Case File
efta-01387182DOJ Data Set 10OtherEFTA01387182
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01387182
Pages
1
Persons
0
Integrity
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Own W
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Met. ocambewido
Deorment of the Omen
Inures Ramie Sete
Request
for Taxpayer
Identification
Number
and
Certification
Give Form to the
reqUeSter. Do not
send to the IRS.
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Southern Trust Company, Inc.
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ma namereartmanSed en* erne, ii diewent owe above
Southern Financial, LLC
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5345•55114115,310
stslomember
simile Mainly
O Unt
Note. For a crejtooteriba
etc In ounlacsson
box ter federal Lu ctreolfratIon: OW sly am of the folloitim seven boom
Minim or
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Pannership
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LLC
p
company. Fakir the
PAC caporatIon. SeS corporation. imperownh10) lo
t/C tat 4 Carentrelon. de Mt creek up; dyed< tno &apogean box D the rebores for
of me omit mammy Cr...CY.
4 aireptions
folir
n antareosipaowlerata"
EAOMOI payee
EalimPtic.1
coda at ens)
lon1/44 a ne....................e.
(codas moil Otto
see
cols Of eon
keen FATCA159"5
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eon
5 P4554333 5/ Inte r. Meet. arid mt rotas red
6100 Red Hook Quarter, B3
Remesala runts sad Scan. (optima/
li Cita. sant ancIZIP cote
St. Thomas, USVI 00802
T Let mcoura memos.) here lepeOrite
Pa -t c
Taxpayer Identification Number (TIN)
Enter your TIN In the appropriate box. The Tim provided must match the name given on lir e 1 to avoid
backup withholdIng. Foe Individuals. IMS Is generaity your social security number (SSN). However, for a
resident alien. sole proprietor, or dtcrepanled entity, too the Part I Instructlibra on page 3. For other
amides. It Is your employer Iclantenetren number (SIN). If you do not have a number. see How Co gat
Trig m page 3.
or
Unto. If the account Is hi more than one memo, see the loam:Miens for lino
and the than on page 4 lot
guldenas on whose number to enter.
soda
tatty numbs,
Certification
Under ponahles of pedury, leen& that
1. The number shown on this form Is My correct taxpayer identlOCation number (orient waiting for a number to be 'tetrad to met and
2. I am not subtract to backup withhoterng because, (a) I ban exempt from backup withholding, cr. (b) I have riot been nothied by the Internal Raven.*
Service ORS) that I ern subject to backup withholding as o result of a lakes to repot all Interest or Oh/Wends. or (e) the IRS has (loaned me that I am
no longer subject to teckup velthholenth and
3. I em a U.S. citizen or other U.S. person (defined Wont end
4. The MICA code(a) entered on tNt tone al any) incrcattng that I am exempt from FATCA reporting b =rect.
Cartfleaden LnatructIons. You must cross out Item 2 above if you have been notified try the IRS that you ere currently subject to backup salltioldng
because you have failed to report all Interest and darldends on your tax return. For real estate hansaceoni. Item 2 does not apply. For snongegs
interest paid. aCiaulsIllOn or abandonment of secured property. catfiCelladon of debt, COntributnna loan inovidutil retirement arrangement
end
gencireity. payments other than Interest and dividends, you me net required to San the cerliCositora but you mitt prodde Your cermet Tilt Seethe
instructions cm pegs 3.
Sign
Hero
Montano
to
US. parson to
General
Instructions
BectIon rainless we le the went Revenue 0:00 USW; otherwise noted.
Future devaleornentr. htonnalon abed deveimmerta IntornoForm W.9 (sun
as nentelbn enacted sitar we sauna it) i o mthrwvottaperolhe9
Purpose of Form
Pa kolMdun Or army (Form Wit Mounter) who Is /none to tee an inkrmaitbn
Ilan% wkh D10 MS mat obtain your carnal taxpayer lonoikaben romber (1154)
*nth "
, be yore 40r-5,5 500•14Y meter PSN.kilichai taxpayer Wane/neon
number pfd). amptbn tamayor lewsakelloo number (4124). or emokler
klitroiricanon Marble: (04 to report en en trikeruclon relish the &Tong paid to
you. or other frownt noon)* an en DlcoentInt morn. Example' of biernlatIon
Want Oxide. but ore net boated to, the lawny:
• Form 1099-IN! (ran% Mood an mkt)
• Form I099-Dry easise ob,. inrAxtem those Imo nods a named Weal
• Fenn ioeStaiSc (.-aMustype of Income. One, net
or VON plIceech)
• ram 1099-0 Mack or mutual fund sake era cadet other tramactiorta by
broken)
• ram 1OXIS iprocoada lioni red mum wreathe/4e
• Form tO324t enentent card are third party remark hertractions)
owes atiOL901*
. Faye 1098 prone manatee tverest). imet modems:urn Waren/ flYST
suktom
• Fern 1099.0 (canopied (so
• Form i099•Atesariallmi et se
t dsecured Property)
Um Mon wet ore/ a you we a U.S person Pliduana a ma'am 0 04 /0
inavlaelart cowed Tilt
Wrath* red Wpm form W-0 la me tequasto (watt • Wit >to Want be Abet
Sc mow airthokona See Mine bactlap with baker& on page 2.
By Sobs the lies:Sout loan. you:
1. Certify Pm ma Tot you are onary3 b sand (a you are *Ong Macomber
to be batted).
2 Coney that you are not neent to tennis withhoktine,
2. Ctirn exemption ham backup withhclosim ayou en a U.S. comp met If
sponse...v. you en aide Caliph") old meat porton. your atom* share of
any ponnorelp ircoma from a US. trade m me nen to not rob.coct to the
wanhoktiro ma an Wean WNW An 01 stfecthebe Conleeled Wein are
4. Cady that MICA co6401 mood mthb form Of ve) heathy me you as
exam (centre FATCA relientml, le comet See wive i MICA nanni?on
orree 2 for further hkernarton.
Cat. No. 10231X
Fenn W-9 (Res 12-201ry
CONFIDENTIAL
- PURSUANT
TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0089354
SDNY GM_00235538
EFTA01387182
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Phone
4554333Phone
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