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efta-01583282DOJ Data Set 10OtherEFTA01583282
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DOJ Data Set 10
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efta-01583282
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Form W-9
IFtev. Decerster 201e
Depannwe or the T
Firrenu•S ruer!
Inane
vica
Request for Taxpayer
identification Number and Certification
Give Form to the
requester. Do net
send to the IRS.
tame iss shoe, en your Income tax tarn)
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Check epoteenne box for retest
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Id C Corporation
0 5 Corperedon
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Partners,* 0
Trust/estate
0 LOWSliebety company. Enter the tax ciasseication (C-C art:aeon S4 corocrsticn. naPumorshin) 8
Other (see instructions),
0 Exempt payee
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WS name ancl acidess (Cap nall
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taxpayer Identification Number (TIN)
•
Enter your TIN in the appropriate box. The TIN prodded root match the name given en the 'Name kne
Social security number
to avoid be:kuP Withhehing. For Individuals, this le your social security number (SSN) However. feta
resident seen. sole proprielct. Or disregarded entity. see the Part I instructions on page 3 For other
entities, It is your emPlOyer identification number OW If you do not have a number. see Now ro der a
"'—
-
-
TIN on page 3.
Note. If the account b in more than one name, see the chart on page 4 for gurderines on whose
number to enter.
I Envoys, ittentleartion number
Lelilll
Certification
Under penalties of perjury. I certify that:
I. The number shown on tNt form is my correct taxpayer identification number (Or I am walling forfora numbs to be issued to me). and
2. I am not subject to backup withholding because: (a) I am exempt from backup vnthholding. Or 0)1 have not been notified by the internal Revenue
Service ORS) that I ant subject to backup withhOlding as a result of a failure to report as Interest or ("Trident's. or (c) the IRS has nailed me that tam
no longer subject to backup withholding. and
3. I am a U.S. citizen or Other U.S. person (defined below).
Certification Instructions. You must
I item 2 above if you have been notified
because you have fated to report
dividends on your taA
interest paid. acquisition or aba
lid pr
generally. payments other era
instructions on page a.
Sign
Here
719 8 6
Signature of
U.S. persona
General Instructions
Section references are to the Internal Revenue Code fl oss Othenvlse
noted.
Purpose of Form
A posy. who Is required to fin an information return with the IRS must
obtain your correct taxpayer Identification number (TIN) to report. lor
example, Income paid to you, real estate transactions, mortgage Interest
you paid, acquisition or abandonment of secured property. cancellation
of debt or contributons you made to an IRA
Use Form W-9 only a you We 8 U.S. person (Including a resident
alien), to provide your correct TIN to the person requesting It (the
requester) and, when applitable. to:
1. Certify that the 11N you are giving Is coned (or you are waiting for a
number to bo issued).
2. Certify that you are not subject to backup withholding or
3. palm exemption from backup withhOlding If you are a U.S. exempt
payee. II applicable, you are also certifying that as a U.S. person. your
allocable share d any Partnersh0 Won.* from a U.S. trade or btninesS
is not subject to the withholding ax on foreign pinnate' share of
effecthey connected Income.
that you are currently subject to backup velbflaklina
estate transactions. item 2 does not apply. For mortgage
debt. contributions to an Individual retirement arrangement (IRA), and
certification, but you must provide your correct TIN. See the
Note. If a requester gives you a term other than Form W-9 to request
your TIN, you must use the requester's lam if it is substantially similar
to flit Form W-9.
Definition of e U.S. person. For federal tax purposes. you are
considered a U.S. person If you we:
• An individual who is a U.S. citizen or V.S. resident alien,
• A partnership. corporation. company, or association crested or
organized in the United Stales or under the laws of the United States.
• An estate (other than a foreign estate). or
• A domestic trust (as defined In Reputations section 301.7701.7).
Special rules for partnerships. Partnerships that conduct a trade or
business n the United States are perversity required to pay a withholding
lax on any foreign partners' share of income from such business.
Further. In certain cases wham a Form W-9 has nd been received. a
partnership * required to presume that a partner is a foreign person,
end pay the withholding tax. Therefore, if you ere a U.S. person that is a
partner in a partnership conducting a trade or business In the United
States, provide Form W-9 to the partnership to establish your U.S.
status and odd wifhtfoloIng on your shwa of partnership Income.
Cat. No. 10231%
Form W-9 (Rai. t2.2011)
Confidential Treatment Requested by JPMorgan Chase
JPM-SDNY-00062923
EFTA01583282
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