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Form W-9 (Rev. 12-2014)
<br />Part If. Certification
<br />To establish to the withholding agent that you area U.S. person, or maiden[ allan,
<br />sign Form W-9. You may be requested to sign by the withholding agent even if
<br />[toms 1. 4, or below indicate otherwise.
<br />For ajolnt account, only the person whose TIN is shown in part 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 payee code earlier.
<br />Signature requirements. Complete the cert[flcatlon as Indicated In Items'I
<br />through 5 below.
<br />1. Interest, dividend, and barter exchange ecce Rule opened before 1004
<br />and broker ac counts considered active during 1983. You must give your
<br />correct TIN, but you do not have to sign the certification.
<br />2. Interest, dividend, broker, and bailer exchange accounts opened after
<br />1983 and broker accounts considered inactive during 1983. You must sign the
<br />certification or backup withholding will apply. ifyou are subject to backup
<br />withholding and you are merely providing your correct TIN to the requester, you
<br />most cross out Item 21n the certification before Blaring the form.
<br />3. Real estate transactions. You must sign the certification. You may cross out
<br />item 2 of the certllcatlon.
<br />4. Other payments. You must give your correct TIN, but you do not have to sign
<br />the certification 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 leads or business for rents, readies, goods (other than bills for
<br />nlorohandise), medical and health care servics.s (Including payments to
<br />corporations), payments to a nonemployee for services, payments made In
<br />settlement of payment card and third parry network transactions, payments to
<br />certain fishing boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />S. Mortgage Interest paid by you, acquislUhn or abandonment of secured
<br />property, cancellation of debt, qualified bullion program payments (under
<br />section 529), IRA, Cove me 11 ESA, Archer MSA or HSA contributions or
<br />alliddhighms, and pension distributions. You most give your correct TIN, but you
<br />do not have to sign the cenification.
<br />What Name and Number To Give the Requester
<br />For this type of account:
<br />Give name and 55N of:
<br />I. Individual
<br />The Individual
<br />2. Two or more Individuals (Jolnt
<br />The actual owner of the account or,
<br />account)
<br />if combined funds, the first
<br />individual on 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 grantor -trustee'
<br />trust (grantor Is also trustee)
<br />b. So-called trust account that Is
<br />The actual owner'
<br />not a legal or valid trust under
<br />BRAD law
<br />5. Sale proprietorship or disregarded
<br />The cord
<br />entity owned by an Individual
<br />B, Grantortrust filing under Optional
<br />The granter"
<br />Form 1099 Filing Method 1 (see
<br />Regulations section 1.871-4(b)(2)O
<br />(A))
<br />For this type of account:
<br />Give name and EIN of:
<br />7. Disregarded entity not owned by an
<br />The owner
<br />Individual
<br />S. Avalid trust, estate, or pension trust
<br />Legal entlty'
<br />9, Corporation or LLC electing
<br />The corporation
<br />corporate status on Form 8832 or
<br />Form 2553
<br />10. Association, club, colli lone,
<br />The organization
<br />charitable, educational, or other tax-
<br />exempt organization
<br />11. Partnership or multi -member LLC
<br />The partnership
<br />12. A broker or registered nominee
<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)ihat receives agricultural
<br />program payments
<br />14. Grantor trust filing under the Form
<br />The trust
<br />1041 Filing Method or the Opticnel
<br />Form 1099 Filing Method 2 (see
<br />Regulations section 1.671-4(h)(2)(1)
<br />(8))
<br />r List first and circle rhe name of the person who aa number you furnish. If only ane parsonce a
<br />jams account has an SSN, that pomon'e number must be fumlahad.
<br />'Circle the minor's name end tumid) the minor's SSN.
<br />°You must show your Individual name and you may also enter your business or OBAname on
<br />the'Busness name/dlarepolual entity' name Ilna. You may use elther your SSN or PIN (if you
<br />have one), but the IRS reasompa you to use your SSN.
<br />List first and clock, the name of the east, ,stale, or pension trual. (no not furnish the TIN of the
<br />pamonol representative or tousles unless the legal entlty Imes Is not deargnarsd In sea account
<br />title,) Also sae Special ones /erpadneohees an peg. 2.
<br />'Nola. Grantor also must provldo a Form W-9 to trustee of trust,
<br />Nate. If no name Is clrcled when more than one home is listed, the number will he
<br />considered to be that of the first name listed.
<br />Secure Your Tax Records from Identity Theft
<br />Identity theft occurs 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 ajob or may file a
<br />tax return using your SSN to receive a refund.
<br />To reduce your risk:
<br />• Pmtacl your SSN,
<br />• Ensure your employer is protecting your SSN, and
<br />• Be careful when choosing a tax preparer,
<br />If your tax records 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 />are at risk due to a last or stolen purse or wallet, questionable credit card activity
<br />or credit report, contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit
<br />Form 14039.
<br />For more information, see Publication 4535, Identity Theft Prevention and Victim
<br />Assistance.
<br />Victims of Identity theft who are experiencing economic harm ora system
<br />problem, or are seeking help in resolving tax problems that have not been resolved
<br />through normal channels, may be eligible for Taxpayer Advocate Service (TAS)
<br />assistance. You can reach TAS by calling the TAS toll-free case Intake line at
<br />be77477-4778 or TTY 7DD 1-800.829-4059.
<br />Protect yourself from suspicioua smalls or phishing schemes. Peeking Is the
<br />creation and use of email and Waddled designed to mimic legitimate bu9lheea
<br />smalls and w.lothes. The most common ant Is sending an email to a user falsely
<br />claiming to be an established legitimate erdarprlae In an attempt to scam the user
<br />Into surrendering private information that will be used for Identity theff.
<br />The IRS does not initiate contacts with taxpayers via smalls. Also, the IRS does
<br />not request personal detailed information through small or ask taxpayers for the
<br />PIN numbers, passwords, or similar secret access information for their credit card,
<br />bank, or other financial accounts.
<br />If you receive an unsolicited small claiming to he from the IRS, forward this
<br />message to phtshing@im.gov. You may also report misuse o1 the IRS name, logo,
<br />or other IRS property to the Treasury Inspector General for Tax Administration
<br />(TIGTA) at 4-800-366-4484. You can forward suspicious smalls to iha Federal
<br />Trade Commission at: spam le ce.gev or contact them at www, fle,govIldthelr or
<br />1-877-IDTHFFr (1-877-438-4338).
<br />Visit IR^u,gov to learn more about Identity theft and how to reduce your risk.
<br />Privacy Act Notice
<br />Section 6109 of the Internal Revenue Code requires you to provide your correct
<br />TIN to persons (Including federal agencies) who are required to file Information
<br />returns with the IRS to report Interest, dividends, or renals 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 HSA. The person collecting this form uses the information on the form to
<br />file hlONVAIDn returns with the IRS, reporting the above Information. Routine uses
<br />of this Information (reach giving it to the Department of Justice for civil and
<br />criminal litigation and to cities, states, the District of Columbia, end U.S.
<br />commonwealths and possessions far use In administering their laws. The
<br />Information also may be disclosed to other countries under a treaty, to federal 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 section 3406, payers must generally
<br />withhold a percentage of taxable Interest, dividend, and certain other payments to
<br />a payee who does not give a TIN to the payer. Cerlaln penalties may also apply for
<br />providing false or fraudulent Information.
<br />75P-45
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