Form W-9

Form W-9 (Rev. August 2013) Department of the NEW" Internal Revenue Service 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. Name (as shown on your income tax return) (nii,stnine Ma xotte IA Business nemedistegerded *May name, if different from above Clie9 appropriate es, individuaVsc4e El Ur iced liability ID Other (see instructions) box for faders tax classification Trust/estate a Exemptions Exempt payee Exemption code (if any) (see instructions): code IA any) proprietor 0 C Corporation 0 s Corporation Ill Partnership • company. Enter the lax classification (CC COMOralco. $4 corporation. Pvparinership) ei. from FATCA reporting Address (number. street, and apt. sr sues no.) Ott, a 105 4r" C'- eat Requesters name and address (optional) Cary. stela and ZIP code New \tort t\i`k tcooc List account numbed*) thre4OPOOnfil Part I Taxpayer Identification Number (TIN) 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 MIN). If you do not nave a number. See How to get TIN on page 3. Note. If the account is Si more than one name. see the chart on page 4 for guidelines on whose number to enter. Social security number Employer Identificationnut Part II Certification Under penalties of penury. 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 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 (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 struclions on page 3. 1 Signature of U.S. persona X General Instructions Section references are to the internal Revenue Code unless otherwise noted. Future developments. The IRS has created a page on IRS6ov for information abet! Form W-9, at wwwmagotqw9. Information about any future developments affecting Form W-9 (such as legislation enacted after we release 4) will be posted on that Page Purpose of Form A person who is required to file an ratormation return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example. income paid to you, payments made to you in settlement of payment crud and third party network transactions. real estate transactions. mortgage interest you paid. aCquisnion or abandonment of sawed property. cancellation of debt. Or contributions you made to an IRA. Us* Form W.9 only if you area 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 wailing for a number to be issued). 2. Certify that you are not subject to backup mon:Ming. or 3. Ii3film 1x0 MInthoP witni i. if you we a U.S. sienna payee. It applizale. you iase zertif,ing that as a U.S. person. you allocable share of any Partnership Income from a V.S. trade of business is not subject to the Date st x withholding tax on Weir partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this rain (rf any) indicating that you are exempt from the FATCA reporting. is correct. Note. If you are a U.S. person and a requester gwes you a form other than Form W.9 to request your TIN, you must use the requesters form if it is substantially similar to the Form W-9. Definition of s U.S. Person. For federal tax purposes. you are considered a U.S. person if you are: • An radividual who is a U.S. citizen or US. resident alien. • A PetnefshiP.C.OrpOranan. Company. or association created of organized in the United States or under the laws of the Deed States. • An estate (other Than a foreign estate). or • A domestic trust las defined en Regulations section 301.7701.7). Vadat rules for partnerships. Partnerships that conduct a trade or business in the united States we genera/1y required to pay a withholding tax under section 1446 on any foreign partners' share 01 effectively connected taxable income from such business. Further. in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a tater person. and pay the section 1446 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 Farm W-9 to the partnership to establish your U.S. status and avoid section 1446 wain: Wing on your share of partnership income Cat. No. 10231X Form W-9 (Rev. 13-2013) CONFIDENTIAL UBSTERRAMAR00000443 EFTA00236149