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<br /> Request for Taxpayer Give Form to the
<br /> Form W 9
<br /> (Rev.October 2018) Identification Number and Certification requester.Do not
<br /> Department of the Treasury send to the IRS.
<br /> Internal Revenue Service Op-Go to www.irs.gov/FormW9 for instructions and the latest information.
<br /> a
<br /> 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank,
<br /> 2 Business name/disregarded entity name,if different from above
<br /> m 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions codes apply only to
<br /> � p Y P ( PP Y Y
<br /> following seven boxes. certain entities,not individuals;see
<br /> Ca
<br /> CL instructions on page 3):
<br /> o ElIndividual/sole proprietor or ElC Corporation ElS Corporation ElPartnership ❑ Trust/estate
<br /> M single-member LLC Exempt payee code(if any)
<br /> ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)t►
<br /> o Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
<br /> N LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is code if an
<br /> a another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that ( Y)
<br /> is disregarded from the owner should check the appropriate box for the tax classification of its owner.
<br /> y E] Other(see instructions)10- (Applies to accounts mafntalned outside the U.S)
<br /> CL 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional)
<br /> M
<br /> a�
<br /> M
<br /> 6 City,state,and ZIP code
<br /> 7 List account number(s)here(optional)
<br /> 0:MIN Taxpayer Identification Number(TIN)
<br /> Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid social security number
<br /> backup withholding.For individuals,this is generally your social security number(SSN).However,for a
<br /> resident alien,sole proprietor,or disregarded entity,see the instructions for Part 1,later.For other —m _
<br /> entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
<br /> TIN, later. or
<br /> Note: If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number
<br /> Number To Give the Requester for guidelines on whose number to enter.
<br /> 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)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue
<br /> 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
<br /> no longer subject to backup withholding;and
<br /> 3.1 am a U.S.citizen or other U.S.person(defined below);and
<br /> 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
<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 withholding because
<br /> 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,
<br /> acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments
<br /> other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions for Part II,later.
<br /> Sign Signature of
<br /> Here U.S.person► Date 0-
<br /> •Form 1099-DIV(dividends,including those from stocks or mutual
<br /> General Instructions
<br /> funds)
<br /> Section references are to the Internal Revenue Code unless otherwise o Form 1099-MISC(various types of income,prizes,awards,or gross
<br /> noted. proceeds)
<br /> Future developments.For the latest information about developments o Form 1099-B(stock or mutual fund sales and certain other
<br /> related to Form W-9 and its instructions,such as legislation enacted transactions by brokers)
<br /> after they were published,go to www.irs.gov/F6rmW9.
<br /> •Form 1099-S(proceeds from real estate transactions)
<br /> Purpose of Form •Form 1099-K(merchant card and third party network transactions)
<br /> An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest),1098-E(student loan interest),
<br /> information return with the IRS must obtain your correct taxpayer 1098-T(tuition)
<br /> identification number(TIN)which may be your social security number •Form 1099-C(canceled debt)
<br /> (SSN),individual taxpayer identification number(ITIN),adoption .Form 1099-A(acquisition or abandonment of secured property)
<br /> taxpayer identification number(ATIN),or employer identification number
<br /> (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S,person(including a resident
<br /> amount reportable on an information return.Examples of information alien),to provide your correct TIN.
<br /> returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might
<br /> •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding,
<br /> later.
<br /> Cat.No.10231X Form W-9(Rev.10-2018)
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