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Form W-9Request <br />(Rev. October 2018) <br />Department of the Treasury <br />Internal Revenue Service <br />for Taxpayer <br />Identification Number and Certification <br />► Go to www.irs.gov/FormW9 for instructions and the latest information. <br />Give Form to the <br />requester. Do not <br />send to the IRS. <br />Print or type. <br />See Specific Instructions on page 3. <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 />3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the <br />following seven boxes. <br />4 Exemptions <br />certain entities, <br />instructions <br />Exempt payee <br />Exemption <br />code (if any) <br />(Applies to accounts <br />(codes apply only to <br />not individuals; see <br />on page 3): <br />code (if any) <br />• Individual/sole proprietor or • C Corporation • S Corporation • Partnership . Trust/estate <br />single -member <br />LLC <br />company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) <br />appropriate box in the line above for the tax classification of the single -member owner. <br />is classified as a single -member LLC that is disregarded from the owner unless the owner <br />is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single <br />from the owner should check the appropriate box for the tax classification of its owner. <br />► <br />► <br />• Limited liability <br />Note: Check the <br />LLC if the LLC <br />another LLC that <br />is disregarded <br />from FATCA reporting <br />Do not check <br />of the LLC is <br />-member LLC that <br />maintained outside the U.S.) <br />• Other (see instructions) <br />5 Address (number, street, and apt. or suite no.) See instructions. <br />Requester's name and address (optional) <br />6 City, state, and ZIP code <br />7 List account number(s) here (optional) <br />Part <br />I 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 <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 <br />entities, it is your employer identification number (EIN). If you do not have a number, see How to get a <br />TIN, later. <br />Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and <br />Number To Give the Requester for guidelines on whose number to enter. <br />Part II <br />Social security number <br />or <br />Employer identification number <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. I 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. I 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 <br />Here <br />Signature of <br />U.S. person ► <br />Date 110 - <br />General <br />General Instructions <br />Section references are to the Internal Revenue Code unless otherwise <br />noted. <br />Future developments. For the latest information about developments <br />related to Form W-9 and its instructions, such as legislation enacted <br />after they were published, go to www.irs.gov/FormW9. <br />Purpose of Form <br />An individual or entity (Form W-9 requester) who is required to file an <br />information return with the IRS must obtain your correct taxpayer <br />identification number (TIN) which may be your social security number <br />(SSN), individual taxpayer identification number (ITIN), adoption <br />taxpayer identification number (ATIN), or employer identification number <br />(EIN), to report on an information return the amount paid to you, or other <br />amount reportable on an information return. Examples of information <br />returns include, but are not limited to, the following. <br />• Form 1099 -INT (interest earned or paid) <br />• Form 1099 -DIV (dividends, including those from stocks or mutual <br />funds) <br />• Form 1099-MISC (various types of income, prizes, awards, or gross <br />proceeds) <br />• Form 1099-B (stock or mutual fund sales and certain other <br />transactions by brokers) <br />• Form 1099-S (proceeds from real estate transactions) <br />• Form 1099-K (merchant card and third party network transactions) <br />• Form 1098 (home mortgage interest), 1098-E (student loan interest), <br />1098-T (tuition) <br />• Form 1099-C (canceled debt) <br />• Form 1099-A (acquisition or abandonment of secured property) <br />Use Form W-9 only if you are a U.S. person (including a resident <br />alien), to provide your correct TIN. <br />If you do not return Form W-9 to the requester with a TIN, you might <br />be subject to backup withholding. See What is backup withholding, <br />later. <br />Cat. No. 10231X <br />Form W-9 (Rev. 10-2018) <br />