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Form Re nest far'Tax a er ;v tern to the .
<br /> �! Pte._.... .. . . ... .
<br /> (Rev: 002}
<br /> `� tdent ficatfcrn Dumber as i G"ertI Teation r Qu
<br /> Depa,>?tnent of the Treasury ....,
<br /> Internal itev2nue Service Send t0 t11G Ill :
<br /> -Business name,if different above
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<br /> Ta Individual/ / G -,^�4� E�tempf Frorn liacifup
<br /> Check_appropriate box: ❑•Sole proprietor Corporation 0 Partnership L_t Other 1► _L __ ___C-._a_.. 0 withholding
<br /> bei,'' t;and a't,dtsuiie ' _ -__...�. :..:_ -. ... - -- -• - -
<br /> Add - ((hixi�J p Requester's name;;d address-
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<br /> City" i ;and IP cod
<br /> N t /1
<br /> [».
<br /> List account number(s)here•(optional)
<br /> Cox:a er:[ eritiIFitatiott Number:{Tt(11)
<br /> Enter your.TIN in the appropriate box. For individuals,this is'your socials muritynumber(SSN); So'craPsecurity'nUmber
<br /> Hovrrever,fol a resident alien,sole proprietor,or disregarded-entity,see the..Part t itistructior?s or
<br /> page-2,-For other entities,it is yout"employer identification number(EIN).If you do-nothave a riumtier,' ��'
<br /> see How to'get a,TW orr page 2.- or it
<br /> Note:•If-the account is in more than one name,see the chart an page 2 far guidelines on whale number [Employer identification number
<br /> to enter.
<br /> ZL
<br /> • - Certification
<br /> Under penaltles'of perjury, I certify that:
<br /> 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
<br /> 2. 1 am not subject to backup withholding because:(a)1 am exempt from backup withholding,or(b)i-have not been notified by the Internal
<br /> Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report aft interest or dividends,or(c)the IRS has
<br /> notified me that i am no longer'subject to backup withholding, and
<br /> 3. 1 am a U.S.person(including.a U.S, resident alien).
<br /> Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
<br /> withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions, item 2 does not apply.
<br /> For mortgage Interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an Individual retirement
<br /> arrangement(IRA),and generally, payments other than interest and dividends,you are not required to sign the Certification, but you must
<br /> provide your correct TIN.(See the-instructions on page 2.)
<br /> Sigh Signature
<br /> Here U.S.pers Date 0- ��Y v
<br /> Purpose of Form What is backup withholding?Persons making 5.You do not certify to the requester that you
<br /> certain payments to you must under certain are not subject to backup withholding under 4
<br /> A person who is required to file an Information conditions withhold and pay to the IRS 30%of above(for reportable interest-and dividend
<br /> return with the IRS must get your correct such payments after December 31,2001 (29% accounts opened after 1983 only). --
<br /> taxpayer identification number(TIN),to report,for after December 31,2003).This is called"backup Certain payees and payments are exempt
<br /> transactions,mortaide merest you aid, withholdirig.• Payments that may be subject to from backup withholding.See the instructions on
<br /> mortgage Y p backup withholding include:interest dividends, page 2 and*the separate Instructions for the
<br /> acquisition or abandonment of secured property, broker and barter exchange transactions,rents. Requester of Form W-9.
<br /> cancellation of debt,or contributions you made royalties,nonempioyee pay,acid certain , q
<br /> to an IRA. payments from fishing boat operators.Real Penalties
<br /> Use Form W-9 only if you are a U.S.persoh estate transactions are not subject to backup
<br /> (Including a•resident alien);to give your correct withholding. Failure to fuinish TIN.If you fall to furnish your -
<br /> TIN to the person requesting it(the requester) Yau will nat be subject to backu withhaldin correct TIN to a requester,you are subject to a
<br /> and,when applicable,to: on payments you receive if you give the g Penalty of$SO for each such failure Mess your
<br /> failure is due to reasonable cause and of to
<br /> 1.Certify the TIN you are giving Is correct(or requester your correct TIN,make the proper willful neglect
<br /> you are waiting for a number to be issued), certifications,and report all your taxable interest
<br /> and dividends on your tax return. Civil'penatty for false information with respect
<br /> 2. Certify you are not subject to backup to withholding.If you make a false"statement
<br /> Withholding,or Payments you receive will be subject to with no reasonable basis that results in no
<br /> 3.Claim exemption from backup withholding if backup withholding iE backup withholding,you are subject to a$Soo
<br /> you are a U.S.exempt payee. 1.You do not€urnish your TIN to the penalty.
<br /> if you are a foreign person,use the requester,or Criminal penalty for falsifying information:.
<br /> appropriate Form W-8.See Pub.515,- 2.You do not certify your TIN when required Milifully falsifying certifications or affirmations
<br /> Mthholding of Tart.on Nonresident Aliens and (see the Part If-instructions on page 2 for may subject you to criminal penalties including
<br /> Foreign Entities. . . details),or fines and/or imprisonment.
<br /> Note:if a requester gibes you a form other than 3.The IRS tells-the requester that you Mtsuse of TINS.-4f the requester discloses or
<br /> Form.W-3 to regraesf.your TIN,you must-use the furnished an iticoirect TIN,or •,. uses TINS.in violation of Federal law,the
<br /> requester's fonn if i2 is substantially similar to this 4.The' it Veils oil that ou'are subject to requester may be subject to civil astd criminal
<br /> Y. Y. j penalties.-
<br /> Form 1N--9, backup•withhotdjhj tieca'U"s)?you,dick.no'treport
<br /> all your interest and;dividends i?f►your.tax;reiurn
<br /> .
<br /> (for reportable interest and.dividends oniy),or
<br /> Cat No.10231X ..,. ..r;, ".: Form W iA' (Rev.i_2hn?i
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