Case File
efta-efta00316380DOJ Data Set 9OtherAcceptance
Date
Unknown
Source
DOJ Data Set 9
Reference
efta-efta00316380
Pages
3
Persons
0
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Acceptance
You understand that this application is subject to acceptance by DBICA.
AuMoi 'red Sion:,
Authonted Sun°.
6; )
'et Name
Print Norm
Data
Dote
For Bank Use Only
Reviewed by:
Son,
Name
Title
Date
Accepted by DBTCA:
Sionettne
Name
Title
Date
Account numbers:
DDA
NOW
MIADA
COIDEIAG
W1.1147246 017524 002017
EFTA00316380
Form W-9
(Rev. December MO
Department of ere Timmy
Yuma Reverts Senioa
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Print or typo
See Specific htstnictions on page 2.
1 Name (as shown on you Income tax return). Name is Muted on this erne: do not leave 'haling blank
The 2017 Caterpillar Trust
2 Business narnWdisregarded entity name. if different from above
3 Check approputo box for federal tax classification: check only one of the toloonno seven boxes:
0
Individual/sole proprietor a
0
C Corporation
0
S Corporation
•
Partnershb
a
TrusVestate
single-membet LLC
0
Limited Mossy company. Enter the tax classification (C=C corporation, SeS atirporation-Pepartnership) i•
Note. For a save-member LLC that is disregarded, do not check u.C: check the appropriate box in the we above for
the tax clasercatica of the tingle-member owner.
ID Other (see Instructions),
4 Exemptions
certain entitles.
instructions
EXIMPI payee
Exemption
code lit My)
tome rererwerieemeee•enterre
(codes apptj only to
not inaividualS; see
on page 3)-
code Of arty)
from FATCA reporting
till
5 Address (number. street. and apt. a suite no.)
8100 Red Hook Quarter B3,
Requester's name nd address (ocreame
e City. state and ZIP code
St Thomas 0 ,08002
7 Ust account nurnborn/ here 0080W
Part I
Taxpayer Identification Number (TIN)
Enter your TIN In the appropriate box. The TIN provided must match the name given on fine 1 to avoid
backup withholding. For individuals. this is generally 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 your employer identification number (E1N). If you do not have a number, see How toper a
7W on page 3.
Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
Social security number
or
Employer Identification number
I
Part II
Certification
Under penalties of perjury. I certify that
1. The number shown on this tom is my correct taxpayer identification number (or I am waiting for a number to be issued to me): and
2. I am not subject to backup witItoltinE) because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report an interest or dividends. or (c) the IRS has notified me that I am
no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below): end
4. The FATCA code(s) entered on this form (d any) indicating that I am exempt from FATCA reporting is correct.
Certification Instructions. You must MOSS Out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report ail interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property. Cancellation of debt. contributions to an Individual retirement arrangement (IRA), and
generally. payments other than interest and dividends, you we not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 3.
Sign
Here
Bombes of
US. parson e
Dale ie6 .3t
General Instructions
Section references am to Ow Internal Revenue Code unless otherwise noted.
Future developments. Information about developments affecting Form W-9 (such
*sepia/Ilion enacted after we release 01 Is at wwwinvoillW9.
Purpose of Form
M Main:bat or entity (Form W-9 requester) wino Is required to foe an information
renew with the IRS mist obtain your correct taxpayer Identification number (IN)
which may be your social security number (SSN), individual taxpayer idontitr.ation
number (MN). adoption taxpayer krontilcation number (AIN), or employer
Identification number (EIN). to reporl on an information return the amount pad to
you. or other amount reportable on an information return. Examples of Woman:to
roams include. but are not limited to, tee following:
• Form 1099 INT (interest earned or pad)
• form 1099-ON (dividends. inclsding those from stocks or mutual funds)
• Form 1099-MISC (various types of income. prizes. awards, or gross proceeds)
• Form 1099.B (stock or mutual fund sales and certain other transactions by
brokers)
• Form I099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and theta party network transactions)
• Form 1096 (home mortgage inf crest). 1098-E (student loan Merest). 1096-T
(tuition)
• Form 1099-C (canceled MIN)
• Form 1099-A Moduisition or abandonment of secured Properly)
Use Form W-9 only if you are a U.S. person (Waning a radon alien), to
provide your correct TN.
Hsu do nor neon Fonn W-9 to the AVM* with a YIN, you might be Subject
to blow Mthhokting. See other a beelna 9-49Fylding? on M42.
By signing the Ned-Out form, you:
I. Certify that tne TIN you are giving is correct (or you are waking for a number
to be issueol.
2. Certify that you are not afibeCI to backup withhoickfl9.
3. Maim exemption Iran backup withholding A you are a US. exempt payee. If
appltable. you we also certifying that as a U.S. person. your allocable Share of
any Partnership Income irOM a U.S. trade a business is not subject to Me
withholding tax on foreign partners' share of effectively connected Income. and
4. Certify that FATCA code(s) entered on this form Of any) IncecatIng that you are
exempt from the FATCA reporting, is correct. See teemed FATCA reporting? on
page 2 for tunnel intorinatiOn
Cat. NO. 10231X
Form W-9 (Rev. 12-2014)
EFTA00316381
Deutsche Bank
Wealth Management
Signature Card
Deutsche Bank Trust Company Americas
The 2017 Caterpillar Trust
Account Holder Title
Individual
ITRPODIATP
Joint, with Rights
Joint, Tenants
0
of Survivorship
in Common
Si nature
S
,
• awr.
Signature
Print Name
Signature
Print Name
Approved
Date
Power of Attorney
Specimen Signattue
For I/POD/ATP Sir Suppl
>e t it bins and COndiliOnS
111111111111111111111111111111111111111
Account Number
Corporate
Limited Liability
Number of Signatures
Corporation
Requited: 1
Partnership
J Other trust
Daphne Wallace
Pont Name
Lesley Groff
Pant Name
Date of Power of Attorney
WM178934 006678 062817
EFTA00316382
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referencesRelated Documents (6)
DOJ Data Set 11OtherUnknown
EFTA02259931
1p
DOJ Data Set 10CorrespondenceUnknown
EFTA Document EFTA01809186
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DOJ Data Set 10OtherUnknown
EFTA01808252
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DOJ Data Set 9OtherUnknown
From: Lesley Groff
3p
DOJ Data Set 9OtherUnknown
From: Lesley Groff
5p
DOJ Data Set 10CorrespondenceUnknown
EFTA Document EFTA01808779
0p
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