EFTA01294990.pdf

Formw ag
Request for Taxpayer Give Form to the
(Rev. December 2011) Identification Number and Certification requester. Do not
Deptnenent d the Treasury send to the IRS.
lowed Revenue Semco
Name
exusese namaiosregattleci entity name, d minded Irem above
Check OPPreinite box for federal tax classification:
Indteduallsole proprietor O C Corporton Ds Corporation O Pannership O Trust/estate
p Exempt payee
Limited liability sensory. Enter the tax classification (C-C corporation. S'S comonicon. P•paruiershiral•
CI Other (see irstnciticesi►
Requester's name and address (optioned
A
List accoult nsrr here OT
Logi
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on the -Name line T *eclat security number
to avoid backup withholding. For individuals, this Is your social security number (SSN). However, for a
resident alon, sole proprietor, a disregarded entity, see the Part I instructions on page 3. For other
entities. it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employes Identification number
number to enter.
_I,
MEE —Certification
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. 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
Service (RS) 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 witMolding. and
3. I am a V.S. citizen or other U.S. person (defined below).
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, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangenent (IRA), and
generally, payments other t the certification, but you must provide your correct TIN. See the
instructions on page 4.
Sign Denature of
Here U.S. porton • Deter. 11 /Z2, 1:1470/ 3
General Instructi ote. If a requester gives you a form other than Form W-9 to request
TIN, you must use the requester's form if It is substantlaly similar
Section references are to th to this Form W-9.
noted.
Definition of a U.S. person. For federal tax purposes, you are
Purpose of Form considered a U.S. person if you we:
A person who is required to file an information return with the IRS must • An individual who is a U.S. Citizen or U.S. resident alien,
obtain your correct taxpayer Identification number (TIN) to report, for • A partnership, corporation, company, or association created or
example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States,
you paid. acquisition or abandonmnt of secured property, cancellation • An estate (other than a foreign estate), or
of debt, or contributions you made to an IRA
• A domestic trust (as defined in Regulations section 301.7701-7).
Use Form W-9 only if you we a U.S. person (inckiding a resident
alien), to provide your correct TIN to the person requesting It (the Special rules for partnerships. Partnerships that conduct a trade or
requests) and, when applicable, to: business in the United States are generally required to pay a withholding
tax on any foreign partners' share of income from such business.
1. Certify that the TIN you are giving is correct (cc you are waiting for a Further, In certain cases where a Form W-9 has not been received, a
number to be issued). partnership is required to presume that a partner is a foreign person,
2. Certify that you are not subject to backup withholding. or and pay the withholding tax. Therefore, if you are a U.S. person that is a
3. Claim exemption from backup withholding if you are a U.S. exempt partner in a partnership conducting a trade or business in the United
payee. II applcable, you are also certifying that as a U.S. person, your States, provide Form W-9 to the partnership to establish your U.S.
allocable share of any partnership income from a U.S. trade or business status and avoid withholding on your share of partnership notime.
is not subject to the withholding tax on foreign partners' share of
effectively connected income.
Cal. No.102MX Form W-9 (Rev. 12-2011)
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EFTA01294990