Case File
efta-01380755DOJ Data Set 10OtherEFTA01380755
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01380755
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1
Persons
0
Integrity
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Forn W-9
(not Decernte 20:4)
>erten or Me neamy
I/1mM Froyamo Sonate
Request for Taxpayer
IdentificatIon Number and CertlficatIon
Glye Form to the
requester. Do not
send to the I RS.
N
§,
& 8
1
S
a.
*. I 6100
Y
dS
t neme las glymn ans« ram las Mbrna "Snoe .s mq..44en an
h
CO m1 leme ital .1ne blank
Southern Trust Company. Inc.
2 Buens namordineweed @Møy nanki. e danen from anave
Southern Feiende', ISC
3 Check oppropa»
n L, IndvIcuaireols
langbanamber
a ankect liabirny
Now Fa • sngle.menber
the tex otaceifbaer
OMN (wa Innuelle~
for federol
daificatbn:
fettrMen
D Troevestaur
le
4 nsercisOmn
h ni el?..:
rk,;..tt
Emnet pens
Ext"
ti°n
cocli yit errA
Wittesameanard
(mana/c* or4 to
on
n ra 11-3;."sat sa
pm*
pode re regt
b«
rex
creedc orer orm ot mo
somt Onn:
proprbtor or
O C CorwatIon
0 a Co:porsar G
Ponnsen4
LLC
company. Fatte Me tro desseicaran (CoC corporadon SeS capandr, Pepasr~
LIC Mat h dammene do not check RC: check te innvortes bOx
or the seenamentrer emner.
" In FATCA n"
ribili
Ma bm *bom br
~
IN VI;
5 ~me @urter, set. end ape a aula nol
Red Hook Quarter. B3
acCentlera nane end arm (Optitne
s em, man and istecode
St. Thomas, USVI 001502
7 LM eCOM-4 memb041,1b44110~1
Pa IS I
Taxpayer IdentMcatIon Number (TIM
etter ymte litt In Me oppropet'a bOx. lherN provIdied mutt match the name given 011 fine 1 to avlid
bisirup
•ro' ind;ooLals, Ibis la genwally your social securtty number Ø.
HOWCY1M, for a
resident aten, We propeletor. or ceiregarded enfly, sa the Pan I hagellons on nage 3, For other
°Meies, d B your employer Identikation nurober (EIN) d you do not havne number, ses How to gote
DM or page 3.
Hote. MIM ~ant
is In moro Man ene name, sog tno eratmclIons lor Snei and Me cha' on naga 4 for
i "
IST& laLmaacraion numbed
guld•lineS on whose ~ber lo enter.
seouila ~flot
Certrficatron
Under pene/gos ol parlere. I ~dy tøt
1. ne mynter *ho« on this foren d my ~OM texpayer Idonnficallon number (or I am metting for tt nutubor ro be 'spued lo mo); and
2. I em not sub;ect to gack ep witM,ot&% benause: gg I am ekornet Iran bactiup wilhltokang, or (b) I have not bnr nobliecl by Un bremas ~ut
Service (PS) tist I am subjaa to backup vathtokIng sa a ntet.lt atal/taum to report sl! Innerest or dividends, or (c) the IRS nes nollled me Mai I am
no longer subjaa lo bedage waleedaingt and
3. I am a U.S. druen or dh« U.S. person Nollled bokse): and
4. The FATCA bodet,' ~red On Iles tomt (if any) indlcallng [holrom exempt kun FATCA repOrtIng le corroct.
Cerefleardon tristructions. You muse posa out Item 2 Wen li you havs been marked by the IRS that you are CUllilfilly 5UblOCt to backup untrholclIng
botause you have foged to report se Intenst and dividende on your lax return. For real °state trancasliont, dom 2 dons not appty. Fot 4111122MM
Inler0s1 pa4, teocesleldon or abandonerer' ol SOMM1X1pnmetty. cancellation ol det4, °rettarbota lo an nclirkruar talkumen* streng 'Ment (MAX end
generalry. payrrents °Med than Intenst ond &ridende, you are not roquIred » eign die cortificadon, Celt yd/ must bratne your come% na See the
'nyttast ons on >ege 3.
Sign
I eignarre
Hors
ud.
..
•riont
r
,
l
~Ml
General Instructions
~Ion referert» am to the Imamar Rome Code enten othenetsenoted.
Futura dnesiopmente Iniarraket toa development. fl atna Form Yir.fl huen
tl legine len enacred arter vm Memo /gan walraw.~.
Purpose or Form
M IniMdui or entity gorm Visa i c c :.19~WhO b •equien b rio m blonnaen
wen eim ihttnS mutt omen yos coaa aaan L'oraFat flata (tre)
Mit, mal be ytt, soda
rumba ;Sarg. tidvclual aspene der,tirione,
nember i, ros. leSnotbnraapreyor IdenalicatIcn rumler (A71N), w enebyer
ktemiricalcn rumba (EIN), to report on al neamacel sum Itle smurd pai to
yot or aner annan monen on en ni:ensar snurre Øgla al kf armane
moms ildne. tut ere not klemd lo, the Voving:
• fonn toe9.INT penne etened or ad)
• Fall lan•DFF fellerkeeda. Includno Iler» Ironi »eks or muta Iun
• Face ICO9•14;SC (saalem14101. al letene, yta astam. or green oracemb)
• Fonn 1099.8 teak amme and snes ard ~dh«
mineactions by
brokar')
• Fot 10»-Sfproceede tent me ende transacioen
• Form t0944t enerchent cad end med party noteark versaskets)
Den>
-2/21/20/
• Fonn 109e(nonte monnet borent.10gbE (9~
lort riene. 1096-T
Polane
• Form 1090-C f cencercd eobn
• Fr 1099A text"
y raardameni or sømer oropona)
Use Form W.9 orer e you Gro • U.S penon 0rnMIng a modent dere ro
pnaide mur correct TIK
ff ye,o ab nor attom Fem W.9 it ~moen« WiCle
YOtibl‘gbf k Slett
te taktø wfrokivp. Sat tenaristeclorp wrY~42 m Vold 2.
By signing ne lieWout tonn, you:
1. ~prat
Mella you ant gid» te COneel (ot yao
~Ang kr ~gir
to te flabeek
2. CarIM UiR you are raa!~
to barJcup altoldiaz, or
3. Cern ~glan from bode.• vahhokang f yenen a U.S. ~opi rayon 3
sopiaao, ya, no tO sor./IyO2 Mal as aU3 pastorn yeur ~satte ~le Or
am trio ‘2, o ~ro hem a u s. trade or tuantos b na Wact to be
wl, ,Mbrg las on boks pannw rors of offectire~ed
Ikorn and
4 Gny !KU FMCA ende>: *torron em lone (4 onn 'Watere sot you as
e...r,m from l^o rATCA zaGeet-'11. is onne«. Sere Woot e FATCA rantirx?y on
paoo 2 fa furta a otainn.
Cal No. 10231X
Form W-9 Man 12.2214)
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0079282
SDNY GM_00225488
EFTA01380755
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