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Form 9
<br />Request for Taxpayer
<br />Give Form to the
<br />(Rev. December2014)
<br />Identification Number and Certification
<br />requester. Do not
<br />Depar€mentoftheTreasury
<br />send to the IRS,
<br />internal Revenue Service
<br />1 Name (@s show40otulincome tax ret . Name
<br />is required on this line; do not leave this line blank.
<br />C�i
<br />2 Business noldIsrega-rifed entity name, if difforent from above
<br />ar
<br />R
<br />a
<br />3 Check appropriate box for federal tax classification; check only one of the following seven boxes:
<br />4 Exemptions (codes apply only to
<br />N
<br />❑ Indlviduailsole proprietor or ❑ C Corporation ❑ S Corporation ❑ Partnershipcertain
<br />❑ Trus#!estate
<br />viduais; see
<br />lon page individuals;
<br />w >=
<br />o
<br />single -member LLG
<br />Limited liabJlJty company, Enter the tax classification C=C corporation, s=S corporation, P= artnershl
<br />Exempt payee coda (if any)
<br />o L
<br />Nate. For a single -member LLG that Is disregarded, do not check LLC; check the appropriate box in the line above for
<br />Exemption from FATCA reporting
<br />— y
<br />the tax classification of the single -member owner,
<br />code (€f any)
<br />0. U
<br />Other (see InSEracfitlns)> �j�' U
<br />(npplresiaaocounlsmainlainadoutside the U.$)
<br />6 Address (number, street, and ap(t�. r suite no,)
<br />try 161
<br />Requester's Hama and address (aptianal)
<br />a
<br />J1 O \8
<br />6 C y, state,, and ZIP c de
<br />7 List account number(s) here (optional)
<br />"
<br />Taxpayer identification Number IN)
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line t to avoid
<br />social security number
<br />_�
<br />backup withholding. For individuals, this is dgenOallyentity, your social security number (Sag). However, fora
<br />resident alien, sofa proprietor, or disregarded entity, see the Part t Instructions on page 3. For other
<br />entities, it is your employer identification number (FIN). If you do not have a number, see How to get a
<br />TIN on page 3. or
<br />Note. IF the account is in more than one name, sea the instructions for line 1 and the chart on page 4 for ErnP€Oyer Identification number _
<br />guidelines on whose number to enter, pp--��
<br />H�fl�� of -+ -d o
<br />tend or penalties of perjury, I certify that:
<br />1. The number shown on this Form is my correct taxpayer Identification number (or I am waiting for a number to be Issued to me); and
<br />2. tam not subject to backup withholding because, (a) t am exempt from backup withholding, or (b) I have not been notified by the internal Revenue .
<br />Service (iRS) that[ am subject to backup withholding as arresult of a failure to report all interest or dividends, or (c) the IRS has notified met hat I am
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below); and
<br />4. The FATCA code(s) entered on this form (if any) indicating that I ant exempt from FATCA reporting is correct.
<br />Certificatton instructions. You must cross out item 2 above If you have been notified by the iRS that you are currently subject to backup withholding
<br />bacause you have failed to i'oport all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mbrtgaga
<br />interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement ORA), and
<br />generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
<br />instructions on page 3. 4
<br />Sig R signature of
<br />Here U.S, person }
<br />General Instructions
<br />Section references are to the Internal Revenue Cade unless otherwise noted.
<br />Future developments. information about developments affecting Form W9 (such
<br />as legislation enacted after we release it) is at www,irs.gov1rw9.
<br />Purpose of Form
<br />An individual or entity (Form W 9 requester) who Is required to file an Information
<br />return with the IRS must obtain your correct tax ayer identification number (TIN)
<br />which maybe your soalef security number (SSN� individual taxpayer Identification
<br />number (MN), adoption taxpayer fdontificatlon number (ATIN), or employer
<br />Identification number (EIIJ), to report on an information return the amount paid to
<br />you, or other amount reportable on an Information return. Examples of information
<br />returns include, but are not ilmlted to, the following;
<br />Dorm tons-INT(Interest earned orpaid)
<br />Worm 1009-DIV (dividends, including those from stocks or mutual funds)
<br />Form i098-MISC (various types of income, prizes, awards, or gross proceeds)
<br />Worm 1099-B (stock of mutual fund sales and certain other transactions by
<br />brokers)
<br />Dorm 1090-5 (proceeds from real estate transactions)
<br />Dorm 1o99-K (merchant Gard and third party network transactions)
<br />pate► (f [ o-
<br />norm 1098 (home mortgage interest), 1098-F (student loan Interest), 1 G98T
<br />(tulilon)
<br />[Form 1099-0 (canceled debt)
<br />Worm 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only If you are a U.S. person (including a resident alien)r fo
<br />provide your correct TIN.
<br />if you do not return Form W 9 to Ina requeslerwith aTiN, ybu might he subject
<br />to backup withholding. See What is backup withholding? on page 2.
<br />By signing the fified-out form, you_
<br />1. Certify that the TIN you are giving is correct (oryou are waiting for a number
<br />to be Issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding ifyou are a U,S. exempt payee, if
<br />applicable, you are also certifying that as a U.S, person, your allocable share of
<br />any partnership Income from a U.S. trade or business Is not subject to the
<br />withholding tax on foreign partners' share of effectively connected income, and
<br />A. Certify that FATCA code(s) entered on this form (ifany) Indicating that you are
<br />exempt from the FATCA reporting, is correct, See What is FATCA reporting? on
<br />pago 2 for further information.
<br />Cat. No, 10231x Form W-9 (Rev.12-2014)
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