Case File
efta-01381180DOJ Data Set 10OtherEFTA01381180
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01381180
Pages
1
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0
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Form
(raw. Decorber
Demers.
Hanoi
W-9
2011)
d en
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
eavey
RiewnaSP
ervke
Print or type
Sal Spool.* Insiructiorts on page 2.
Name (as shown on yaw kicaris tax rosin)
Butterfly Trust
Busereas namerdaregarded entity name. II deferent horn above
Check Appropriate
0 indiyicorageroe
•
Limited liability
0
Other gee bethesticns)
box for Word tax cissericaticer
a
0
(aril% WM.
proprietor
•
C Cceporabon
0
SComerarlion
0
Partnedhp IS TIILIVOSIZIIII
company. Enter theta dosser:aeon (CC corporstIon. SoS corporation. Pwannarship)
a
Arkkess (number, test aid apt. a sate no.)
MOORS Hook Quarter, III3
Risdiesteis name end address (0Perrisi)
City.
ZIP code
00802
steak and
St. Thomas, U.S.V.I.
Lint account nurrinetelnera Wilma*
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the 'Name' line
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Past 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
77N on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Part II
Certification
Seidel security nunber
I Employer identiltostien rxrtbm
Under penalties of perjury, I certify that
1. The number shown on this form is my correct taxpayer identification number (or I an waiting for a number to be issued to me). and
2. lam not subject to backup withholding because: (a) I am exempt horn backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a laws 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 am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above ri you have been notified by the IRS that you are currently subject to backup v.ithhokling
because you have failed to report all interest and dtviderxls on your tax return. For real estate transactions, hem 2 does not apply. For mortgage
interest paid. acquisition or abandonment of secured property, cancellation of debt, contributions to an IndMdual 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 4.
Sign
Here
Signature of
U.S. Demon►
72):X/W44,
General Instructions
Sector references are to the Internal Revenue Code unless otherwise
noted.
Purpose of Form
A person who Is required to file an information return with the IRS mat
obtain your correct taxpayer identification number (Tel) to report, for
example, income paid to you, real estate transactions, mortgage interest
you paid. acquisition or abandonment of secured property, cancellation
of debt, or contra:whom you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the
requester) and, when applicable, to:
1. Certify that the TIN you we giving is correct (or you are waiting for a
number to be issued),
2. Certify that you we not subject to backup withholding, or
3. Claim exemption from backup withholding Jr you are a U.S. exempt
payee. if applicable. you are also certifying that as a U.S. person, your
allocable share of any partnership income from a U.S. trade or business
is not subject to the withholding tax on foreign partners' share of
effectively connected income.
Dad.
X
eS 0
I FS*
Note. If a requester gives you a torn other than Form W-0 to request
your TIN, you must use the requester's form If h is substantially similar
to this Forrn W4.
Definition of a U.B. person. For federal tax purposes, you are
considered a U.S. person If you are:
• M individual who is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United States.
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section 301.7701-7).
Special rules for partnerships. Partnerships that conduct a trade or
business in the United States are generally required to pay a withholding
tax on any foreign ostlers' share of Income from such business.
Further, in certain cases where a Fenn W-9 has not been received, a
partnership is required to presume that a partner Is a foreign person.
and pay the withholding tax. Therefore, if you are a U.S. person that is a
partner in a partnership conducting a trade or business in the United
States, provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership Income.
Cat. No. 10231
Farm Wfa (Rat 12-2011)
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0079969
SDNY GM_00226153
EFTA01381180
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