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URN w
<br />:o�,
<br />W"� Request for Taxpayer
<br />Rev. November 201-6 Identification Number and Certification
<br />Give Farm to the
<br />)epariment of the Treasury
<br />requester. Do not
<br />ntemal Revenue Service i► Qo to www.irs.gov/FormW9 for Instructions and the latest Information.
<br />send to the 1i15.
<br />1 Name (as shown on your I moms tax return). flame Is required on this line; do not leave this line blank.
<br />ENTECH SOLUTIONS LLC
<br />2 13uslness nameldisregardad entlly Hama, If different From above
<br />3 Check appropriate box for federal tax classification of the person whose name is entered an line 1. Check only one of the
<br />following seven boxes,
<br />A Exemptions (codes apply only to
<br />certain entities, not indlvidua€s; see
<br />p
<br />❑" Individual/sole propHelor or ❑ C Corporation ❑ S Corporation ❑ Partnership ElTrust/eslats
<br />Instructions on page 3):
<br />n
<br />single -member LLC
<br />Exempt payee code fit any)
<br />?
<br />❑ Limited liability company. Enter the tax classification (C=O corporation, S=S corporation, P—Parinersh€p) ►
<br />p
<br />Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
<br />LLC If the LLC Is classified as a single -member LLC that Is disregarded from the owner unless the owner of the LLC is
<br />Exemption from FATCA reporting
<br />V
<br />another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
<br />code (f any)
<br />is disregarded from the owner should check the appropriate box for the tax classification of Its owner.
<br />❑ Other (see instructions))--
<br />µppi-te acewala—kdak,d-ft", the U.S.)
<br />5 Address (number, street, and apt. or suite no.) See instructions.
<br />Requester's name and address (opt€onal)
<br />635 S LAFAYETTE BLVD, SUITE 1-22L
<br />Co
<br />a City, state, and ZIP code
<br />SOUTH BEND, IN 46601
<br />7 List account numbet(s) here (optloha�
<br />identification Number
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
<br />I social security
<br />number
<br />this is generally your seine security number (SSNr. However, for a
<br />backup withholding. s €ie For individuals, disregarded
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Part f, later. For other
<br />entities, It is your employer Identification number (EIN). It you do not have a number, see Now to get a
<br />TIN, later.
<br />or
<br />Note: If the account is In more than one name, see the instructions for line 1. Also see What Name and
<br />I Employer identification number
<br />Number To Give the Requester for guidelines on whose number to enter.
<br />4
<br />7
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<br />4
<br />1 8 1 9
<br />1 1
<br />1 4
<br />1 b
<br />5
<br />ROMM Certification
<br />Under 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. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Intemal Revenue
<br />Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that 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 codes) entered on this form (if any) Indicating that I am exempt from FATCA reporting is correct.
<br />Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because
<br />you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
<br />other than interest and dividends, you are not required to sign the certif€cation, but you must provide your correct TIN. See the instructions for Part 11, later.
<br />Sign Signature
<br />Here I U.S. personf► �"� —I Date 5/ 1 f'1 1 A
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Future developments. For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go to www.irs.gov1FormlN9.
<br />Purpose of Form
<br />An individual or entity (form W-9 requester) who is required to file an
<br />information return with the IRS must obtain your correct taxpayer
<br />identification number (TIN) which may be your social security number
<br />(SSN), individual taxpayer Identification number (ITIN), adoption
<br />taxpayer Identification number (ATIN), or employer Identification number
<br />(EIN), to report on an information retum the amount paid to you, or other
<br />amount reportable on an Information return. Examples of Information
<br />returns include, but are not limited to, the following.
<br />• Farm 1099-INT (interest earned or paid)
<br />• Form 1099-DIV (dividends, including those from stocks or mutual
<br />funds)
<br />• Form 1099-MISC (various types of Income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1099-B (stock or mutual fund sales and certain other
<br />transactions by brokers)
<br />• Form 1099-3 (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 (home mortgage Interest), 1099-E (student loan interest).
<br />1098-T (tuition)
<br />• Form 1099-0 (canceled debt)
<br />• Form 1099-A. (acquisition or abandonment of secured property)
<br />Use Form W-9 only if you are a U.S, person (including a resident
<br />alien), to provide your correct TIN.
<br />If you do not retum Form w-9 to the requester with a TIN, you might
<br />be subject to backup withholding. See What is backup withholding,
<br />later.
<br />Cat. No, 10231x Form W-9 (Rev. 111-20117)
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