EFTA Document EFTA01402616

W-9 Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Form (Rev. December 2011) Departmert o( the Treasury Intemal Revenue Service Name (as shown on your Income lax return) Business nama/disrerfarded entity name, if difforent from above e\i Check appropriate box for federal tax classification: y' K Individual/sole proprietor K C Corporation Q^Ctwporation 8 D Partnershp Q Tnist/estate 11 n Exempt payee K Limited liability company. Biter the tax classification (C=C corporation, S=S corporation, P=partnershp) >• 8 r—1 other (see Instnjctiors) Requester's name and address (optional) Address City, state, and ZIP code mST (Wt COlio-»^ List account number(s) here (optionaD Taxpayer Identification Number (TIN) Part I Social security number Enter your TIN in the appropriate box. The TIN provided must match the name 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 entities, it is your employer identification number (EIN). 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 chart on page 4 for guidelines on whose number to enter. EFTA01402616 Employer Idsntificatioo manbar - o7 J Certification Part II 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 b^K:kup wKhholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Senrice (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). 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 Interert.and dividends on your tax return. For real e^te transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonmenfdf secured'oropwty, cancellation of dejjVocSntributtons to an individual retirement arrangement (IRA), and generally, payments other than Int^est and dividends) you are not requl- rod4qrgigMhe certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. parson >is Datse- ^^.^'^ote. If a requestor gives you a form other than Fonri W-9 to request your TIN, 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 are; • An individual who is 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 tmst (as defined in Regulations section 301.7701-7). 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 are a U.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 income. General Instructions Section references are to the Internal Revenue Code unless otherwise noted. EFTA01402617 Purpose of Form A person who is required to tile 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 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 oomect TIN to the person requesting it (the requester) and, when applicable, 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 are a U.S. exempt payee, if applicable, you are also certifying that as a 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' share of effectively connected income. Form W-9 (Rev. 12-2011) Cat No. 10231X EFTA01402618