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Form W-9(Rev.1-2011) Page 3
<br /> Other entities.Enter your business name as shown on required federal Part I:Taxpayer Identification Number(TIN)
<br /> tax documents on the"Name"line.This name should match the name Enter your TIN in the appropriate box.If you are a resident alien and
<br /> shown on the charter or other legal document creating the entity.You
<br /> may enter any business,trade,or DBA name on the"Business name/ you do not have and are not eligible to get an SSN,your TIN is your IRS
<br /> disregarded entity name"line. individual taxpayer identification number(ITIN).Enter it in the social
<br /> security number box.If you do not have an ITIN,see How to get a TIN
<br /> Exempt Payee below.
<br /> If you are exempt from backup withholding,enter your name as If you are a sole proprietor and you have an EIN,you may enter either
<br /> described above and check the appropriate box for your status,then your SSN or EIN.However,the IRS prefers that you use your SSN.
<br /> check the"Exempt payee"box in the line following the"Business name/ If you are a single-member LLC that is disregarded as an entity
<br /> disregarded entity name,"sign and date the form. separate from its owner(see Limited Liability Company(LLC)on page 2),
<br /> Generally,individuals(including sole proprietors)are not exempt from enter the owner's SSN(or EIN,if the owner has one).Do not enter the
<br /> backup withholding.Corporations are exempt from backup withholding disregarded entity's EIN.If the LLC is classified as a corporation or
<br /> for certain payments,such as interest and dividends. partnership,enter the entity's EIN.
<br /> Note.If you are exempt from backup withholding,you should still Note.See the chart on page 4 for further clarification of name and TIN
<br /> complete this form to avoid possible erroneous backup withholding. combinations.
<br /> The following payees are exempt from backup withholding: How to get a TIN.If you do not have a TIN,apply for one immediately.
<br /> To apply for an SSN,get Form SS-5,Application for a Social Security
<br /> 1.An organization exempt from tax under section 501(a),any IRA,or a Card,from your local Social Security Administration office or get this
<br /> custodial account under section 403(b)(7)if the account satisfies the form online at www.ssa.gov.You may also get this form by calling
<br /> requirements of section 401(f)(2), 1-800-772-1213.Use Form W-7,Application for IRS Individual Taxpayer
<br /> 2.The United States or any of its agencies or instrumentalities, Identification Number,to apply for an ITIN,or Form SS-4,Application for
<br /> 3.A state,the District of Columbia,a possession of the United States, Employer Identification Number,to apply for an EIN.You can apply for
<br /> or any of their political subdivisions or instrumentalities, an EIN online by accessing the IRS website at www.irs.gov/businesses
<br /> and clicking on Employer Identification Number(EIN)under Starting a
<br /> 4.A foreign government or any of its political subdivisions,agencies, Business.You can get Forms W-7 and SS-4 from the IRS by visiting
<br /> or instrumentalities,or IRS.gov or by calling 1-800-TAX-FORM(1-800-829-3676).
<br /> 5.An international organization or any of its agencies or If you are asked to complete Form W-9 but do not have a TIN,write
<br /> instrumentalities. "Applied For"in the space for the TIN,sign and date the form,and give
<br /> Other payees that may be exempt from backup withholding include: it to the requester.For interest and dividend payments,and certain
<br /> 6.A corporation, payments made with respect to readily tradable instruments,generally
<br /> you will have 60 days to get a TIN and give it to the requester before you
<br /> 7.A foreign central bank of issue, are subject to backup withholding on payments.The 60-day rule does
<br /> 8.A dealer in securities or commodities required to register in the not apply to other types of payments.You will be subject to backup
<br /> United States,the District of Columbia,or a possession of the United withholding on all such payments until you provide your TIN to the
<br /> States, requester.
<br /> 9.A futures commission merchant registered with the Commodity Note.Entering"Applied For"means that you have already applied for a
<br /> Futures Trading Commission, TIN or that you intend to apply for one soon.
<br /> 10.A real estate investment trust, Caution:A disregarded domestic entity that has a foreign owner must
<br /> 11.An entity registered at all times during the tax year under the use the appropriate Form W-8.
<br /> Investment Company Act of 1940, Part 11.Certification
<br /> 12.A common trust fund operated by a bank under section 584(a), To establish to the withholding agent that you are a U.S.person,or
<br /> 13.A financial institution, resident alien,sign Form W-9.You may be requested to sign by the
<br /> 14.A middleman known in the investment community as a nominee or withholding agent even if item 1,below,and items 4 and 5 on page 4
<br /> custodian,or indicate otherwise.
<br /> 15.A trust exempt from tax under section 664 or described in section For a joint account,only the person whose TIN is shown in Part 1
<br /> 4947. should sign(when required). In the case of a disregarded entity,the
<br /> The following chart shows types of payments that may be exempt person identified on the"Name"line must sign.Exempt payees,see
<br /> from backup withholding.The chart applies to the exempt payees listed Exempt Payee on page 3.
<br /> above,1 through 15. Signature requirements.Complete the certification as indicated in
<br /> items 1 through 3,below,and items 4 and 5 on page 4.
<br /> IF the payment is for... THEN the payment is exempt 1.Interest,dividend,and barter exchange accounts opened
<br /> for. before 1984 and broker accounts considered active during 1983.
<br /> Interest and dividend payments All exempt payees except You must give your correct TIN,but you do not have to sign the
<br /> certification.
<br /> for 9
<br /> 2.Interest,dividend,broker,and barter exchange accounts
<br /> Broker transactions Exempt payees 1 through 5 and 7 opened after 1983 and broker accounts considered inactive during
<br /> through 13.Also,C corporations. 1983.You must sign the certification or backup withholding will apply.If
<br /> Barter exchange transactions and Exempt payees 1 through 5 you are subject to backup withholding and you are merely providing
<br /> patronage dividends your correct TIN to the requester,you must cross out item 2 in the
<br /> certification before signing the form.
<br /> Payments over$600 required to be Generally,exempt payees 3.Real estate transactions.You must sign the certification.You may
<br /> reported and direct sales over 1 through 7 2 cross out item 2 of the certification.
<br /> $5,000'
<br /> 'See Form 1099-MISC,Miscellaneous Income,and its instructions.
<br /> P However,the following payments made to a corporation and reportable on Form
<br /> 1099-MISC are not exempt from backup withholding:medical and health care
<br /> payments,attorneys'fees,gross proceeds paid to an attorney,and payments for
<br /> services paid by a federal executive agency.
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