|
Form
<br />(Rev. November 2005)
<br />Department of the Treasury
<br />Internal Revenue Service
<br />Part I
<br />-9
<br />L L.1 O 7 741,3 t9 1/--t.
<br />Taxpayer Identification Number (TIN)
<br />Request for Taxpayer
<br />Identification Number and Certification
<br />of Name (as shown on your income tax return)
<br />ar
<br />rn
<br />m
<br />o
<br />B usin nam if different from above
<br />b e� VAJ 4 co I S rc /l1 c f S
<br />f U L Gf C'C rD 1
<br />a o Indi vidual/
<br />Check appropr box: Sole proprietor Corporation Partnership Other
<br />o 3
<br />Address (number, street, and apt. or suite no.)
<br />:E City, state, and ZIP code
<br />0. L4CeL1 kiA- 9 5O 3
<br />W
<br />m List account nulnl21r(s) here (optional)
<br />a)
<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 your social security number (SSN). However, for a resident
<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.
<br />Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
<br />number to enter.
<br />Part II
<br />Certification
<br />Cat. No.
<br />Give form to the
<br />requester. Do not
<br />send to the IRS.
<br />Exempt from backup
<br />withholding
<br />Requester's name and address (optional)
<br />Social security number
<br />I I I
<br />Date q /25/O 7
<br />or
<br />Employer identification number
<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
<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. I 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 />Sign U.S. person of l// C J
<br />Here U.S. person b.
<br />Purpose of Form
<br />A person who is required to file an information return with the
<br />IRS, must obtain your correct taxpayer identification number
<br />(TIN) to report, for example, income paid to you, real estate
<br />transactions, mortgage interest you paid, acquisition or
<br />abandonment of secured property, cancellation of debt, or
<br />contributions you made to an IRA.
<br />U.S. person. Use Form W -9 only if you are a U.S. person
<br />(including a resident alien), to provide your correct TIN to the
<br />person requesting it (the requester) and, when applicable, to:
<br />1. Certify that the TIN you are giving is correct (or you are
<br />waiting for a number to be issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a
<br />U.S. exempt payee.
<br />In 3 above, if applicable, you are also certifying that as a
<br />U.S. person, your allocable share of any partnership income
<br />from a U.S. trade or business is not subject to the
<br />withholding tax on foreign partners' share of effectively
<br />connected income.
<br />Note. If a requester gives you a form other than Form W -9 to
<br />request your TIN, you must use the requester's form if it is
<br />substantially similar to this Form W -9.
<br />For federal tax purposes, you are considered a person if you
<br />are:
<br />An individual who is a citizen or resident of the United
<br />States,
<br />A partnership, corporation, company, or association
<br />created or organized in the United States or under the laws
<br />of the United States, or
<br />Any estate (other than a foreign estate) or trust. See
<br />Regulations sections 301.7701 -6(a) and 7(a) for additional
<br />information.
<br />Special rules for partnerships. Partnerships that conduct a
<br />trade or business in the United States are generally required
<br />to pay a withholding tax on any foreign partners' share of
<br />income from such business. Further, in certain cases where a
<br />Form W -9 has not been received, a partnership is required to
<br />presume that a partner is a foreign person, and pay the
<br />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 />United States, provide Form W -9 to the partnership to
<br />establish your U.S. status and avoid withholding on your
<br />share of partnership income.
<br />The person who gives Form W -9 to the partnership for
<br />purposes of establishing its U.S. status and avoiding
<br />withholding on its allocable share of net income from the
<br />partnership conducting a trade or business in the United
<br />States is in the following cases:
<br />The U.S. owner of a disregarded entity and not the entity,
<br />10231X Form W -9 (Rev 11 -2005)
<br />
|