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efta-efta01364063DOJ Data Set 10CorrespondenceEFTA Document EFTA01364063
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Form Ill/-9
(Rev. December 2014)
0opatment of Me Treasury
Internal flevenqa Sante
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Print or type
See Specific Instructions on page 2.
1 Name (as shown on your income tax return). Name is requited on this no. Co not lone this line blank.
The 2017 Caterpillar Trust
2 Business nannies's...gonad entity name. if different from above
3 Check appropriate box for federal tax classification: Check only one of the Wowing seven boxes:
O inowidualisole proprietor or
O
C Corporation
O S Corporation O
F-artrorsho
single-member LLC
•
Limited liability company. Enter the lax censfication (C•C corporation, S•S corporation, Npennership)
Note. For a single-member LLC that is disregarded. do not check LLC: check the eopropiate box In
the tax classification of Met single-member owner.
O Other (see MsfrUCtiOne) I.
Q Trust/estate
e
4 Exemptions
certain entities,
instructions
Exempt payee
Exemption
code (if any)
Ames barroH•nei.$aracente
(codes AP* Only lo
not individuals: see
on page 3):
code (if any)
from FATCA reporting
Me line above for
es U9J
6 Address (number, street. and apt. or win no.)
6100 Red Hook Quarter B3,
Requester's name and address (optional)
6 City. stale. and ZIP code
St Thomas 0 .08002
7 List account numbers) hero (optional,
Part I
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However. Ice 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 (ON). If you do not have a number, see How to get a
TIN on page 3.
Note. If the account is in more than one name, see the instructions for line I and the chart on page 4 for
guidefineS on whose number to enter.
Part II
Social security number
or
Employer Identification number
Certification
Under penalties of perjury. I certify that:
1. The number 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 to backup withholding 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 all 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): and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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 all interest and dividends on your tax retum. 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 are not required to sign the certification, but you must provide your correct TIN. See the
instructions on page 3.
Sign
Here
Signature of
0
U.B. person e
Date e•(,15)
.
General Instructions
Section references are to the internal Revenue 0000 unless °Macrae° noted.
Future developments. infoimation about oevelcoments affecting Form W-9 (such
as legato' ion enacted after we release i0 a at mnvirsgovita9.
Purpose of Form
An IndiVidUal Or entity (Form W-9 requester) who is required to file an information
return wish Ms IRS must obtan your correct taxpayer loam:cabal number (TIN)
which may Ws your social cocunty number ISSN). individual taxpayer Identification
number (MN), adoption taxpayer identification rants WIN). or employer
identdication number (EN), to report on an Internal:an return the amount paid to
you. or other amount reportable on an Information rattan. Examples of information
returns Include. but am not Smiled to, the following:
• Form 10994NT (interest earned or Paid)
• Rem 1089-DIV (dividends, Including Mate from stocks or motto! Raids)
• Fenn 1099-MISC (various types of Income. pram awards. a gross proceeds)
• Form 109943 (stock or mutual fund sales and certah other transactions by
broken)
• Form 1099-S (Proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transaction)
• Form 1098 (home mortgage interest). 1098-E (student loan interest), 1098-T
(tuition)
• Form 10'39-C (canceled dint)
• Form 1098-A (acquisition or abandonment of secured property)
Use Fawn W-9 only if you are a U.S. person (including a resident alien), to
monde your correct TIN.
11 you do not return Form VI-9 to me requester with a TIN, yOu might be sulqIect
to backup wiethcadihg. See Mat AS backup wehttalcang700 page 2.
By signing the elle4-001 form. you:
1. Certify that the TIN you are giving is correct (or you are waiting tor a number
to be issued),
2. Candy that you are not subject to backup withholding. or
3. Claim exemption from backup withholding if you ere a U.S. exempt payee. If
applicable, you are also Gelding that es • U.S. Parsee. your allocates snare 01
any partnership income from a U.S. trade or business is not subject to the
withholdirg tax on foreign partners' snare of effectively connected roomer. and
4. Certify that FATCA code(a) entered on this form (4 any) Indicating that you arc
exempt from the FATCA reporting. a correct. See What Is FATCA tenoning? on
page 2 for further information.
Cat No. 10291X
Form W9 Rev. 12.2014)
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
DB-SDNY-0054565
CONFIDENTIAL
SDNY_GM_00200749
EFTA01364063
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