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Form W'9 Request for Taxpayer Give form to the
<br /> (Rev. November 2005) Identification Number and Certification requester. Do not
<br /> Department of the Treasury send to the IRS.
<br /> Internal Revenue Service
<br /> N Name (as shown on your income tax return)
<br /> d
<br /> m
<br /> m
<br /> C- Busin nom if different from above
<br /> �J I I I s -�r� I f f S
<br /> C'C� rD
<br /> a o Individual/ Exempt from backup
<br /> 6 Check appropriate box: Sole proprietor E] Corporation E] Partnership Other withholding
<br /> 2
<br /> Address (number, street, and apt. or suite no.) Requester's name and address (optionaq
<br /> a
<br /> City, state, and ZIP code
<br /> a L- 4 C L1 YV j�'
<br /> W
<br /> m List account numtdr(s) here (optional)
<br /> aD
<br /> FMM 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 social security number
<br /> backup withholding. For individuals, this is your social security number (SSN). However, for a resident 1 1 I 1 1
<br /> alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
<br /> your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
<br /> Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number
<br /> number to enter. A 1,5 1 71 :Z 1 -7 I �-I
<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. 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
<br /> 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
<br /> notified me that I am no longer subject to backup withholding, and
<br /> 3. 1 am a U.S. person (including a U.S. resident alien).
<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
<br /> withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply
<br /> For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
<br /> arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
<br /> provide your correct TIN. (See the instructions on page 4.)
<br /> i
<br /> Sign Signature of
<br /> Here U.S. person 10. l// CYr� v Date
<br /> Purpose of Form An individual who is a citizen or resident of the United
<br /> A person who is required to file an information return with the States,
<br /> IRS, must obtain your correct taxpayer identification number A partnership, corporation, company, or association
<br /> (TIN) to report, for example, income paid to you, real estate created or organized in the United States or under the laws
<br /> transactions, mortgage interest you paid, acquisition or of the United States, or
<br /> abandonment of secured property, cancellation of debt, or Any estate (other than a foreign estate) or trust. See
<br /> contributions you made to an IRA. Regulations sections 301.7701 -6(a) and 7(a) for additional
<br /> U.S. person. Use Form W -9 only if you are a U.S. person information.
<br /> (including a resident alien), to provide your correct TIN to the Special rules for partnerships. Partnerships that conduct a
<br /> person requesting it (the requester) and, when applicable, to: trade or business in the United States are generally required
<br /> 1. Certify that the TIN you are giving is correct (or you are to pay a withholding tax on any foreign partners' share of
<br /> waiting for a number to be issued), income from such business. Further, in certain cases where a
<br /> 2. Certify that you are not subject to backup withholding, or Form W -9 has not been received, a partnership is required to
<br /> 3. Claim exemption from backup withholding if you are a presume that a partner is a foreign person, and pay the
<br /> U.S. exempt payee. withholding tax. Therefore, if you are a U.S. person that is a
<br /> partner in a partnership conducting a trade or business in the
<br /> In 3 above, if applicable, you are also certifying that as a United States, provide Form W -9 to the partnership to
<br /> U.S. person, your allocable share of any partnership income establish your U.S. status and avoid withholding on your
<br /> from a U.S. trade or business is not subject to the share of partnership income.
<br /> withholding tax on foreign partners' share of effectively
<br /> connected income. The person who gives Form W -9 to the partnership for
<br /> Note. If a requester gives you a form other than Form W -9 to purposes of establishing its U.S. status and avoiding
<br /> withholding on its allocable share of net income from the
<br /> request your TIN, you must use the requester's form if it is
<br /> substantially similar to this Form W -9. partnership conducting a trade or business in the United
<br /> States is in the following cases:
<br /> For federal tax purposes, you are considered a person if you The U.S. owner of a disregarded entity and not the entity,
<br /> are:
<br /> Cat. No. 10231X Form W -9 (Rev 11 -2005)
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