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W-9 Request for Taxpayer
<br />Give Form to the
<br />Number and Certification
<br />requester. Do not
<br />(Rev. October2018) identification
<br />send to the IRS.
<br />Department of the Treasury
<br />Internal Revenue Service III -Go to www.1rs gov1FormlW 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 line blank.
<br />MILESTONE CONTRACTORS NORTH, INC
<br />2 Business nameldisregarded entity name, if different from above
<br />M 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
<br />4 Exemptions (codes apply only to
<br />certain entities, not Individuals; see
<br />rnfollowing seven boxes.
<br />ko
<br />Instructions on page 3):
<br />a
<br />0 ❑ 1ndividuaVaole proprietor or ❑ C Corporation 0 S Corporation ❑ Partnership TruaVestate
<br />0
<br />� single -member LLC
<br />Exempt payee code ('rf any)
<br />❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
<br />0 2 Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
<br />1: 1ii 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 />code (if any)
<br />C 5 another LLC that Is not disregarded from the owner for U.S. federal tax purposes, Otherwise, a single -member LLC that
<br />a is disregarded from the owner should check the appropriate box for the tax classification of Its owner.
<br />❑ Other(seeInstructions) ►
<br />Waa�sroacc«manwntan�eeouaaeseus�
<br />y 5 Address (number, street, and W. or suite no.) See Instructions. Requestees name and address (optional)
<br />1700 EAST MAIN STREET
<br />6 City, state, and ZIP code
<br />GRIFFITH IN 46319
<br />7 List account numbers) here (optiono
<br />EVtW Taxpayer Identification Number IN)
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid —1 Social aecurigr number
<br />backup wlien, sole
<br />For Individuals, this Is generally your social security ebony number (SSN). However, for a — m
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
<br />entitles, it Is your employer Identification number (EIN). If you do not have a number, see How to get a
<br />TIN, later. FT7
<br />Note: If the account is in more than one name, see the Instructions for line 1. Also see What Name and IEmpioyer identiRca0an number
<br />Number To Give the Requester for guidelines on whose number to enter, �
<br />13151 — 1 1 2 0 6 8 5`
<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 I am waiting for a number to be issued to me); and
<br />2. 1 am not subject to backup withholding because: (a)1 am exempt from backup withholding, or (b) I have not been notified 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 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 am exempt from FATCA reporting is correct.
<br />certification Instructions. You must cross out ftem 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 QRA), 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 11, later.
<br />sign signature of
<br />Here I u.s. parson ►
<br />General Instructions
<br />Section references are to the Intemal 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.1rs.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 QTIM, adoption
<br />taxpayer Identification number (ATIN), 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 limited to, the following.
<br />• Form 1099-INT (Interest earned or paid)
<br />Date► 1/� aoaa)
<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-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 (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. person (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 withholding. See What is backup withholding,
<br />later.
<br />Cat No. 10231X Form w-9 (Rev.10-2018)
<br />
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