Text extracted via OCR from the original document. May contain errors from the scanning process.
Form W-9
(Rev. December 2019
Department N the Treasury
Internal Preemie Service
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Do not
send to the IRS.
Print or typo
See Specific Instructions on page 2.
Name (act Moen on your Income tax retten)
Southern Trust Company, Inc
Suertros IVITe/disrogated entity name, rt deferent from above
Check appropriate box for federal tax classification:
0 Inclivkluatrsole proprietor
El C Corporation
0 S Corporation
UPannershin li Trust/estate
O Limited liabety company. Enter the tax clandration (C.0 corporahon. STS corporation. Proartnoship) ii.
__--_
0
Other pee ., cart;.: tient)*
LI Exempt payee
Address (number, street. and apt. or suite no .l
6100 Red Hook Quarter 83
I Requesen an and attest (000300
City, stark and ZIP code
St MOMS% USVI 00602
I
List eocount nurrayertp here (optorsaft
lall
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The T1N 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 Pal I instructions on page 3. For other
entitles, It Is your employer identification number (Elfig. If you do not have a number, see How to gel a
TIN on page 3.
Not*. If the account is in more than one name. see the chart on page 4 for guidelines on whose
number to enter.
Social ~way camber
Employer laintieciaion number
Iran
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, a (b) I have not been notified by the Internal Revenue
Service ORS) 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 8a Interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonmentOaecured property, cancellation of debt. contributions to an individual retirement arrangement ORA), and
generally, payments other than interest aid d? ?ends, you are not re )&ettfe sign the certification, but you must provide your correct11N. See the
instructions on page 4.
Sign
I Signature&
Here
u.s. person►
General Instructiods
Section references are to the Internal Revenue
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 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 are giving is correct (Or you are waiting for a
number lo be Issued),
2. Certify that you are not subject to backup withholding. Of
3. Claim exemption from backup withhacfing if you are a US. exempt
payee. If applicable, you are also certifying that as a U.S. person, your
&Kaaba share of any partnership income from a V.S. trade or business
Is not tabled to the withholding tax on foreign partners' share of
effectively connected income.
<2'
Note. If a requester gives you a form other than Form W-9 to request
Your TIN, you must use the requester's form if It Is substantially similar
Ise
to this ECNTI1 W-9.
Definition of a U.S. person. For federal tax purposes. you are
considered a U.S. person if you at
• M Individual who is a U.S. citizen or V.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), a
• A domestic trust (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.
Cal. No. 10231X
Form W-9 gait 12-2019
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
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