EFTA01299114.pdf

W-9
Request for Taxpayer Give Form to the
Form
requester. Do not
December Identification Number and Certification
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Taxpayer Identification Number (TiN)
Enter your TIN In the appropriate box. The TIN provided must match the Darns °hen on the 'Name' line Social wordy mentor
to avoid backup with /yoking For individuals, this is your social now* number (SSN). However, for a
resident alien, *ode proprietor. or dieregarded entity. see the Pal I instructions on page 3. For other
entities, it is your employer Identification number (EIN). II you do not have a number. see How to pet a
11N on pope 3.
Note. If the account is in rnore than one name, see the chart on page 4 for guideinee on whose I Employer tdereificathan °weber L
number to enter.
Part II Certification
Under penalties or perjury, I certify that:
1. The number shown on this form a my correct taxpayer identification number (or I am waning 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, a (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a Mute to report all interest or dividends, or (c) the IRS has notified me Matt am
no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out it1 14 2 above if you have been notified by the IRS that you we currently subject to backup withholding
because you have felled to report el interest and di rends on your tax m. For real estate transactions, item 2 does not apply. For mortgage
interest paid. acquisition or abandonment of secur property, of debt. contributions to an Individual refinement anangement (IRA), and
generally, payments other thaninterest and dividends, not required toN qn the certification, but you must provide your correct TIN. See the
instructions on page 4. /
Sign oilmen of Dan Vaiii
1.1920 U.S. personI;
General Instructions Note. If a requester gives you a form other than Form W-9 to request
your TN, you must use the requester's form If it Is substantially similar
Section references are to the Internal Revenue Code unless otherwise 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 as
A person who is required to fa an information return with the IRS must • An individual who lea 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 Field to you, real estate transactions, mortgage interest organized In the United States or under the awe of the United Slate.,
you paid, acquisition or abandonment 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 action 301.7701-7).
Use Form W-9 only If you are a U.S. person (including a resident
alien), to provide your correct TIN to the person requesting it (the Special rules for partnerslips. Partnerships that conduct a trade or
requester) and, when applicable, to: business in the United Static are generally required to pay a withholding
tax on any foreign partners' share of income from such business.
1. Certify that the TIN you we giving is correct (or you are waiting for a Further, In certain cases where a Form W-9 has not bean received. a
number to be Issued). partnership is required to presume that a partner is a foreign pinion
2. Certify that you am not subject to backup withholding. or and pay the withholding tax. Therefore, if you are a V.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. If applicable. 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 boom* from a U.S. trade or business status and avoid withholding on your share of partnership incans
is not subject to the withholding tax on foreign partnere' share of
effectively connected income.
W-9
Cat No 10231X Form (Rev. 12.2011)
SD NY_GI,l_00064811
IDENTIAL
AKE DB-SDNY-0027636
CONFIDENTIAL - PURSUANT TO FED_ R.QP
EFTA_00175314
EFTA01299114