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efta-01363180DOJ Data Set 10Other

EFTA01363180

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DOJ Data Set 10
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efta-01363180
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EFTA Disclosure
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Form W"9 (Rev. December 2014) Dspartimmt ce Pa Treassy IN.anal Rovers* Se'tco Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type..Ir See Specific Instructions on page 2. I Name (as shown on your income tax return) Name is reo mreo on this lino: do nal led.: his linr bSeli Prytanee, LLC 2 &Airless name/disregarded entity name. If different from above 3 Check appropriate box la federal tax classificatbrx check only one oi the foacninng seven boxes, EI Individual/sole proprietor Or 0 C Corporation 0 s Corporaton 0 Partnership 0 postroetate single-member LLC o Lirnited lialstity company. Enter the lax classification (C.0 caporal'ion, S•S corporation. Pi:partnership) le Note. For a single-member LLC that a disregarded. do not check LLC: Heck the appropriate box in the line above lor the tax classification of the singet-menter owner. 0 Other (see instructiOrd).. 4 Exemptpoi's certain on inemzbone ExerrePt payee Fxemptich code (4 any) gimlet w.),,,e{orninetl.xer.." cedes noir oniy to not indencluais, see on one 3.3: code Of fel' from FATCA reporting ,.0 Us; 5 Address (number, street, arld apt. Or suite no.' 6100 RED HOOK QUARTER, 63 Recuestet's nee* and address (optional; 6 City, state. and ZIP code ST. THOMAS, USVI 00802 7 List account numbers) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. Social enemy number or Employer idendficatiore number 6 6 0 8 6 5 9 2 5 Part II Certification Under penalties of perjury. I certify that; 1. The number shown on this form is my correct taxpayer identification number (or I ern waiting for a number to be issued to me): and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (bl I have not been notified by the Internal Revenue 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 no longer subject to backup withholding: and 3. I ton a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because 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. acquisition or abandonment of secured property. cancellation of debt. contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends. you are not required to sign the certification, but yOu must provide your correct TIN. See the instructions on page 3. Sign Here Signature of g) U.S. person a- Date ►f General Instructions Section rely:en:4G ate IC the Interne' Revenue Coee unless other rule noted Future developments. Information etc../ developments atlectirg Form W-9 Muth as legislation enacted after we release ia is at we gordwg. Purpose of Form An individual or entity (Form W-9 requester) who is mouved to tee an information ream with the RS must obtain your correct taxpayer identification number (TIN) which may be your social security number ISSN). individual taxpayer identification number (ITIN). adoption taxpayer identification number MTN). or employer identification number (EN). to report on an infcrmation return the amount paid to you, or other amount reportable on an information return. Examples of information returns include. but are not limited to. the Meowing: • Form t099-INT (interest tamed or paid) • Fenn 109a-CIV latvidands, including those from stocks or mutual funds) • Form torrarose (various types of income. prizes. awards. or gross proceeds) • Form 1099-8 (stock or mutual fund sales and certain odier transactions by brokers) • Form 1099-5 (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Rent 1038 mom. inwmago merest). 1098-E %ardent loan intent), 10914-T • Form 1099-C 'canceled Cobb • Form 1099-A (coulamon or abandonment of secured properly) Use Form W-9 only if you are a U S. person (Including a redden( Men). to provide your correct TIN If you do rot return Forth W-9 to the feQuester wen a TIN, you fright be submcf to backup kasthholdetg. See What es backup TedhleedhOT on page 2. By signing me teedoot form. you: I. Certify mat the Tel you are Own° is correct (or you are waiting 'prank:rater to be issacii. 2. Certify that you aid not suCeice to backup withholding, or 3. Clam exempriOn from backup Withnoiding if you are a U.S. exempt payee. If appiicabie. are also certifying that as a U.S. person, your allocable share of any pannership income nom a U.S. trade or business is rot subject to the nutenceding tax on Veer partners' snare of effectively connected hcome. and 4 Certify that FATCA wef(s) entered on this form pi any) end/sating that you are exempt from the FATCA reporting, is correct. See What h FATCA repOlting7 on cage 2 for lures information. Cat. Nc. l023IX Form W-9 (Rev. 12.2014) CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DB-SDNY-0053083 CONFIDENTIAL SONY GM_00189267 EFTA01363180

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