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Form W-9 (flew.
<br />Part II. Certification
<br />To establish to the withholding agent that you are a U.S. parson, or resident ellen,
<br />sign Form W-9. You may be requested to sign by the withholding agent even If
<br />Items 1, 4, or 5 below Indicate otherwise.
<br />Fora joint account, only the person whose TIN Is shown In Pad I should sign
<br />(when required). In the case of a disregarded entity, the person identified on line 1
<br />must sign. Exempt payees, see Exempt pays, code earlier.
<br />Signature recall ements. Complete the certification as Indicated In items 1
<br />Gar huge 5 below.
<br />1, Interest, dividend, and barter exchange accounts opened before 1084
<br />and broker accounts considered active during 1083. You must give your
<br />correct TIN, but you do hot have to sign the certification.
<br />2. Interest, diagram it, broker, and barter exchange accounts ape nod after
<br />1903 and broker accounts considered Inactive during 1883. You must sign the
<br />.edification or backup withholding will apply. If you are subject to backup
<br />Withholding and you are merely providing your correct TIN to the roqusses, you
<br />must cross out item 2 in the can ficallen before signing the fens.
<br />3. Real estate transactions, You must sign the certification. You may crass out
<br />item 2 of the mini fication.
<br />4, other payments. You must give your correct TIN, but you do not have to sign
<br />the c milfloollon unless you have been notified that you have previously given an
<br />Incorrect TIN. "Other payments' Include payments made In the course of the
<br />requester's trade or business for rents, royalties, goods (other than bills for
<br />merchandise), medical and health care services (Including payments to
<br />corporations), payments to a nonemployee for services, payments made In
<br />settlement of payment card and third party network transactions, payments to
<br />certain fishing boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (finciudfng paymems to corporations).
<br />A. Mortgage interest paid by you, acquisition or abandonment of secured
<br />property, cancellation of debt, qualified tuition program payments (under
<br />section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your correct TIN, but you
<br />do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this type of account;
<br />'
<br />Give name and SSN of:
<br />1. Individual
<br />Th. Individual
<br />2. Two or mora Individuals Coln
<br />The actual owner of the account or,
<br />account)
<br />It combined funds, the first
<br />Individual an the account'
<br />3. Custodian account of a minor
<br />The minor'
<br />(Uniform Gift to Minors Act)
<br />4, a. The usual revocable savings
<br />The granter -trustee'
<br />treat (grantor Is Was trustee)
<br />On. So-called trust account that is
<br />The actual owner
<br />net a legal or valid Most under
<br />state law
<br />5. Sole proprlelorehlp or disregarded
<br />The aware
<br />entity owned by an individual
<br />5. Granter trust filing under Optional
<br />The orshor'
<br />Foran 1080 Filing Method 1 (see
<br />Regulations section 1.671-4(b)(2)O
<br />(A))
<br />For this type of awounC
<br />Give name and EIN of:
<br />7. Disregarded entity not owned by an
<br />The owner
<br />Individual
<br />B. Avalid trust, estate, of pension trust
<br />Legal entity'
<br />8. Corporation or LLG electing
<br />Tha carpormlon
<br />corporate status on Form 8832 or
<br />Form 2553
<br />10. Association, club, adulous.
<br />The organization
<br />charitable, educatlanal, orothertax-
<br />exempt organtertlon
<br />11. Partnership or multi -member LLC
<br />The partnership
<br />12. A broker or registered narninee
<br />The broker or nominee
<br />13. Account with the Department of
<br />The public entity
<br />Agriculture in the name of a public
<br />entity (such as a state or local
<br />government, school district, or
<br />prison) that recelve , agricultural
<br />program payments
<br />14. Grantor trust filing under the Form
<br />The trust
<br />1041 Filing Method or the Optlonal
<br />Farm 1000 Filing Method 2 (see
<br />Regulations section 1.67'1-4(b)(2)@
<br />IS))
<br />List first and circle the name of the person whew number you Nrnbh. If only one person on a
<br />joint account has an SSN, that aware number must bz Nehhhed,
<br />° chain the minor's name and furnish the minor'. SSN.
<br />Page 4
<br />You must show your Indbidual name and you may also enter your business or DBA name on
<br />the"9usln,cs namelearegarded entity" name 11110. YOU may use either your SSN or HIS Of you
<br />have ono), huh the IRS encourages you to use your SSN.
<br />° Llst Nat and clecle the name of tho trust, estate, or season trust. (Do Itat (urniare the TIN of the
<br />personal repreconlatSe or hushes unless the legal entity Itself fe not designated inthe account
<br />hila.) Alan sac Spacial to. I.,rnamon bi oa page 2.
<br />"Note. Grantor also .,,at P,.aide a Form W -a to Wstre of trust.
<br />Net.. Van name Is circled when morethan one name is listed, the number will be
<br />considered to be that of the flesh name listed.
<br />Secure Your Tax Records from identity Theft
<br />Identity theft acctim when someone uses your personal Information such as your
<br />name, SSN, or other Identifying Information, without your permission, to commit
<br />fraud or other crimes. An identity thief may use your SSN to got Sieh or may file a
<br />tax return using your SSN to receive a refund.
<br />To reduce your rlsic
<br />• Protect your SSN,
<br />• Ensure your employer Is protecting your SSN, and
<br />• Be careful when choosing a tax preparer.
<br />If your tax I'cracks are affected by Identity theft and you receive a notice from
<br />the IRS, respond right away to the name and phone number printed on the IRS
<br />notice or letter.
<br />If your tax records are not currently affected by identity theft but you think you
<br />ore at risk due to a lost ar stolen purse or wallet, questiar ie credit cam activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4480 or submit
<br />Farm 14039.
<br />For more Information, see Publication 4535, Identity Theft Prevention and Victim
<br />Assistance.
<br />victims of Identity theftwho are experiencing economic harm are system
<br />problem, or are seeking help in reaoiving tax problems that have not been resolved
<br />through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
<br />...Islands. You can reach TAS by calling the TAS toll-free owe Intake line at
<br />1-877-777-4778 or TTY(TDD 1-800-829-4059.
<br />Protect yoursalffrom suspicious email, at phishing schemes. Phishing is the
<br />creation and use of Small and websites designed to mimic legilimata business
<br />.mails and websites. The most common act Is sending an email to a user falsely
<br />claiming to be an established legitimate enterprise In an attempt to scam the user
<br />Into surrendering private Information that will be used for Identity theft.
<br />Th. IRS does not Initiate contacts with taxpayers via smalls. Also, the IRS does
<br />not request personal detailed Information through email or ask taxpayers for the
<br />PIN numb ars, passwords, or similar secret access Information for their credit card,
<br />bank, or other financial accounts.
<br />If you receive an unsolicited email claiming to be from the IRS, forward this
<br />message to phishingaurs,gov. You may also report misuse of the IRS name, logo,
<br />or other IRS property to the Treasury Inspector General for Tat Administration
<br />(TIGTA) at 1-800-388-4484. You can forward suspicious emails to the Federal
<br />Trade Commission at: spam®uca.gov or contact them at www.fte.gota idthelt or
<br />'1-877-I0THEFT (1-877-438-4338).
<br />Visit IRS.gov to learn more about Identity theft and how to reduce your risk.
<br />Privacy Act Notice
<br />Section 6100 of the Internal Revenue Coda requires you to provide your carrect
<br />TIN to persons (Including federal agencies) who are required to file Information
<br />returns with the IRS to report Interest, dividends, or certain other Income paid to
<br />you; mortgage Interest you paid; the acquisition or abandonment of secured
<br />property; the cancellation of debt; or contributions you made to an IRA, Archer
<br />MSA, or RSA. The parson collecting this form uses the Information on the fore to
<br />file Information returns with the IRS, reporting the above Informatlon. Routine uses
<br />of this Information include giving It to the Department of Justice for civil and
<br />criminal litigation and to titles, states, the District of Columbia, and U.S.
<br />commonwealths and possessions for use in administering their laws. The
<br />Information also may be declared to other countries under treaty, to fe ke ft and
<br />state agencies to enforce civil and criminal laws, or to federal law enforcement and
<br />Intelligence agencies to combat terrorism. You must provide your TIN whether or
<br />not you are required to file a tax return, Under Sharon 3406, payers must generally
<br />withhold a percentage of taxable interest, dividend, and certain other recommits to
<br />a payee who does not give aTIN to the payer. Certain penalties may also apply for
<br />providing false or fraudulent Information.
<br />75L-61
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