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efta-01363180DOJ Data Set 10OtherEFTA01363180
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DOJ Data Set 10
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efta-01363180
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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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