EFTA01298552.pdf

W-9
Form Request for Taxpayer Give Form to the
Certification
pet. Dearrber 2011) Identification Number and requester. Do not
Sepriews d the Tansy send to the IRS.
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Namegeshown on vow hearse tax ream)
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Check appropriate box for federal tax deseiketors
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0 tinted nary cortanny. Enter tie tex deaselostkn (C=C energise. ItbS esrporetke, eiecr tnenino me ....... .....________.
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name and addesskolioneil
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Rag I Taxpayer Identification Number (TIN)
Enter your TIN In the appropriate box. The TIN provided must match the name given on the •Name• fine Segel noway number
to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Part I Mtn's-dons on pipe 3. For other
entitles, 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 mare than one name, see the chart on pace 4 for guidelines on whose Employer Identlecation number
number to enter.
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Lai
Certification
Under penalties of perjury, I certify that:
1. The number shown on this form Is my correct taxpayer identification number (*clam 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 (IRS) that I an subject to backup withholding re a resuh of a failure to report all interest or dividends, or (c) the RS has notified me that I am
no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined belay).
Certifiranion instructions. You must crone out item 2 above if you have been notified by the IRS that you are amenity subject to backup withholding
because you have tailed to report at interest and drvidends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of property. tanceletbn of debt, contributions to an individual retirement arrangement DRY. and
generally, payments other than intern and d you are not required to sign the certification, but you must provide your contact TIN. See the
,
instructions on page 4. —
Sign
Skinature of 9403
Here U.S. pinion le lJ Date
General Instructions ate. If a requester gives you a form other than Fenn W-9 to request
your TIN, you must use the requester's form if It Is substantially similar
Section references are to the Internal Revenue Code unless o to this Rim W-D.
noted.
Definition of a U.S. person. For federal tax pewees, you are
Purpose of Form considered a U.& portion/you are:
A person who Is required to file an information return with the IRS must • An individual who Is • U.S. citizen or U.S. resident gen.
obtain your correct taxpayer Identification number (TIN) to report, for • A partnership, corporation, company, or aseociation 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 abandonment of secured property, cancellation • An estate (other than a foreign estate). or
of debt, or contnbutions you made to an IRA
• A domestic trust (as defined in Regulations section 301.7701.7).
Uee Form W-9 only/you are a U.S. person (Including a resident
alien), to provide your correct TIN to the person requesting it (the Special nibs for partnerships. Partnerships that conduct a trade or
requester) and, when applicable, to business in the United States are generally required to pay a withholdrg
tax on any foreign partners' shore of income from such business.
1. Certify that the TIN you we giving is correct (or you we waiting for a Further, In certain cases where a Form W-9 has not been received, a
number to be keyed), partnership is required to pwaurne that a partner le a foreign person.
2. Certify that you we 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 we a U.S. exempt partner in a partner hip conducting a trade or buskins in the United
payee. If applicable, you are also certifying that as a U.S. person, your Slates, provide Form W-9 to the partnership to establish your U.S.
eilocab:e share of any partnership Income from a U.S. trade or business status and avoid withholding on your share of partnership 'orns.
is not subject to the withholding tax on foreign partners' share of
effectively connected income.
W-9
Cat No. 10231% Fonn give. 12-2011)
„QC.)N EIDENTIAL SDNY_Givl_00063405
CONFIDENTIAL - PURSUANT TO FED_ DB-SDNY-0026230
EFTA_0O1739 I 3
EFTA01298552