Case File
efta-01581803DOJ Data Set 10OtherEFTA01581803
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DOJ Data Set 10
Reference
efta-01581803
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0
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Form W-9
Oted. array 2005)
osperwen or svineraw
ken awe. seem
Request for Taxpayer
Identification
Number and Certification
Give form to the
requester. Do not
send to the IRS.
Print or type
See Specific InetnictIons on page 2.
Spates shorn on your moarne tax retunl
7 — On Id ern( -T-12ust- 6,41/014,1 ir NJ c_ .
et*,
name. if dither eons above
r-, Inclakluelf
Check ardreprisa Nee Ll Sole paexistee
Capceadon
FirtnerStdp 0
Otter iv
r —j Exempt from backup
LI witindelne
Address (nurrept. *554 end sat or oda no)
(PI OO Atli NMI t-- aineArit
I
SCa fe--• 4 3
aequeates name and eddies (optional)
City. state. and IP code
SC 17-loi-rte
LtSv.E 4,01-0 7
—
Lis emount numbe(.) nee potions,
Part I
Taxpayer Identification Number (TIN)
•
•
Enter your TIN In the appropriate box. The TIN provided must match the name given on Line 1 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 Part I instructions on page 3. For other entities. it is
yew employer identification number (EIN). If you do not have a number. see How to get a 77W on page 3.
le
Note. If the account Is kt more than one name, see the chart on page 4 for gridetnes on whose number
to enter.
Part II
Secret seams), matter
I
I
+ 1 +
I
I
I
Certification
or
Under penalties of perjury. I certify that
1. The number shown on thls form Is my correct taxpayer identification ntrnber (or I am waiting for a number to be issued to me). and
2. I am not subject to backup withholding because: (a) I an exempt from backup withholdings or (b) I have not been notified by the Internal
Revenue Service ORS) that lam subject to backup withholding as a result of a faire to report all interest or dividends. Or (c) the IRS has
notified ens that I am no longer subject to backup withholding. arid
3. I am a U.S. person (inducing a U.S. resident alien).
Codification instructions. You must cross out item 2 above If you have been notified by the
withholding because you have faded to report ell interest and cividends on your
For mortgage interest paid, acquisition or aba
of secured
arrangement ORA), and generally. payments
rarest and d
provide your correct TW. $See the ri
4.)
Sign
I mason
Here
US. person le
Purpose of F
A person who Is
red to file an inform
retum with the
IRS. must obtain your correct taxpayer identification number
(TIN) 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
contributions you made to an IRA.
U.S. person. 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 are giving Is correct (or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding,
or
3. Claim exemption from backup withholding if you are a
U.S. exempt payee.
Note. If a requester gives you a form other than Fenn W-9 to
request your nN, you must use the requester's form if it is
substantially similar to this Form W-9.
For federal tax purposes you are considered a person if you
are:
• M incavidual who is a citizen or resident of the United
States.
• A partnership, corporation, company, or association
created or organized in the United States or under the laws
of the United States, or
t you are currently subject to backup
. For real estate transactions, item 2 does not apply.
lation of debt. contributions to an individual retirement
e not required to sign the Certilcetion, but you must
• My estate (other than a foreign estate) or trust. See
Regulations sections 301.7701.6(a) and 7(a) for additional
information.
Foreign person. If you are a foreign person, do not use
Form W-9. Instead, use the appropriate Form W-8 (see
Publication 515, Withholding o' Tax on Nonresident Aliens
and Foreign Entities).
Nonresident alien who becomes a resident alien.
Generally. only a nonresident alien individual may use the
terms of a tax treaty to reduce or eliminate U.S. tax on
°erten types of Income. However, most tax treaties contain a
provision known as a "saving clause: Exceptions specified
in the saving clause may permit an exemption from tax to
continue for certain types of income even after the recipient
has otherwise become a U.S. resident alien for tax purposes.
If you we a U.S. resident alien who is retying on an
exception contained in the saving clause of a tax treaty to
claim an exemption from U.S. tax on certain types of income,
you must attach a statement to Form W-9 that specifies the
following five items:
1. The treaty country. Generally, this must be the same
treaty under which you claimed exemption from tax as a
nonresident alien.
2. The treaty ankle addressing the income.
3. The article number (or location) in the tax treaty that
contains the saving clause and Its exceptions.
Ca. No. 10231X
Form W-9 (Rev. 1-2005)
Confidential Treatment Requested by JPMorgan Chase
JPM-SDNY-00061239
EFTA01581803
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