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t Farm Request for Taxpayer Gtve form to the
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<br /> t,~, iRev. tJovember 2005) Identification Number and C@rtiflcation requester. »ot
<br /> oapatment ~ ma Tresswv sand to the IRS.
<br /> Mtemal Ra+rmue service
<br /> N Name (as shown orc ur income tax rat rn)
<br /> a eus<ness name,. if dit erertt tmm above
<br /> ~d
<br /> ~p ~ Individual! .
<br /> ~Garparation Partnership ? Other r ? wthhoidirrg backup
<br /> a Cttecic appropriate box: Sae proprietor
<br /> .w Address lrtumt~, atrset, and apt:. or suite noa Requester's Hama and address {optionaq
<br /> City, state, and ZiP code
<br /> ~ ust account number(s) here {optional)
<br /> Tax a er Identiffcetfon Number TIN
<br /> Enter your TiN in the appropriate tmx. The T?N provided must match the name given an Una 1 to avoid social ssourtty number -.~1~
<br /> backup withhokiir~. For individuals, this is your social security number (SSiV). Flawever, for a resident
<br /> alien, sole pnsprtetor, ar disregarded entity, see the Part 1 tnstruettons otr page.9. For other entities, it is
<br /> your employer identitiCation number {EItJ). if you do not have a number, sea Now to get a 77N on page 3. or
<br /> Nate. if the account is (M more than one name, see the chart on page 4 far guidelines an whose Empto er Identfftcation number
<br /> number to enter. ~ ~ E ~J
<br /> Certltication
<br /> Under penalties of per}ury, i certify that:
<br /> f. The number shown on this form is mycotrect taxpayer identifieakton number {or I am wetting for a number to tretssued to me}, and
<br /> 2. i arrt not sub)ect to backup witfthoiding because: {ej t am exempt from 4ackup withholding, or {b) t trays Hat tteen natifled by the intemat
<br /> Revenue Service {tfSj that i am subject to backup wittthoidtng as a result of a #allure to report all interest or dividends, or {c} the iR5 has
<br /> natitied me that t arrt no longer sutrject to backup withhotdittg, and
<br /> 3. t am a U.S. person {including a U.S, resident aiten}.
<br /> Certticattan instructions, You must cross out item 2 atrave if you have been notified by the ifiS that you era currently subject to trackup
<br /> withholding because you have felted to report alt interest and dividends an your tart return. For real estate transactions, item 2 does not apply.
<br /> Fot mortgage interest paid, acqutsttton or abandonmtnt of secured property, aanceitatton of debt, contributions to an individual retirement
<br /> arrangement {IfiA}, anti gene manta other than interest aril tlivtdends, you era not required to sign the Gertificatton, but ynu must
<br /> provide your correct fitN. {S the in ructions page d.)
<br /> $tgn Signature of ,C,~tx.rnc.+~:mrJ' ~ ~ 'L. is o 3
<br /> I'let'e U:S. person ~ Dots it t
<br /> PUt'pf338 of FOt•rrt • An tndividural who is a citizen or resident of the United
<br /> A person who is required to file an i» n return with the States,.
<br /> IRS,. must obtain your correct taxpayer identification number • A partnership, corporation, company, ar association
<br /> {rlNj to report, #or example, income paid to you, real estate created or organized in the United States or under the taws
<br /> transactions, mortgage interest you paid, acquisition or of the United States,. ar
<br /> abandonment of secured property, canceilatian of debt, or s Any estate (other than a foreign eskatej or trust. See
<br /> contributions you made fa an it~A. Reguiations sections 301.77(}1-6{aj and 7{aj for addkional
<br /> tJ.5. person. Use Form Vii-9 only tf' you are. a U.S. person information,
<br /> (fneiuding a resident atienj, to provide your correct Tlhl to the Special rules for part»arshtpa. Partners(}ips that. conduct a
<br /> parson requesting It {the requester}. and, when applicable, to: trade or business in the United States era generally required
<br /> 1. Certify that the 7lN you era giving is correct {ar you are to pay a withholding tax on any foreign partners' share of
<br /> wafting fora:number to bs issuedj, income from such business. Further, in certain cases where a
<br /> 2. Certify that you era not subject to backup withholding, or Form W-t3 has not bean received, a partnership is required to
<br /> 3. Claim exemption from backup withholding if you area presume that a partner is a foreign parson, and pay. the
<br /> U.S. exempt payee. withholding tax, Therefore, if you era a U.S. person that is a
<br /> partner In a partnership conducting a trade or twsiness in the
<br /> in 3 above, if applicable, ,you are else certifying chat as a United States, provide Form VV-9 to the partnership to
<br /> U.S. person, your a0ocable 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 subjaot to the share of partnership income.
<br /> withholding tax on foreign partners' share of effectively
<br /> connected income. The person who gives Form VU-9 to the partnership for
<br /> Note. tf a requester gives you a form other than Farm W-9 to purposes of establishing its U.S. status and avoiding
<br /> uest our TIfJ, ou must use the requester's form if tt Is withholding on its allocable share of net income from the
<br /> y ~ partnership conducting a frade or business in the United
<br /> substantially simi)ar to this Form VV-9: States is in the following cases:
<br /> For federal tax purposes, you era consrdered a person If you • The U.S, owner of a disregarded entity and not the entity,
<br /> are:
<br /> Cat. Na. 10231X Farm -'8 play. 11.200ti)
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