Account statement (EFTA01456743)

Form W (Rev. August 2013) Department of Ina Treasury Internal Revenue Service -9 Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. c•i Name las shown o your ncome tax return) Business name/disregarded entity name. it different from above Check appropriate box for federal tax clasmfcation: 0 Inds/dual/sole proprietor 0 C Corporation 0 S Corporation 0 Partnership 0 Trust/estate O Limited liability company. Enter