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efta-efta01255060DOJ Data Set 9Other

Form W..9

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DOJ Data Set 9
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EFTA Disclosure
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Form W..9 Res Droner 2011/ Depathers dile away Interred RevenuethWice Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. el I g il 0 15 i IS o I Nemeth' tax Man) I II- naridiftwers from abode AJ 5 (ti k sppoprine al naviduarsosproprietor 0 threw Natty 0 Cow ewe kienctioneS box for Windt= clessilkation: s Ennwt P•ets 0 CC orporation 0 S Corporation II PritrenNp III Inattestrus company. Enter re tax danklartion (GC corporetion. ss ccimonekn. Pasertnennth Ackeen sernbe, it.. Itequever's nen. encl balms SorelanIS ram. a suitenee • 6/ 00 —.Pin No* arttikr / 8? at% sale5reir cub in L$vl OS the sward herelopikinell P irt I Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box The TIN provided must match the name given on the 'Name Sine I tiodei to avod backup withholding. For individuate this Is your social security number (SSN). However, for • resident Wien, sob proprietor, or disregarded entity, wee the Pat I Instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get • TIN on page 3. Note. M the account Is in more than one name, see the chart on page 4 for ging:fame on whom* number to enter. meter 1/Y Employ« iderieficalten resew Part II Certification Under penalties of perjury, I certify that 1. The number shown on this form is my correct taxpayer Identification number (orient waiting for a number to be Issued to me), and 2. lam not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (RS) that I wn subject to backup withholding se a result of • Mune to report WI Interest or dividends. or (o) the RS has notified me that Ian no longer subject to backup withholding, and 3. I ern • U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out hem 2 above t you have been notified by the IRS that you we currently subject to bedew withholding because you have failed to report WI Interest endollvidends on your tax Mum. For real estate tramadlons, item 2 does not apply. For mortgage Interest paid, acquisition or abandatrilent of sawed property. cancrilation of debt, contributions to an Individual retirerreel anancement (RA), and generally, paymente other than/ Inferest and dMdende, you are not r u air the e:edification but you must provide your comet TIN. See the instruction on page 4. / Sign flumstur• Hire ca.paten Setae (04. 7 / General Instructions Note. If • requester gives you a form than orm W-9 to request Section references are to the Internal Revenue Cade unless otherwise noted. Purpose of Form A person who is required to Fite an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, Income paid to you, reel estate transactions. mortgage :stereot you paid, acquisition or abandonment of secured property, cancellation of debt, or cOntributions you made to an IRA Use Form W-9 only if you are a U.S. Ninon (including a resident ellen). to promos your coned TIN to the person requesting it (the requested and, when applicable, to 1. Certify that the TIN you are caving 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 t you we • U.S. exempt payee ff applcable, you are also certifying that as • U.S. person, your allocable share of any partnership Income from a U.S. trade or business is not subject to the withholding tax on foreign partners' shire of effectively connected hon. your TIN, you must use the nequestior's form lilt is eubstantiatiy similar to this Form W.9. Definition of • U.S. person. For federal tax purposes, you ere conedered • U.S. person If you etc • An individual who is • U.S. citizen or U.S. resident then, • A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States. • An estate (other than • foreign estate), or • A domestic trust (ee defined in Regulations section 301.7701.7). Special flies for perthereNps. Partnerships thst conduct • trade or business WI the United States are generally required to pay • vellhholdlng tax on any foreign partners' share of Income from such butinese. Further, In certain cases where a Form W-9 the not been received, a partnership is required to presume that a partner Is • 1 oreign person, and pay the withholding W. Therefore, If you are a U.S. person that Is • psdner in • partnership conducting a (rode or business h the United Suites, provide Form W-9 to the partnership to establish your U.S. status and avoid wahhoiding on your share of partnership income. Cet No. 10231X Fern W-9 (Rev. 12-2011) SDNY_GM_00053762 CONFIDENTIAL — PURSUANT TO FED R.QP .NE I DENTIAL DB-SDNY-0016586 EFTA_00164334 EFTA01255060

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