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Form WW-- Request for Taxpayer
<br />(Rev. October 2018) Identification Number and Certification
<br />ZWDepartment of the Treasury
<br />WI Revenue Service ► Go to wwwJrs.gov/FlormM for instructions and the latest information.
<br />1 Name (as shown on your income tax return). Name is required on this line; do not leave this fine blank.
<br />MILESTONE CONTRACTORS NORTH, INC.
<br />4 Business nanne/dIsregarded entity name, If different from above
<br />WALSH & KELLY, INC.
<br />m 3 Check appropriate box for federal tax classification of the person whose name is entered on Una 1. Check only one of the
<br />following seven boxes.
<br />C
<br />O
<br />ai
<br />rA
<br />-iS
<br />❑ Individuatkole proprietor or ❑ C Corporation El 5 Corporation ❑ Partnership
<br />aingle-member LLC
<br />❑ Tnustiestate
<br />Give Form to the
<br />requester. Do not
<br />send to the IRS.
<br />)—____.
<br />4 Exemptions (codes apply only to
<br />certain entlHes, not incitvlduale; sea
<br />instructions on page 4
<br />Exempt payee code (If any)
<br />❑ Umlted liability company. Enter the tax dassFflcatlon (C -C corporation, S -S corporation, F6Partnership) 110 -
<br />Note:
<br />Note: Check the appropriate box In the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting
<br />LLC If the LLC Is classified as a shpts -member LLC that is disregarded from the owner unleas the owner of the LLC Is
<br />another LLcoda Pf aC that fe not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that r'y)
<br />is disregarded from the owner should check the appropriate box for the tax classification of its owner.
<br />❑ Other (am Instructions) ► W,4e8 W 6W.00712 mdw~ cub de to us.J
<br />5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional)
<br />1700 EAST MAIN STREET
<br />8 City, state, and 7P code
<br />GRIFFITH, IN 46319
<br />7 Lht account number(,) here (optional)
<br />Identification
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
<br />backup withholding. o r individuals, this LS generally your social security number Bair. However, for a
<br />ro- m -
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Part I,,later. For other
<br />entities, it Is your employer Identification number (EIN). If you do not have a number, see Now to get a
<br />TIN, later. or
<br />Note: If the account is in more than one name, see the instructions for line 1. Also see What Name andirnployer identiffc_ation number
<br />Number To Give the Requesterfor guidelines on whose number to enter. ��
<br />13151 -11 1 1 1 2 1 0 1 6T81 51
<br />JaMULI Ced cation
<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 notlW by the Internal 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 on
<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 an this form Of any) indicating that I em exempt from FATCA reporting is correct.
<br />Certification Instructions. You must cross alt item 2 above 9 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 ORA), and generally, payments
<br />other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
<br />Sign Signature of
<br />H@re U.S. Person ► %Z'1(j( v lam' ► t W� (DVI tn G� Date ► �`, q Zi
<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 wwwJrs.gov1FormW9.
<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 (AMN), or employer identification number
<br />(EIN), to report on an information return the amount paid to you, or other
<br />amount reportable on an information return. Examples of information
<br />returns include, but are not lirrited to, the following.
<br />• Form 1099 -INT (interest earned or paid)
<br />• Form 1099 -DIV (dividends, Including those from stocks or mutual
<br />funds)
<br />• Form 1099-NpSC (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-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 (home mortgage interest), 1098-E (student loan interest),
<br />1098-T (tultion)
<br />• Form 1099-C (canceled debt)
<br />• Form 1 D99 -A (acquisition or abandonment of secured property)
<br />Use Form W-9 oNy it you are a U.S. person (including a resident
<br />alien), to provide your correct TIN.
<br />If you do*not ratum 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. 10011X Form W-9 (Rev. 110-2018)
<br />
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