Form W-9

Form W-9 (Rev. Docembe 2011) Department of the Treaaury Intim& Re ante Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. • or I S yy b :I I Nerneles'sham on your Income Po; return) ,,, k Ar_Y N A _)114/ Ir 44, nerne/ Duelries diamond's; entity name. V diagram lice, above __A,/ fl ak eltrapriste box for federal tax ct ..2444re• , ' gindhiqueyeas proprietor O C Corporation O $ Corporation O Partnership O Twat/estate O Limited sabety company Enter the tax clinstficabon (C-C corporation. Sea Carporatkm. P•parbliflhiP)0' !O O Other (sa0 rstructons) le Exempt price CRY. Requesters name and address (coon.) Mr "- Loa Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the nary. given on the Name' line 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 entitles. it Is your employer identification number (EIN). If you do not have a number, see How to get a 77N on page 3. Note. If the account is In more than one name, see the chart on page 4 for guidelines on whose number to enter. SOCkil security number 1 - I &Delayer klentilleation number Part II Certification HT Under penalties of perjury, I certify tnat: 1. The minter shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me). and 2. I am not subject t0 backup withholding because: (a) I am exempt from backup withholding, or (b) I have riot been notified by the Internal Revenue Service (IRS) that I em subject to backup withholding as a result of a talkie to report as 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). Certification Instructions. You must cross 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 as 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 ORA), and generally, payments other than int and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Mgrieler• el U3. person,. General Instructions Section references we to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return 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 ol secured property. cancellation of debt or contributions you made to an IRA. Use Form W-9 only If you are a U.S. Parsee (lnaluilin9 a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when appficable. 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 ate a U.S. exempt payee if appicable, you are also certifying that as a U.S. person, your aliocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income. Oats P. /2 1 / 2 4C1/- Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requesters form if it is substantially smiler to this Form W-9. Definition or • U.S. person. For federal tax purposes, you are considered a U.S. person If you we: • An incrividual whoa b a U.S. citizen or U.S. resident alien. • 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 a foreign estate), or • A domestic Vint (as defined in Regulations section 301.77014). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners' share of Income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person. and pay the withholding tax. Therefore, If you ore a U.S. parson 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 avoid withholding on your share of partnersNp income. Cat No. 10201X Form W-9 (lev. 12.20't1) SDNY_Glil_00061772 CONFIDENTIAL - PURSUANT TO FED. R.Q0 .NEIDENTIAL DB-SDNY-0024597 EFTA_00172284 EFTA01255463