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<br />Give Fom'io tl'le
<br />Form I�
<br />ReqC9G5'L Te.J:L(?ayG6'
<br />(Rev. January 2011)
<br />5
<br />Identification Nunaba and] CE„ rd loation
<br />requester. Do not
<br />DRW.Jnantoft2011) sury
<br />send tothe IRS.
<br />Irdemai Rawnue Smuirs
<br />Name Iw shown on your Income tax retum)
<br />N
<br />Business nab disregarded entity name, if different from above
<br />m
<br />m
<br />m
<br />a
<br />Check appropriate box for federal tax
<br />c
<br />c
<br />ciassHkation (required): Q Indviduaysole pmpdebr ❑ C Corporation ❑ S Corpornticn ❑ Partnership ❑ Tmst/estais
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<br />❑ Exempt payee
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<br />❑ I Indted IlabNty. company F�rthe tax classification (C =C corporation.* S=S corporation, P--partnership) rr
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<br />other (see Instructions) P
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<br />Address (number, street, and apt rx suite no.)
<br />Requesters name and address (opOOna)
<br />c
<br />m
<br />a
<br />W
<br />m
<br />City, state, and ZIP erode
<br />m
<br />u1
<br />Ust account numbers) hem (optional)
<br />Taxpayer Identification Number LTIN)
<br />Faster your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line I Social security number ,' ,' .' .' .' .' . • • i
<br />to avoid backup withholding. For Individuals, this Is your social security number (SSM. However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other
<br />entitles, It Is your employer identification number (EIM. If you do not have a number, see Now to get a
<br />TIN on page 3.
<br />Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose lEmployeridentificafforfrximber.
<br />number to enter. m
<br />UP Ma Certification I I ' I L 11
<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 I am not subject to backup withholding because: (a)1 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).
<br />Certification Instructions. You must cross out Item 2 above If you have been notified by the IRS that you we currently subject to backup withholding
<br />because you have failed to report all Interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. Fornodgaga, ' .
<br />interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement a m4smant (IFW. and'
<br />generally, payments other than Interest and dividends, you are not required to sign the certffication, but you must provide your corW(11 j,F,6/ai,,_
<br />instructions on oaoe 4.
<br />H 9 S19naftwe of
<br />e I 11.5. person P Date G
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Purpose of Form
<br />A person who Is required to file an information return with the IRS must
<br />obtain your correct taxpayer Identification number (fIM to report, for
<br />example, Income paid to you, real estate transactions, mortgage Interest
<br />you paid, acquisition or abandonment of secured property, cancellation
<br />of debt, or contributions you made to an IRA.
<br />Use Forth W -9 only If you are a U.S. person (including a resident
<br />alien), to provide your correctTlN to the person requesting It (the
<br />requester) and, when applicable, to:
<br />1. Certify that the TiN you are giving is correct (or you are waiting for a
<br />number to be Issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />S. Clelm exemption from backup withholding if you are a U.S. exempt
<br />payee. If applicable, you are also certifying that as a U.S, person, your
<br />allocable share of any partnership Income from a U.S. trade or business
<br />Is not subject to the withholding tax an foreign partners' share of
<br />effectively connected Income,
<br />Nome. If a requester gives you a form other than
<br />your TIN, you must use the requester's form It it
<br />to this Form W -9.
<br />Definition of a U.S. person. For federal tax purposes, you we
<br />considered a U.S. person if you are:
<br />• An Individual who is a U.S. citizen or U.S. resident alien,
<br />• A partnership, corporation, company, or association created or
<br />organized In the United States or under the laws of the United States,
<br />• An estate (other than a foreign estate), or
<br />• A domestic trust (as defined in Regulations section 301.7701 -7).
<br />Special miss for partnerships. Partnerships that conduct a trade or
<br />business In the United States are generally required to pay a withholding
<br />tax on any foreign partners' share of Income from such business.
<br />Further, In certain cases where a Forth W -9 has not been received, a
<br />partnership Is required to presume that a partner is a foreign person,
<br />and pay the withholding tax Therefore, if you we a U.S. person that Is a
<br />partner in a partnership conducting a trade or business In the United
<br />States, provide Forth W -9 to the partnership to establish your U.S.
<br />status and avoid withholding on your share of partnership Income.
<br />Cat No. I=1X Forth Yfd-J (Rev. 1-2011)
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