Case File
efta-01387592DOJ Data Set 10OtherEFTA01387592
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01387592
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
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Form W
'''9
:Rev. ocambrunq
bessniatia of the Petrel
enema Range Swam
Request
for Taxpayer
Identification
Number
and Cert
ification
Give Form to the
reqUeSter. Ro not
send to the IRS.
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I team age shown on yore Inccens um rehem Name :a coquar0 on This vier. di nial ifsbV0 1 I Sl• blank
Southern Trust Company, Inc.
Burm
a
ma itamoklartmanSed only tame, aMorey from above
Southern Financial, LLC
3 Check approortale
O infiTletelik011
sircps-menter
O Uglier! Welly
For a s.nakameriber
ate In Veneerer:in
box for federal loft etreelfratIon: check a* an of the tortorAng seven tome
Prof:Meat of
O
COVFOMFOrl
OSCaporatIon O
Penarnhip
O Frweeslato
U.0
company. Iota the tax
PAC capor3440. SwS Ceeporallon. Peparecesh94F
LLC WM 4 esreiertlecy de net Mack CSC; Omer< the ups/role box 4 No rebore tor
0 The AS mambo/ Cr "CY .
a
4 afienipliens
gas° anttpagrEiter31
EA anti payer
b.mpda
each (if ear)
lose a raw.r...arwei.sts
(=MOS mot, 0410
fee
code et end
If= FATCA M CC'S
Ill Dow how rains:cony)
...US)
F F49Mes (00400,.* 041. video. ceaes red
6100 Red Hook Quarter, IfS3
RagvetYla rune and edemas amliceot
I City. stale, anclta? cote
St. Thomas, USVI 00802
7 Ust acorn nootene) Nee Optletal)
Pa-t f:
Taxpayer Identification Number (TIN)
Enter your RN In the appropriate box. The TIN provided must match the name given on lir e 1 to avoid
16oda aro
backup withholding. Foe Individuals. Iles Is generally your social security rWMber (SSU). Howevot, tore
resident alien. ado proprietor, or disregarded Drafty, too Ns Part I Instructiora on page 3. For other
t rades. It Is your employer IdenlIticatiOn number (EIN). It you do not have a number. see How Co get 0
TIN on page 3.
or
Note. If the account Is in room than ono nano. see the Insuuollons for line I and
than on page 4 lot richtioacof friefeittoe3On numbs:
guldeines on whose number to *MCC
Certification
Undo/ penalties a I perjury. loon& that
1. The number shown on this loon Is my correct taxpayer identlatallon number (or I am waking (outnumber to be Issued to met and
2. I ant not suofect to backup withhoietng because, (a) I ern exempt from backup withholding, cr (o) I have riot been noWied by the Internal Rennin
Service (RS) that I ern subject to backup withholding as o roster of a tailors to repal all Interest or cry/Wends, or
the IRS has notiSed me that I em
nO longer subject to backup withholding; and
3. I em a U.S. citizen at other U.S. person (defined blank end
4. The MICA code(a) entered on tNt form al any) indicating that I am exempt from FATCA roporliry b canct.
Careflearean Instructions. You must cross out Item 2 above II you ham been notified try the IRS that you ate currently subject to backup ietthholeeng
because) you have railed to roper all Interest and &Mends on your tax return. For real estate hansacaons, Item 2 does not apply. For Monne
interest paid. acquisition or abandonment ce secured property. contention of debt, contributions lo an indvidual retirement arrangernent OM), one
gencireity. payments Other than Interest and dividends, you are not required to sign the cerlikettort, lea you mint provide your correct N. Seethe
instructions mi pegs 3
Sign
siemtm,
Nero
its. pa
General Instructions
26:110n filOt Otos Mlle the front Rennes coos UM= othenvisa noted.
Future devoloprnener. htoonsuen abaa deveraenierts aides, Form W.9 bush
• WOhtillbri enactor/ ever we release is is a thrwvottaperollva
Purpose of Form
An Waykiulg a wiey (Forst W-9 roomers) Me) te !metro to No an bionneeket
with ale MS mat oblein yaw co-reel trarrayer looreirearren menbor (MO
itniat Mr be Your Facial 1,90-MY number PSN).kiNklial taxpayer idenlait4e01
robe( pfNy aotptIon taxpayer tersekellon number (Allen. or emosayer
irlenaricaton Maxtor (EIN). to roped n en eiforthrion Wien iho sett P0410
you, or caw amount reporlobie on ors arkentalker nun. EX/InpIel of btfOrMation
Want iv-We. Out are not United to, the lama*
• For/310094W (ran% tamed or pall
• Form I092-DIV (Selena& :taxing those Irani nods a mused krodst
• Fenn 1099-MISC (voids trees of Income, pram emeek. or creep prOcoode)
• Fenn 1099-0 Wei or mutual fund sake era anal other tramacdom by
broken)
• Form nigeliS ;proceedb lions red ewe wreathe/el
• Form ttraditt enentent card aro, third parry network iranstelIC05)
ono
It90
1 i*
• ewe 109a pone mortgego heereso. 1098e tee/dere loan Internet/ 1091-T
autroat
• roan 1099.0 (canoe** (so
• Form trieWi(anallatiortrabaneitinclotcluctired POWS
Use town W-li only! you we a U.S person Cnduiare a ofislami 0 04 Oa
Feavkieloor correct Jul.
tr)eirob red maim town 19-9 so me tequasth (watt • MN, tau nth! be Abet
to Now sekrerokono see Multi bachpMooring? on page 2.
By Saha the lillrefrOu1 roars YOU:
1. CS* Om the Tor you are poky Is end jur you aro *Wing kr a camber
10 be Sued).
2, Coney that you are nth 3111:00.1 to bolero withhokerm,
2. Clain oacmptron ham baCkup..yelloldrog X you ere a U.S. exempt men If
eppecetle. yarn 6•20 CerlayS2 teal meat pooch yew amble Mare of
any porereohlp Ircome Porn a U S. trade or out Min e not ouVcact to the
wimhodirg lex on Wean pad"., aye el elfrothehr comorafrd lecovs. old
4. Corley that FAT CA ©GOO* Orem* cel fib lOml ar vry) haunt% the you aro
exam from the FATCA cranky. le cemict See whet 4 MICA naturf?on
ono 2 to kinky hkernerisu
Cat. No. 10 alit
Form W-9 (Roe 12-201e)
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0090600
SDNY GM_00236764
telly number
EFTA01387592
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