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Form.W-.9.' Request for'T:axpayer Give form to the .
<br /> (Rev:January-2002) : .: -,.._._._._.._..r.�,-.:-._._t .r�QUteC:.DQ iio't
<br /> Identification Number dfid.C"e'rtification
<br /> Department of.the Treasury ....• ;
<br /> -send to the IRS:
<br /> Intemal Revenue Service
<br /> ni Name - -
<br /> Q Business name,if different m above '
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<br /> Q-o ' Individual/ :_ ( / Ez'e'm f frorn tiacku
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<br /> Check appropriate box: ❑ Sofe proprietor 11 Corporation 0 PartneFShip Other> L�G ______ ___ withholding
<br /> 3
<br /> N Add r" :(nugibe?;: f'and api.dtstiite ..j "' ` - Requester's name and address•(opUonal)
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<br /> City,'s t ;and IP cod
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<br /> Ust account number(s)here.(optional)
<br /> _T6k a ,6rJ elitifie6fion Numbw:61% _-
<br /> Enter your TIN in the appropriate box.For individuals,this is your social security_number(SSN). Social-se,curitty'number
<br /> Howeydr,for a resident alien, sole proprigtor,or.disregarded"entity,see the:.Part 1 instructions an
<br /> page-2.f-or other endties;it is your."•employer identification number(EIN). If you do-not'have a number,'
<br /> See How to get a;TIN on•page 2.• or
<br /> Note:If-the account is in more than one name,see the chart on page 2 for guidelines on whose number Employer identification number
<br /> to enter.J' .,
<br /> •M. I ' Certification
<br /> Under penalties'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 all 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 /> Sign - TSi gnature of
<br /> Here U.S.person r Date ► — 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 /> example,income paid to you,real�estateport for after old rig,December
<br /> Payments that may be Is led subject to Certain payees and pa.S payments are exempt
<br /> transactions,mortgage interest you paid, backup withholding include:interest,dividends, from backup withholding.See the instructions on
<br /> acquisition or abandonment of secured property, broker and barter exchange transactions,rents, page 2 and*the separate Instructions for the
<br /> cancellation of debt,or contributions.you made royalties,nonempfoyee pay,and certain Requester of Form W-9.
<br /> to an IRA. payments from fishing boat operators.Real
<br /> Use Form W-9 only if you are a U.S'.person estate transactions are not subject to backup PenaEtlt3S
<br /> (including a.resident alien);to give your correct withholding. Failure to furnish TIN.If you fail to-furnish your
<br /> TIN to the person requesting it(the requester) You will not be subject to backup withholding correct TIN to a requester,you are subject to a
<br /> and,when applicable,to: on payments you receive if you give the penalty of$50 for each such%lure uss your
<br /> 1.Certify the TIN you are giving is correct(or requester your correct TIN,make the proper failure is due to reasonable cause and of to
<br /> you are waiting for a number to be issued), certifications,and report all your taxable interest willful neglect
<br /> 2. Certify you are not subject to backup and dividends on your tax return. Civi'penalty for false information with eespect
<br /> Withholding,or Payments you receive will be subject to to withholding.If you make a false'statement
<br /> backup withholding if: with no reasonable basis that results in no
<br /> 3.Claim exemption from backup withholding if backup withholding,you are subject to a$500
<br /> you are a U.S.exempt payee. 1.You do not furnish your TIN to the penalty.
<br /> If you are a foreign person,use the requester,or Criminal penalty for falsifying Y g P P Y fy' g information:.
<br /> appropriate Form W 78.See Pub.513, 2.You do not certify your TIN when required Willfully falsifying certifications or affirmations
<br /> Withholding of Tax.on Nonresident Aliens and (see the Part li-instructions on page 2.for may subject you to criminal penalties including
<br /> Forefgq.Entities. details),or fines and/or imprisonment
<br /> Note: If a requester gives you a form other than 3.The IRS tells-the requester that you Misuse of TINS._If the requester discloses or
<br /> Form.W--9 to request.your.T/N,you must,use the furnished an incorrect TIN,or - uses TINS.in violation of Federal law,the
<br /> requester's form if it is substantially similar to this 4.The IRS fells you that you are subject to requester may b'e'sitbject to civil and criminal
<br /> enalties-
<br /> Form W-9. backtip'withholding because ygu,did.not report P "
<br /> all your interest ah'd:dividehc s'qp your fax;retrrrn
<br /> (for reportable lfiI46st and 64{4nds oniy),.or
<br /> Cat No.10231X,.. . ; •• Form-w=9'(Rev.t-2rin�1 r
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