)(i)
<br />F—A dealer 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 651 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 a section 403@) plan or section 457(9) plan
<br />Nate. You may wish to consult with the financial Institution requesting this form to
<br />determine Whether the FATCA coda and/or exempt payee code should be
<br />completed.
<br />Line 5
<br />Enter your address (number, street, and apartment or suite 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 />Enter your TIN In the appropriate box. If you are a resident alien and you do not
<br />have and are not eligible to get an SSN, your TIN is your IRS Individual taxpayer
<br />Identification number (ITIN). Enter It in the social security number box. If you do not
<br />have an [TIN, sae How to get a TIN below.
<br />If you are a sole proprietor and you have an EIN, you may enter either your SSN
<br />or EIN. However, the IRS prefers that you use your SSN.
<br />If you are a single -member LUG that Is disregarded as an entity separate from Its
<br />owner (sea Limited Liability Company (LLC) on this page), enter the owner's SSN
<br />(or LIN, If the owner has ane). Dc not enter the disregarded entity's FIN. If the LLC
<br />is classified as a corporatlon or partnershlp, enter the entity's EIN.
<br />Note. See the chart on page 4 for further clarification of name and TIN
<br />combinations.
<br />Now to gata TIN, If you do not have a TIN, apply for one Immediately. To apply
<br />for an SSN, get Form SS -5, Application for a Social Security Card, from your local
<br />SSA office or gel this form online at wu w.ssa.gov. You may also get this form by
<br />calling 1-800.772-1213. Use Farm W-7, Appllcatlon for IRS Individual Taxpayer
<br />Identlfloatlon Number, to apply for an [TIN, or Form SS -A, Application for Employer
<br />IdenilHoutlon Number, to apply for an EIN. You can apply for an FIN online by
<br />accessing the IRS webslle at www.in.gov/businesses 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 />(f-890-829-3676).
<br />If you are asked to complete Form W-0 but do not have a TIN, apply for a TIN
<br />and write "Applied For' in the space for the TIN, sign and date the farm, 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 reque.ter before you are subject to backup 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 />Note. Entering "Applied For" 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 ownermust use the
<br />appropriate Form W-8.
<br />75K-55
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