Case File
efta-01372733DOJ Data Set 10OtherEFTA01372733
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01372733
Pages
1
Persons
0
Integrity
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Form W
'''9
(Rev. ocarierene
04;themi el the heathy
thaws Ranee Santa
Request
for Taxpayer
Identification
Number and Certification
Civil Form to the
requester. 0o net
send to the IRS.
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I Nam go amen on yet/ Inecene lax worn} Nome 4 a °quirt", on This lNr. ea not erne ,Ms SW blank
Southern Trust Company, Inc.
pum
a
ma nameMisteganSod enthy Ire, ii
went Item above
Southern Financial, LLC
3 Check *egoistae
O 53.45•Jalkell
is
mantis
O Untied %salary
For a brogbalictibel
etc tax cunlectMon
box ter federal lax cirsolgoagan: OW sty eve of the tonotAng seven toe=
Menial et
O 0 Comordion
0
SCaporalon O
Penneship
O the-Weida
LLC
EA
company. Iola the taa caratestkm PAC Gemara:ch. SeS corporation. Paparmashh(P
tic WI 4 C.srgar0t0, do net awe: LW; duck go appnecOle box D the rabCro3 for
0 lhO Acta mamba/ CFACIf.
•
4 Exemptions
gas° anteoewleral
anti payee
bemPtic"
coda at eny)
tusk.. vaavoavoniorvavo
(codas aceit Otto
fee
code et ash
keen FATCAnPerni
Ill pow poor rains:Coro)
...vac
5 11/454•333 (nUelber•Onet. and ate. cesceere3
6100 Red Hook Quarter, .B3
RagtesYle mete and addiff4 Comae/
a City. stilt anOZO? co0e
St. Thomas, USVI 00802
7 Ust account masthead Nee leptiente
:Pa -t c
Taxpayer Identification Number (TIN)
Enter your TIN In the appropr!ate box:therm provided must match the name given on tine 1 to avoid
backup withheldIng. Foe (ode/ duds. IMS Is generalty your social security number (SSN). However, for o
resident alien. sole OlOcatOf, or dtcreganled entity, too tha Part I Instructions on paged For other
amides. It Is your eMployerldentliCaU00 number (EIN). If you do not have a number, see How CO pet
TIN on page 3.
Unto. If the account Is hi mote than one name. see the Inalmottons for line I and the chart on page 4 lot
guldenes on whose number t0 enter.
6oaa
unyntrmber
or
Rending Identification number
616
0 7 7 9
711 .
Certification
Undo/ ponaftles oI perjury. leen& that
1. The number shown on this form Is my WOOS taxpayer identification number (or t am waiting (outnumber to be leaved to met and
2. I arn not sugect to tockup within/Ging because, (a) I ern exempt from backup withholding, a Mitt/Ivo riot been nothied by the Internal Raven.*
Service fit/St that I ern subject to backup withholding as o /mat of a Wily!a to racial ell interest or cihrktends, or
the IRS has notified MO that I ern
n0 longer subject to backup velthholenth and
3. I em a U.S. citizen or other U.S person (defined Wont end
4, The MICA coding entered on tNs form QI ant indicating thole/a exempt from FATCA reporlinolscarect.
CartHleadan LnatructIons. You must cross out Rent 2 above If you have been notified by the IRS that you we currently subject to backup sidithilIng
because you have failed to report shinier/al end dividends on your tax return. For real estate hansackons. Item 2 (loan not apply. For trion0.96
Interest paid. acquisition or abandonment of secured property. cetneellation of debt, cOntributiCA3 to an friovidute retheMent arrangement (MK end
generally. payments other than Interest and dividends, you ere net required to sign the cerliCoottort, but you neat provide Your correct 11N. Seethe
instructions cm doge 3.
Sign
Hero
SIgnalure el
US. Ramon►
General Instructions
Seaton telOtelCos 010 le the !hint Annus 0000 Wane Otherwise noted.
Future develOprnenb. Infonnekst abed developments anectue Form W.9 Duch
ioebtabn enacted snot we release igistvnYve.ttapowlhe9.
Purpose of Form
An frollyktue; Or way (Form W-9 lacunas) van is coquted 10 Do an infonatition
Often wkh u1a OX9 Mat obtain yea cirreet to p lie losoiscatcn mote Rti4)
*nth mho' bows sor-bl (coat meter PSNOellidual taxpayer identathstron
number prin, adoption taxpayer tOloielcalloo Dauber OM or rtmCDayel
dernificahon Marto: (En to report on an Intetrudon rotten the among paid le
you, or cow anoint reportable an on DIcarnaeCct Mum. &an0lea or Informatkm
(gum :yid°. but are net linked to, the losevraw
• Form 1009.INY (edam( area or pad)
• Foam 1099•DN ethisenco. :taxing those ham n0ds a narked West
• Fenn 1099•MISC Oulu: typos of Income, prim nth. or onte3 precool.)
• Fens 10994( Moth or mutual fund ales Watt
aviv tramactions by
broken)
• "coo 1039.S ;proceedb Inn red estate Uareadlond
• Form t099-K (nentent cad as tiled pasty network ranractlats)
este Ida0L901*
• Farm l0ea terms mortgage Neese nett "dent lean sweep. flYST
(token)
• Form 1099.0 Pampa( (so
• Form i099•Ageradetimi or &Wm:errant of secured Property)
Use Than Wei only a you we alia parson credusas a madam 0 04 00
rgaVloe yaw *wool TIN.
drarob not maim firm Vi-9 so me tetensity we', • MN, stu Wolves rope
to beceimenkenokano. See Matt soap inane/Cr& on pop 2.
By Siena to thed(out loon you:
1. Can* ewe the Tor you any poky Is owed lot you am *Wing to a camber
to be solidi.
2. Coney that you ant not lketeel to totkue withhoklitc,
2. Ctirn manglon ham backup wall:agog If you ce a U.S. ramp payee if
vocal.. you are OtS0 Cenlyhg VW meat person your acre sane of
any pornthavo 'room* Porn a U.S. trade or sus nen is not oup;oot to the
wanhoairg tax on keep Pennon' Mae Of elfvelhobe Corner:COO VOX,. oft
4. Gay that FAT CA codael nom at V* Ion ef ere hat% vut you Na
°WV; from N0 FATCA teronhg le comet See Mot is MICA neenni?on
geo 2 tor hasher elfemerion.
Ca. No. 10230(
Form W-9 (Rot 12-201ry
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0066577
SDNY GM_00212761
EFTA01372733
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