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35 <br /> FORM W-9 <br /> [Rev,1-92; Rev. 10-94 <br /> for Division Contract Use] <br /> Pursuant to Internal Revenue Service Regulations, vendors must furnish their Taxpayer <br /> Identification Number (TIN) to the State. If this number is not provided,you may be <br /> subiect to a 3l% withholding on each payment. To avoid this 31%withholding and to <br /> insure that accurate tax information is reported to the Internal Revenue Service and the <br /> State, please use this form to provide the requested information exactly as it appears on <br /> file with the IRS. <br /> Legal Business Name <br /> Address <br /> 9 Digit Taxpayer Identification Number <br /> Social Security Number <br /> Federal Employer Identification Number Flo- ��r0\SSS <br /> Business Designation (Check One) Individual (Soc.Sec. #) <br /> Sole Proprietorship (Soc.Sec. #) <br /> Partnership (Fed. ID) <br /> Estate/Trust(Fed. ID) <br /> V Corporation(Fed. ID) <br /> Public Service Corporation(Fed. ID) <br /> Governmental/Non-Profit(Fed. ID) <br /> Under penalties of perjury, I declare that I have examined this request and to the best of <br /> my knowledge and belief, it is true, correct, and complete. I have not been notified by the <br /> IRS that I am subject to backup withholding for failure to report income. <br /> Name(Print or Type name of individual-not company) Title(Print or Type) <br /> Signature Date Telephone Number <br /> 49 <br />