Case File
efta-01392921DOJ Data Set 10OtherEFTA01392921
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01392921
Pages
1
Persons
0
Integrity
Extracted Text (OCR)
Text extracted via OCR from the original document. May contain errors from the scanning process.
IV. TAX ELECTION/DFCLARA I ION OF TAX STATUS
This Account Agreement is designed for use by both U.S. Persons and Non-US. Persons. Please check the box next to the applicable item below.
Client certifies that Client veil notify DEISI in writing Immediately il the representation certified to below ceases to be stue and correct.
$52g.wAik,w(Fs.:~s
Form W9
Substitute
Request for Taxpayer Idaatification Number and Certifioation
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K Limited liability company. Enter the tax classification (C.0 corporation. SeS corporation, Pepartneahlp) ti
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F:: p• I Taxpayer Identification Number (TIN)
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The TIN provided must match the name given on the "Name tine
to avoid bear* withholding:F& individuals, this is your social security number ISSN). For other
entities. it Is your employer Identlficabon number WIN).
P, r. II
Sign
Here
~owl Identification Number
LO-LLIJ I DE1
Certification
Under penalties of perjury. I certify that:
1. The number shown on this tom, is my correct tata»Yer Identifikation number (or I am waiting for a number to be Issued to me). and
2. I am not subject to backup withholding because: tel land exernpt from backup withholding. or lb) I have not been notified by the Internal Revenue
Semite (IRS) that I am subject to backup withholding as a result of a talk» to report all interest or dividends. or lc) the IRS has notified me that I am
no longer sublet* to backup withholding. and
3.1 am a U.S. Øen or other U.S. pen
In the instructions).
C..erdfication inatructiona. You
st cross out ism above if you have been
by the IRS the' you ale cwamdy subject to backup wilhhohing
because you have failed to
rt all interest and d
inde on your tax
2.0 Non-US. Person
I am not a U.S. person Including a U.S. resident alien). I am submitting the applicable Form W-8 with this form to cowl,/ my toregn status and. if applicable,
claim tax treaty benefits.
For example. Client is not a Lt.& person (including a U.S. resident alenl. Client agrees to provide DBSI with this application the applicable Internal Revenue
Service (IRS) Ferm W.8 to certify the darts foreign status. W-8 forms and Instructions am available on the IRS website at www.irs.gov.
[THIS SPACE INTENTIONALLY LEFT BLANK]
12.PVVM-0573
e
012145 011113
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0098236
CONFIDENTIAL
SDNY_GM_00244420
EFTA01392921
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www.irs.govIPv6
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