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efta-01387182DOJ Data Set 10Other

EFTA01387182

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DOJ Data Set 10
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efta-01387182
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
Own W '''9 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. ar ; .li. ! t S K 7st C * s, z E t in a I Kamm pa shown on your Interne lax wont} Nana a coquatel on Ina wtP0 Ml bevel Ma ere blank Southern Trust Company, Inc. pum a ma namereartmanSed en* erne, ii diewent owe above Southern Financial, LLC 3 amok approortaie O 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 ❑O CConteradon 0 S emperor,' O Pannership O Trwthreato 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 Ill Dow Dee rains:Ponta 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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