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efta-01374177DOJ Data Set 10Other

EFTA01374177

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efta-01374177
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EFTA Disclosure
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Form W-9 (Rev. 12-2014) Page 3 Line 2 If you have a business name, trade name. DOA name. or disregarded entity name, you may enter it on line 2. Une 3 Check the appropriate box in fine 3 for the U.S. federal tax classificaticn of the person whose name is entered on line 1. Chock only one box in line 3. Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a partnership for U.S. federal tax purposes, check the "Limited Liability Company box and enter "lo- in the space provided. If the LLC has filed Form 8832 or 2553 to be taxed as a corporaticn, check the "Limited Liability Company" box and in the space provided enter -O" for C corporation or '5" for S corporation. Hats a single.member LLC that is a disregarded entity, do not check the 'Limited Liability Company" box: instead check the first box in line 3 "Individual/sole proprietor or single-member LLC.* Line 4, Exemptions a you are exempt from backup withholding and/or FATCA reporting. enter in the appropriate space in line 4 any code(s) that may apply to you. Exempt payee code. • Generally. individuals (including sole proprietors) aro not exempt from backup withholding. • Except as provided below, corporations are exempt from backup withholding for certain pawn/wits, including interest and dividends. • Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. • Corporations are not exempt kom backup withholding with respect to attorneys' fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC. The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 1 —An organization exempt from tax under section 501(a). any IRA or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2) 2—The United States or any of its agencies or instrumentalities 3—A state. the District of Columbia. a U.S. commonwealth or possession. or any of thew political subdivisions or instrumentakties 4—A foreign government or any of its political subdivisions, agencies, or intrumentahties 5—A corporation 6—A dealer in securities or commodities required to register in the United Stales. the District of Columbia, or a U.S. commonwealth or possession 7—A futures commission merchant registered with the Commodity Futures Trading Commission 8—A real estate investment trust 9—An entity registered at all times during the tax year under the Investment Company Act of 1940 10—A common trust fund operated by a bank under section 584(a) 11—A financial institution 12—A middleman known in the Investment community as a nominee or custodian 13—A trust exempt from tax under section 664 a described ei section 4947 The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above. 1 through 13. IF the payment is for ... TT1EN the payment is exempt for ... Interest and dividend payments All exempt payees except for 7 Broker transactions Exempt payees I through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquied prior to 2012. Barter exchange transactions and patronage dividends Exempt payees 1 through 4 Payments over 5600 required to be reported and direct sales over $5.000' Generally, exempt payees 1 through 5' Payments made in settlement of payment card or third party network transactions Exempt payees 1 through 4 See Form 1099-MISC. Miscellaneous Income, and its instructions. 'However. the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments. attorneys' fees, gross proceeds paid to an attorney reportable under section 6045(0, and payments for services paid by a federal executive agency. Exemption from FATCA reporting cods. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United Stales by certain foreign financial institutions. Therefore. if you are only submitting this form for an account you hold in the United States. you may leave this field blank. Consult with the person requesting this form it you are uncertain if the financial institution is subject to these equ ements. A requester may indicate that a code is not required by providing you with a Form W-9 with 'Not Applicable' (or any arnier indication) written or printed on the line to a FATCA exemption code. A—An organization exempt from tax under section 501(a) or any individual retirement plen as defined in section 7701(a)(37) B —The United States or any of its agencies or instrumentalities C —A state. the District of Columbia. a U.S. commonwealth or possession. or any of their political subdivisions or instrunwntalitles D—A corporation the stock of which is regularly traded on one or more established securities markets. as described in Regulations section 1.1472-1(c)(1)(i) E —A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section 1.1472-1(O(1)0) F —A dealer in securities, commodities. or derivative financial instruments 6rockiding notional principal contracts. futures, lanyards. and options) that is registered as such under the laws of the United States or any state G —A real estate investment trust H —A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940 I —A common trust fund as defined in section 584(a) J —A bank as defined in section 581 K —A broker L —A trust exempt from tax under section 664 or described in section 4947(a)M M —A tax exempt trust under a section 403(b) plan or section 457(g) plan Note. You may wish to consult with the tragical institution requesting this bon to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your address (number, street. and apartment or suite number). This is where the requester of this Form W-9 wit mail your information returns. Line 6 Enter your city. state. and ZIP code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. 11 you are a resident alien and you do not have and aro not eligible to get an SSN. your TIN is your IRS individual taxpayer identificalicn number (ITN). Enter it in the social security number box. If you do not have an ITIN. see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on this page). enter the owner's SSN la EIN. if the owner has one). Do not enter the disregarded entity's EIN. If the LLC is classified as a corporation or partnership. enter the entity's EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not hare a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at WvAv.SSagov. You may also get this form by calling I-800-772-1213. Use Form W-7. Application for IRS Irdividual Taxpayer Identification Number, to apply for an MN, or Fam SS-4. Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at www.irs.govibusinesses and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS'4 from the IRS by visiting IRS.gov or by calling 14300.TAX-FORM (1-800-829-3676). you are asked to complete Form W-9 but do not have a TIN, apply for a T1N and write "Applied For in the space for the TIN, sign and date the form. and give it to the requester. For interest and dividend payments, arid certain payments made with respect to readily tradable instruments generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering "Applied For' means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded U.S. entity that has a foreign owner must use the appropnate Form W-8. CONFIDENTIAL - PURSUANT TO FED. R. GRIM. P. 6(e) DB-SDNY-0068744 CONFIDENTIAL SDNY_GM_00214928 EFTA01374177

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