Case File
efta-01362692DOJ Data Set 10OtherEFTA01362692
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01362692
Pages
1
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0
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Font, W '''9
:Rev. ocambrenq
04;.therit el the treasury
enema Revenue Santa
Request for Taxpayer
Identification Number and Certification
Giva Form to the
requester. Do not
send to the IRS.
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I Neer let slam on rut name lax worn} Names roquiral on This lNr. 00 nth Dave, Ms Sy blank
Southern Trust Company, Inc.
pum
a
ma namordisteganSed enbly nese, ectillwera eye above
Southern Financial, LLC
3 Cneck approortaie
0
Coe5•55daVen50
enlymenter
0 mimic, Wanlycompany.
Unt
Far a 3.09331itelbel
the tax conlection
box £or federal Lot dreelecatIon: OW onry ere of the following seven box=
Mentor or
❑0 CCoroordion
0
SCapormlon 0
Penne-ship
0
ThaVestate
U.0
Erna
tee cassaketkm PAC caporatIon. SeS corporation. P4paracesMo)lo
LLCM 4 C.soier0e0. de net stook t.1.C; dycx me appoorOle box D the arboreta
of The Ace mambo/ Cr...CY.
a•
4 F.xempticris
gas° anttipoewlerta"
EA anti payee
bemPtic"
code (f int)
Idotft ex todedaed.x...r
(codas atoll Otto
fee
code et yea
Item FATCA159"5
ill Dino hoe rains:aorta)
odd,
5 11
/454•333 5/ UrObOr • Ones. amt am. stags rod
6100 Red Hook Quarter, Ek3
ROgbeiYle mete sad Seine (omae/
li City. stale, araltlf? ca0s
St. Thomas, USVI 00802
7 tut account nun0ey) here @patinae
Pa -t c
Taxpayer Identification Number (TIN)
Enter your TIN In the appropriate box:Therm provided must match the name given on lir a 1 to evOld
I SOON ere
backup withholding. Foe Individuals. IMS Is gsneraity your social security number (SSN). Howevor, tore
resident alien. ado proprietor, or dicrepaniad Gnaw, too Ns Part I Instructlora on page 3. For other
snide,. It Is your employer Identlicabon numbor (EIN). If you do not have a number. see How Co gal
TIN on page 3.
Or
Note. If the account Is In more than one memo. see the Insuuellons for line I aniline than on page a TOT
IM Oyer hkel5rdetiert numbs/
guldeinos on whose number to enter.
•
Certification
Undo/ penattles of perjury. leen& that
1. The number shown on this form Is My correct taxpayer Mental/anon number (or I ern waiting (outnumber to be [Med to mot and
2. I arn not suCfect to badivp waits/Ong because, tailor exempt from backup withh0lding, or MI have riot been noWied by the Internal Raven.*
Service (p/Si that I am subject to backup withholding as o result of a Wye to repel ell Interest or dividends. or (c) the IRS has notiCod mo that I am
nO ledger subject to backup withholding; and
3. I em a U.S. citizen or other U.S. person (defined Wont end
4. The MICA codepn entered on tNs font IE any) inecating that I am exempt from FATCA reporting Is =Mot.
Cart fleetlan instructions. You must cross out Item 2 above If you here been notified try the IRS that you ate currently subject to backup isithhoicling
because you have felled to repor all Interest and dividends on your tax return. For real estate hansacaona, ken 2 dorm not apply. For triodOne
kitemst paid. acquisition or abanconmont of secured property. arninellation of debt, C.Ontribut10113 loan frioviduel retirement arrangement OK and
genera/. payments other than interest and dividends, you ere oat required to sign tha oerliFortitonl but you mitt Nodes YOur =Ma TEL Seethe
instructions on pogo 3.
Sign
Hero
Venture el
US.
personth
General Instructions
Sedlon dints:
we le the !hint Annus 0:00 USW; Otherwise noted.
FMK* if evalOprnentt. Infonnetcn shod decals nterta dtecdre Form W.9 (nth
as 53313101bn enacted seer we release it) i a I www.trispoydw9
Purpose of Form
An frdM&ci Or way (Form W-9 mounter) etc is rooptcd 10 Do an informaition
learn wkh ell m3 mat obtain no cored itopayer lasmilkeben ramber 1DM
*n th "
, be your 50r-5,5 500•13Y 51•31301PSNOttidual taxpayer Wiser-Won
Mentor pfd). edcptkm taxpayer kiyealcellon number (ATM. or amokler
Cerealcalion nano (ON), to report on an (Myrmidon roam the amount paid to
you. Or other snood report)* an on DIcert0OCct ream. Example, of biormatkm
Wane CrAide. but are not ached to, the losewner
• Fenn 1009.INT fedora% cans, or ask()
• Form 1099-Dry ePrilevas, Coaxing those Mega dodo a mord hinds1
• Form 1094MiSC Various types of Income, pram nth. or ortea procoe0t)
• rent, 1099-0 (no* or mutual fund sake era atoll Oyer trarcycdoris by
broken)
• ram 10394 ipmeoode rim red estate toreadlond
• Form t092-K enentent card arC third party network trartractIca5)
oaths
1/1.40L901*
. ram 109a pwour melange Inierest). toete. taerdenl lean erased. MST
otAtore
• Fawn 1099-C (tenoned ace
• Form tolnAkmavisilon et Sh1r4ormcni of seared P390 45
Use tom wai ore( k you weaua portion Cded:503 a rodelaM 0 04 /0
Idaddayour codedTIN.
drat® red rearm firma/4 to me inward fwd., • Ma >to ottani supper
to Now $nihrookand. Ses Yew al boat, wittedkeng? on pope 2.
By Siena the Noma lain you:
1. Cerefy Om the 1fl you are grey Is owed lor you are *Ong kr a camber
to be bevel.
2 Candy tea you aro not hfieektel to baton withnotEry, cw
2. Ctirn oxempilon barn clap withholding If you age a U.S. menet payee. If
vocable you an ODA Cederthe Deg sir a at person your acre snare of
any porronnip 'room* Worn a US. Vale Or cos Otte not uudroct to an
wIthhoktirg lex on Wean primer,' An Of elfeetheht comrade 130014. arc
4. Cents that FAT CA comae Intend eel thb I0M1(deny) hart% out you aro
camp: hem MO FATCA lilliOnha. le cemmt. See what it MICA npanni?on
Per 2 to Whet hkerneaan
Cat. No. 10231%
Form W-9 (Rea 12•201ry
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0052266
SONY GM_00198450
achy numbs!
EFTA01362692
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