ST0301C-CS141216 (2)FormW'.7
Request for Taxpayer
Give Form to the
(Rev. August2013)
Identification Number and Certification
requester. o not
IRS.
send to the IRS.
Department of the treasury
Internal Revenue Service
Name (as shown on your income tax return)
of
8 iness name/disregarded entity name, H diflerant from above
tkC .
1.
Check appropriate box for federal tax classification: ���......,,,ttt
Exemptions (see instructions):
❑ IndMduaVaole proprietor ❑ C Corporation R[t S Corporation ❑ Partnership ❑ Trust/estate
Y
g
Exempt payee coda Of any)
S
❑ Umned liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership)►
Exemption from FATCA reporting
code (if any)
c
❑ Other (seeinaWclions)►
D
Atldrees (num r, 9VBet, and apt. or suite
Requester's name and address (optional)
ono..)/
lQ/(V�J \ W
ity slate. and ZIP code 'I�aDaJ 1
List account numbers) hem (optional)
KOH
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line Social securtly, number
to avoid backup For individuals, this Is your social security number ISSN). fora
3. For of
le proprietor, sea the Part I Instructions on page 3. For other
resident alley, sole proprietor, or disregarded entity,
FM _ m _
rMI
entities It IS our emdo ar Idannfinannn number lFlM. If vnu do not have a number. see How to pet a
Y Y
TIN on page 3.
Note. If the account is In more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Under penalties of perjury, I certify that:
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
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
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
no longer subject to backup withholding, and
3. 1 am a U.S. citizen or other U.S. person (defined below), and
4. The FATCA codes) entered on this form Of any) Indicating that I am exempt from FATCA reporting Is correct.
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 you have failed to report all Interest and dividends on your tax return. For real estate transactions, Rem 2 does not apply. For mortgage
Interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and
generally, payments other the Int t and divide ds, you are not required to sign the certlflcation, but you must provide your correct TIN. See the
instructions on siege 3. 1 Mn U
Signature of
U.S. perwn
General Instructions
Section references are to the Internal Revenue Cade unless otherwise noted.
Future development$. The IRS has created a page on IRS.gov for information
about Form W-9, at www.es.9ov/w9. Information about any future developments
affecting Form W-9 (such as legislation enacted after we release it) will be Posted
on that page.
Purpose of Form
A person who is required to file an information return with the IRS must obtain your
correct taxpayer identification number (TIM to report, for example, Income paid to
you, payments made to you in settlement of payment card and third party network
transactions, real estate transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or contributions you made
to an IRA.
Use Forth W-9 only if you aro a U.S. person (including a resident alien), to
provide your ommet TIN to the person requesting it fire requester) and, when
applicable, to:
1. Certify that the TIN you are giving is correct (or you are wading for a number
to be issuer/),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S. exempt payee. It
I bl an o f
Dale► Ivl Ito
withholding tax on foreign partners' share of effectively connected income, and
4. Certify that FATCA code(s) entered on this farm (if any) indicating Mat you are
exempt from the FATCA reporting, is correct.
Nota. If you are a U.S. portion and a requester gives you a form other Man Forth
W-9 to request your TIN, you must use Me requester's form H it is substantially
similar to this Forn W-9.
Definition of a U.S. person. For federal tax purposes, you are considered a U.S.
parson it you are:
• An Inoividual who Is a U.S. citizen or U.S. resident alien,
• A partnership, corporation, company, or association created or agonized in the
United States or under Me laws of the United States,
• An estate (other than a foreign estate), a
• A domestic trust las defined in Regulations section 301.7707.7).
Spacial rutes for partnerships. Partnerships that conduct a trade or business m
the United States are generally required to pay a withholding tax under section
1446 on any foreign panneB' share of effectively connected taxable income from
such business. Further, in certain cases where a Forty W-9 has not been received.
the rules under section 1446 require a Partnership to presume Mat a partner is a
foreign person, and pay the section 1446 withholding tax. Therefore, if you we a
U.S. person that is a partner In a partnership conducting a trade a business in the
United States, provide Form W-9 to Me parMxship to establish your U.6. stews
and avoid sectim 1446 withholding on your share of partnership income.
applicable, you are also codifying that as a U.S. person, your a me a are
any partnership income from a U.S. trade or business is not subject to the
Cat. No. 10231X Form W-9 (Rev. 8-2013)