EFTA Document EFTA01299114

Form W-9 fi r. December 2011) Dapersaant dthe Treeary Hetet Revenue Sevier Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not tend to the IRS. a i I I mir anber .0O i fiersofralialenwsoyousnrwiscorrte tax ratime . NC vile, 1-1-t Businen ' witty new, if ditlwora firm Nee. Check oppropriate boa for federal tax deestycaticw r,rccnsor 0 C Corperation 0 ourpony. Enter the to ciaasiratation (GC 9. Fajahi7:219 vela 0 Exempt payee • wayeastisa. s Corporation 0 Owtnarstib II Inetrastat• EK.ImIted lability Moth" pie intaxsonq corporation. S.S careratirn. larlatrawrilia ervn *ettitr if )1D) Ot-nr- 5 3 Recureure name and orates (apiarist City, al;e..ird Zia etnit i Li 1 V/ 0 °S°2---- the accouit martens) hers Rani Ian Taxpayer Identification Number (TiN) Enter your TIN In the appropriate box. The TIN provided must match the Darns °hen on the 'Name' line to avoid backup with /yoking For individuals, this is your social now* number (SSN). However, for a resident alien, *ode proprietor. or dieregarded entity. see the Pal I instructions on page 3. For other entities, it is your employer Identification number (EIN). II you do not have a number. see How to pet a 11N on pope 3. Note. If the account is in rnore than one name, see the chart on page 4 for guideinee on whose number to enter. Social wordy mentor I Employer tdereificathan °weber L Part II Certification Under penalties or perjury, I certify that: 1. The number shown on this form a my correct taxpayer identification number (or I am waning for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, a (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a Mute to report all interest or dividends, or (c) the IRS has notified me Matt 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 it 2 above if you have been notified by the IRS that you we currently subject to backup withholding because you have felled to report el interest and di rends on your tax m. For real estate transactions, item 2 does not apply. For mortgage 114 interest paid. acquisition or abandonment of secur property, of debt. contributions to an Individual refinement anangement (IRA), and generally, payments other thaninterest and dividends, not required to Nqn the certification, but you must provide your correct TIN. See the instructions on page 4. / Sign o ilmen of 1.1920 U.S. personI; Dan Vaiii General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to fa an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, Income Field 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. 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 we giving is correct (or you are waiting for a number to be Issued). 2. Certify that you am not subject to backup withholding. or 3. Claim exemption from backup withholding If you are a U.S. exempt payee. If applicable. you are also certifying that as a U.S. person, your allocable share of any partnership boom* from a U.S. trade or business is not subject to the withholding tax on foreign partnere' share of effectively connected income. Note. If a requester gives you a form other than Form W-9 to request your TN, you must use the requester's form If it Is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you as • An individual who lea U.S. citizen or U.S. resident alien, • A partnership, corporation, company, or association created or organized In the United States or under the awe of the United Slate., • An estate (other than a foreign estate), or • A domestic trust (as defined in Regulations action 301.7701-7). Special rules for partnerslips. Partnerships that conduct a trade or business in the United Static 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 bean received. a partnership is required to presume that a partner is a foreign pinion and pay the withholding tax. Therefore, if you are a V.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 avoid withholding on your share of partnership incans Cat No 10231X Form W-9 (Rev. 12.2011) SD NY_GI,l_00064811 CONFIDENTIAL - PURSUANT TO FED_ R.QP AKE IDENTIAL DB-SDNY-0027636 EFTA_00175314 EFTA01299114