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<br />vitw LtSii.,n rHx
<br />
<br />F' . 0 2
<br />~"' N-"~ Re asst ter '~r~x a er
<br />~, ttrh43 ~ ~ y Give farm to the
<br />Y tdentif~Qafiiorr Itiumioler and ~~rtiflcafion ~at,~~tef. oo Nor
<br />send to the IRS,
<br />(lt btnt tGVnes, Net that end aerate Use name er the pardon ac ealnY whose nvm6er you enter In PIA t tktow. See tnrtrvcuens en pope t;,t tfear acme hts etnagea.t
<br />o` ti~klass name (3o[b prapdetors see instruction on page aJ '-----»~---."."
<br />~l i t1 inc.
<br />p, Phase C+hedt aptxoprtate t~ tnetvWuW~ote proprietor ()Orpoti<ti~n [] Pervtersnlp ^ Ocher - ..-_-.. ..------"."-"`-
<br />'~ Mdcese (nurnbar, and apt or r~ulty nod R~,w+aeaters nanto aM acleress (opuo~,p.
<br />t'I t'~ -~,e. St • • '
<br />Utt~v, stilt@. and ZIP C4d0
<br />t.rst eco0unt numbcrtr) tiara {optlonaQ """
<br />Enter' yourfiN to the appropriate box Fa
<br />irs~Hdutttsy, tiers 1.3 your trodai secuity rxattbsr
<br />(5SNJ. For's~o1a propdstor;3, site Ute Itistntotions
<br />orb ~g~ ~. Fot other mtrtr~. tt ts,ycwr etnptoyer
<br />Iderttr~Catlort number ~-M. If you do not have a
<br />ttumbeP, s@e•,How To Stet a TIN trelow.
<br />Note: h'the aoC~ocrnf is ht more than ono clams,
<br />see t`Jtt1 cha~f l~r pays 2 tY~r ~ufdellnes ort whose
<br />ntutr6eir to dntr~r.
<br />Pbr Payees Fatempt From Racketp
<br />WtthBotdiaq (See Pact It
<br />Irtsttvotione an Dees 21
<br />
<br />lfndsr i~ttaitles Of ptcr)cay, l certffy t~
<br />t. Tt^-e dumber stl0um oA !h!s iortll(s my correct taxpayer tdentitiCation t-umD9r (ar 4 em wanlr-g for a numtser to bs Issued to me), and
<br />2, lam Rot ~tbjetzt to Gsckup withholditg baseless: (a) i 8m e>rempt (rpm beditrP withhoktng, ~' tee 1 IiaV~a not Veen tatlflud by th@ Itlterpat
<br />Rev4nt:4A Fervtob that t am t;t,lbJeot to b3dN¢ withttotdtng es a result at a•f8lture t0 report alt fntete-st or dlvtdends, of (c) the tA8 has ttol3fied
<br />m+q drat 1 arrr no longer subject to backup wnhhotding,
<br />-.tf'ica-ttan Ins~rctottor-sr-You must,oross out ftertt 2 above it you have t~gen notitied by the IRS that you atv txnrerttty subject to l~acF~p
<br />>tta beoatlse of Imcl8ri@pOfting kit®rESt Or NviCf9nds on your tax r0ptm. Far reai estate tractsaat(ons, tteRt 2 does hat apply. Pot nxxiga$e
<br />Mteres~t p' d~ ttts aCqulsltion of tibandonment of saxtte4 ptq~erty, cancet6atbn of debt, aotstr~utifons to an ktdiwlciuus! rettremeM esrengement
<br />Ate},, aced Oe~y payments other lfian Intexest and dividends, you are not required to sfgr- the Certtlioa`~lart, tint you must proYlder your~G•orrai~t
<br />TIN, (Also sea Pact Ill tns~truatiosts on page ~.3 •
<br />Sign
<br />Nerd 6ism3trlr'e ~
<br />. SQCdart r~+terarrce~s am td~fie lMetrb&!
<br />fiet~erttr~e Gods,
<br />Purpose cf Form,--A person why b
<br />requlrAd to tits an Intormatlon returtt with
<br />th9 iFis ttlu3t get year ootrcot TIN to report
<br />Inoamep~ d to you, root estate
<br />trtl~tsar~lort.4, mortgage kttarrest yott petd,
<br />the aDgtet:ation or ttbandortmrrrtt of seexered
<br />property Crir+ooilatTart of debt, a
<br />earktbutlc>tts you made td en Il~A. Use
<br />FOtytti W 9 to give your oorreot TiN W the
<br />teter ¢he person requesting yeti TIM
<br />~r wl'rort ttpptbabla, (t) t0 Cetttty late TiN
<br />Yrw aro phAng is coned (0r~rou arse wartir-g
<br />far b ntmttrer to be issued), i~) to cyettify
<br />vote sue no! sttbJeot to mockup withhotdittg,
<br />at ) to deem Qxemptran from backup
<br />ing K you are en exempt payee.
<br />CdNing ysaut correct TIN t3ted tnaldr>g the ,
<br />a~pat~ts N um beh~ip s~ubje~ct tv
<br />badaP ~9-
<br />Note. if s re~uesfer Alves ysxr a fonrt otter
<br />~,, Neon s W-8 fa request your 7JN, yryrl must
<br />user tfr9 rt~esror's taint /f k !s substantially
<br />slm~ M tyres Form W-s.
<br />What Is BsCkuP Withholding?--~Pe-sons
<br />oertaln payments to you must
<br />pay ca the rsas 3i 9.6 of snob
<br />pa•~nta~ts under oertaln Nrtditions. This is
<br />called 'baclaep witi~ttoldinQ" Payments
<br />that oatrld be subject to backup
<br />wrthhotding knYtr~ Mterest. div[dends,
<br />broker told barter exchange transeotions,
<br />rents, royatdes, nonemxtoyae pay, and
<br />crrtelrt p~aytitents from ftshU'-g bast
<br />OpBt'9tarS. Rest eStBte ttgfl3aatrons ere not
<br />subject to badtup whhhvlding.
<br />If you glue the requester your correct
<br />T1N, make the proper certificatlotts, and
<br />report ell your taxable Interest ttnd
<br />drvkiends on your tax return, your
<br />payments wIN slat be subject to backup
<br />witWtialding Payments You rrk3eive will be
<br />subject t backup wittthotdlttg if:
<br />i. You ills trot furnish your TiN to the
<br />requester. ar
<br />2. "the iFiS tells file requester tt>,at you ,
<br />iumtshed an incorrect TiN, or
<br />3. ThE3 iR5 teats you that you anh subject
<br />to backup wtthhatding because you did not
<br />report ail your Interest and divMettds on
<br />your left t+ett,tm (tor reportable Inta~rest and
<br />dividends only), ar
<br />4. Yau do not comity to the requester
<br />that you era not subject to backup
<br />withholding under 3 sttsove (for repotable
<br />Sodat sewrtty number
<br />aR
<br />Employer t4e~tpttcitroe number
<br />913.112 {3~~} 13 i'~ f 8
<br />
<br />Interest stand dividend accounts opent~ce
<br />after 5989 onlyj, or ,
<br />5, You do not certrly your 11K. See the
<br />Part ill Irtstrtactians for exceptions.
<br />Certain payees anQ paytneMs one
<br />exempt frattt bactatp withholding acrd
<br />hfotttlatron reportttig. See if>d Pact tl
<br />tastrriotton3 and the separate fnsdYrotians
<br />for the Rer;uestar of (assn W-9.
<br />Haw Ta ta8t•@- TiN.--It you do not have a
<br />Tli~, apply for Otte itnmediately.'I`o apply,
<br />get Form ES-5, App[tcaUort far a Soctal
<br />Sec;ustty Number Card (far rr~ividtaats),
<br />from year lour office of the t5odst Security
<br />Admrnrstrtstion, or Form SS-+S, Apptfoatian
<br />for Employer IQentficatton Ntunt~,r {for
<br />twstrtesses anti en other eRtitieS), froth
<br />your bcai lRS oftke.
<br />it you da not hsve 8 TiN, wttte 'Appited
<br />For" tn•the space for the TIN in part 1, slgrs
<br />and date the form, artd gtYB it to the
<br />requester. Cerybrgtfy, you wUl titan hav~0 so
<br />drys co aet a TIN and give tt to ate
<br />roqu8ster. tf the regtte5ter tSaes not receive
<br />your TIN vrttWn 60 days, beolNp
<br />withholdiap, if sppitcabte, wilt twin and
<br />oorttlrtue unfit you t~,lmish your TIN.
<br />-----~-...,_._..r..~.~.~..........~..._.__ ._.._-.-..-~ ,._.,-...----~----
<br />Crst. No. 1029tx l~'Wr~ ~'~`~ ~~' x-94!
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