|
Form T�Jp .�
<br />(P*v. October 2018)
<br />00
<br />Irdt3era � Servtoe��
<br />Request for Taxpayer
<br />Identification Number and Certification
<br />W Go to wwwA*.yoy/formWV for inetructions and the latest Infommtion.
<br />1 Name (as shown an your income tax return). Name Is required on this line; do not !save this fine
<br />MILESTONE CONTRACTORS NORTH, INC.
<br />2 Eluolness narriardsregarOsd wuity name. If different from above —
<br />WALSH & KELLY, INC.
<br />8 Check appropriate box for federal talc clesaifieation of the person whose name is entered on line 1. Check only one of the
<br />following seven boxes.
<br />❑ lnc1vid0aUaole proprleton Of ❑ C Corporation i] S Corporation ❑ partnertship ❑ Tnuat/eatale
<br />singietm ffibsr LLC
<br />❑ United liability company. Enter the tax classification (0-0 corporation, S■S corporation. P.Partnership)
<br />Note: Check fits appropriate box In the line strove for the tax ciasclfirMlon of the single -member owner. Do not check
<br />LLC N the LLC is Chit ltd as a efngle-member LLC that is disregarded from the owner unless the owner of the LLC is
<br />another LLC that is not diereperdod from the owner for U.S. federal tax purposes. Otherwise. a slrpio-member LLC tin
<br />is disrpparded from the owner should check the appropriate box for the tax elasafgcation of its owner.
<br />❑ Other (see instnxlkxts) ►
<br />5 Address (nuober, etnet, and apt or suite ro J Flea insrructions Requester's risme
<br />1700 EAST MAIN STREET J
<br />e City, state, and ZIP code �— 1
<br />GRIFFITH, IN 46319 iI
<br />7 List account number(e) here (optloneo -
<br />Give Form to the
<br />requester. Do not
<br />send to the IRS.
<br />4 Exatnptions (Codes apply Only to
<br />certain entities, not rndlviduais; to
<br />Instructions on page 3):
<br />Exempt payee code (H any)
<br />Exemption from FATCA repordn
<br />cotta 0 an)
<br />WOW 00 WW" WMI .darwar M use
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid E 9galat security number
<br />resident
<br />withholding• For individuals, this to generally your sada* security fo Part O3Shi1. Frother
<br />However. fora � _ (— ]
<br />resident alien, tecta proprietor, or disregarded entity, see the instructions for Part 1, later. For cher {f f( II
<br />entities, it Is your employer Identification number (EIM. It you do not have a number, we How to gat a
<br />77N, later. or
<br />Note: If the account is in more than tate name, ase the instructions for line 1. Aleo ass What Name and Emplow Id*nmcauon number
<br />Number To Give the Requesterfor guidelines on whose number to enter. ti
<br />3 5i 1 1 2 D 6 8
<br />Certification
<br />Under penalties of perjury, I certify that: --
<br />1. The number shown on this form is my correct taxpayer identification number (or 1 am waking 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 wkhhoiding, or (b) I have not been notified by the Internal Revenue
<br />Service ORS) that I am subject to backup withholding as a result of a fallure 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 oode(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is oorrem.
<br />CeMftation instructions. You must cross out iter 2 above It you have been notified by the IRS that you are currently subject to backup withholding because
<br />you have failed to report ail interest and dividends on your tax return. Forrest estate transections, ttem 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 tete instructions for Part 11, later.
<br />6Iol signature of
<br />Here u.S.parsonb- � ,�i.)Z i (?i (Y( �ic1?(jc� - �f; +rr,11C.: Date * `'11gI2t zl
<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 />refitted to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go to www.lrs.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 MM which may be your social security number
<br />(SSM, individual taxpayer identification number OTIM. adoption
<br />taxpayer identification number WnN), or employer identification number
<br />(EIN), to report on an information return the amourd paid to you, or other
<br />amount reportable on an intom►stion return. Examples of information
<br />returns include, but are not limited to, the following.
<br />• Form 1099 -INT (interest earned or paid)
<br />Cat. No.10231X
<br />• Form 11799-OtV (dividends, Inckrding those from stocks or mutual
<br />funds)
<br />• Form 1099-tASC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1098-8 (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 1088 (home mortgage interest), 10913-E (student loan Interest),
<br />1098-T(tuition)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only if you are a U.S. parson (including a resident
<br />alien), to provide your correct TIN.
<br />If you do not return Form W-9 to the requester with a TIN, you might
<br />be subject to backup wlthholding. See What is backup withholding,
<br />later:
<br />Form W-$ (flay, 1p-2018)
<br />
|