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Form W -e(1 12-201
<br />Line 2
<br />If you have a business name, trade name, DBA name, or disregarded entity name,
<br />you may enter It on 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 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 01sd Form 8832 or 2553 to
<br />be taxed as a corporation, check the "Limited Liability Company" box and In the
<br />space provided enter "C" for C corporation or "S" for corporation. It It Is a
<br />single -member LLC that Is a disregarded entity, do not check the "Limited Liability
<br />Company" box; instead check the first box In line 3 "Individuallsole proprietor or
<br />single -member 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 codes) 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 made In
<br />settlement of payment card or third party network transactions.
<br />- Corporations are not exempt from backup withholding with respect to shards a'
<br />fees or gross proceeds paid to attorneys, and corporations that provide me lost or
<br />health care services 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 50'[(a), any IRA, or a
<br />custodial account under section 401 If the account satisfies the requirements
<br />of section 401
<br />2—The United States or any of its agencies or instrumentalities
<br />3—A state, the District 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 securlika orcommodltles required to register In the United
<br />States, the District of Columbia, ora U.S. commonwealth or poasesslen
<br />7—A futures commission merchant registered with the Qatar by Futures
<br />Trading Commission
<br />3—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 bust fund operated by a 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 />43—A trust exempt from tax under section 684 or described In section 4047
<br />The following chart shows types of payments that may he exempt from backup
<br />withholding. The chart applies to the exempt payees listed above, 1 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 />Broker transactions
<br />Exempt payees 1 through 4 and 6
<br />through 11 and all C corporations. S
<br />corporations must not enter an exempt
<br />payee code because they are exempt
<br />only for sales of dencovered securities
<br />acquired prior to 2012.
<br />Renter exchange transactions and
<br />Exempt payees 1 through 4
<br />patronage dividends
<br />Payments over $600 required to be
<br />Generally, exempt payees
<br />raponed and direct sales ever $5,0001
<br />1 through 5�
<br />Payments made In settlement of
<br />Exempt payees 1 through 4
<br />payment card or third party network
<br />transactions
<br />1 See Form 1099-MISC, Miscellaneous Income, and its Instructions.
<br />'However, the following payments made to a corporation and reportable on Form
<br />1098-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 6045(6, and payments for services paid by a federal 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 farm for accounts maintained outside of the United States by
<br />certain foreign financial Institutions. Therms, If you are only submitting this form
<br />for an account you hold in the ballad States, you may leave this field blank.
<br />Consult with the person requesting this form if you are uncertaln lithe financial
<br />institution fa subject to these requirements. Arequester 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 section 501(a) or any Individual
<br />retirement plan as defined In section 7101(a)(37)
<br />B—The United States or any of Its agencies or Instrumentalities
<br />C—A stale, 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 asset land In Regulations section 1.1472-1(c)(1)(1)
<br />F—A dealer in securitles, 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 an defined in section 851 or an entity
<br />regisiered 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 4047(a)(1)
<br />M—A tax warnsttruet undera section 403(b) plan or section 457(g) plan
<br />Note. You may wish to consult with the financial Institution requesting this form to
<br />calamine whether the FATCA code 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, slate, and 21P code.
<br />Part]. Taxpayer identification Number (TIN)
<br />Enter your TIN in the appropriate box. If you are a resident allen 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 ITIN, see How to get a TIN below.
<br />If you are a sole proprietor and you have an FIN, you may enter either your SSN
<br />or TIN, However, the IRS prefers that you use your SSN.
<br />If you are a singls-member LLC that is disregarded as an entity separate from IN
<br />owner (see Limited Ltebllity Company (LLC) on this page), enter the owner's SSN
<br />(or FIN, if the owner has one). Do not enter the disregarded entity's FIN. If the LLG
<br />Is classified as a corporation or partnership, enter the entity's EIN.
<br />Note. See the chart on page 4 for further clarification of name and TIN
<br />combinations.
<br />How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
<br />far an SSN, get Form SS -5, Application for a Social Security Card, Gem your local
<br />SSA office or get this farm online at www.sca.gov. You may also get this form by
<br />calling 1-800-772-1213. 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 />Ideafiflcatlon Number, to apply for an EIN. You can apply for an EIN online by
<br />accessing tha IRS webslle at www.im.gov/buslnossae 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 />(1-800-029-3676).
<br />If you are asked to complete Form W-9 but de not have a TIN, apply for a TIN
<br />and write "Applied Far" In the space for the TIN, sign and date the farm, and give It
<br />to the requester. For Interest and dividend payments, and retain payments made
<br />with respect to readily tradable Instruments, generally you will have 60 days to gat
<br />a TIN and give it to the requester 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 owner most use the
<br />appropriate Form W-8.
<br />75P-44
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