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Oct.11. 2010 7 :50AV ROGER LANGELIERS CONSTRUCTION
<br />No. 0659 P. 6
<br />Fnm w-9 . 10 -2W71 pu 3
<br />Generally, Individuals (lncludtog sole proprietors) are not exempt
<br />from backup withholding. Corporations are exempt from backup
<br />withholdi for certain payments, such es intiersal and dividends.
<br />Note. It you we exempt from backup wilhholding, you should
<br />still oo form olo this fo to amid possible erroneous backup
<br />Wilhhold fig.
<br />The following payees are exempt from backup withholding:
<br />1. An organhatlon exempt from tax antler section 601(x), any
<br />IRA, or a custodial account under soolbn 403(b)(71 If the account
<br />*alleges the requlmments of section 401(1)(2).
<br />2. The United Stales or any of Its agencies or
<br />Inafrumenlaillfas,
<br />3. A stare, the Dlslrld of Columbia, a Posaesslon of the United
<br />Stales, or any of their political oubdivlalons or InalrurmenWluee,
<br />4. A forallin Comme or any of Its political subdivisions,
<br />agNClea, Of Inahumentalltles, or
<br />6. An International orgentrallon or any of Ile agendas or
<br />Inelrumehte0ties.
<br />Other payees That may be exempt from backup withholding
<br />Inohede:
<br />S. A corporation,
<br />7. A foreign central bank of Issue,
<br />8, A dealer In sOcurlllee of commodllles required to reg181er n
<br />the United States, the District of Culumbla, or a possession of
<br />the United Stoles,
<br />9. A futures comnilmlon merchant fogletwed With the
<br />Commodity Futures Trading Commission,
<br />10. A real estate Investment trust,
<br />11. An enllly registered at AN Simms during the lax year Under
<br />lire Investment Company Act of 1040,
<br />12. A common trust fund operalod by a bank under section
<br />504(a).
<br />13, A financial Institution,
<br />14. A middleman known In the InveslmNl community as a
<br />nominee or custodian, or
<br />16. A trust axornot from tax under sedlon Wd or described In
<br />section 4847.
<br />The shad below shows types of payments that may be
<br />exempt from backup wilhholdng The chest applies to the
<br />exempt payees hated above, 1 through 16.
<br />IF the payment Is for ...
<br />THEN Ilse payment Is exempt
<br />for .
<br />Interest and divdend peynwoe
<br />AN oxsmpt payees except
<br />for 0
<br />6tokat transactions
<br />Exernpt pays*8 1 ihrotph 13.
<br />_
<br />Also, a person regglered order
<br />the Inv4etmml Advieers Aol of
<br />1840 who regularly sale we a
<br />broker
<br />Batter exchange transactions
<br />Exempt payer 1 through 6
<br />and pabonags dtvidtxtda
<br />Payments over $800 requited
<br />Qmtorolly, exempt payees
<br />to be reported and daeal
<br />1 thrown 7
<br />aet*o over 86,000'
<br />'Son Farm 1092 -1,090, Mtn:tlgneous trays, and its autnpapa.
<br />e lrowaecr, the Iel&vdrq paymeNa ntsds to a carpmetan QitaNdng *roes
<br />prmmas paid W en axetney andar &Milan 6U6(4, den x I a Blaney Is a
<br />mpori lorf and Iepo m Farm 1090 -MISO we no wwpl horn
<br />bwlwp vAhhokft- madxal led health care pny~le. gtborrs p' lees. and
<br />p r,urle tar eMlvk'*e pall by a federal eCMAI,W agar cy.
<br />Part I. Taxpayer Identification
<br />Number (TIN)
<br />Enler your TIN In the appropriate box, if you are a resident
<br />p 01100 and YOU do rmol have and are not ell Ile to al an SSN
<br />number
<br />(IT N). Il n the social aecu number box. � dodo not
<br />ve N I TIN, All How to get a A below.
<br />If you area ode roprletor and you have en EIN, you may
<br />enter either your SSN or EIN. However, the IRS prefers that you
<br />use your SSN.
<br />11 you see a allgle- momber LLC that Is disregarded u an
<br />entity eparate from Its owner (see Limited aabi6fy company
<br />gg.L.C) on page 2), enter the owner's SSN (or EIN, It the owner
<br />has one). Do not anise the disregarded entity's EIN. If the LLC Is
<br />detalfied as a corporation or paMerehlp, enter the entlty'e EIN.
<br />Nola. See the chart on page 4 for further clarification of name
<br />and TIN combinations
<br />How to get a TIN. If you do not have a TIN, apply fee one
<br />Immediate To app ply for an SSN, get Form SS-6, Application
<br />for a Bodi ity Card, from our local Social Security
<br />Administration office or get this form o ling at www.sss.gov. You
<br />may also ggeel this form 6y calling 1.800. 772 -1213. Use Form
<br />W -7, Applbatien for IRS 7ndMdual Taxpayer Identification
<br />Number, to a pp� Iyy for en ITIN, or Form 59.4, Application for
<br />Employer fdNlificelipn Number, to apply for an EIN. You can
<br />apply (or an EIN online by eoceasing the IRS websllo 91
<br />www,lrs.goV /businesses and d inking ore Employer IdNllllcrotlon
<br />Number (EIN) under Slating a Business. You can gel Forte W -7
<br />tram the IRS by visiting www.as.gov or by calling
<br />1. 800 -TAX -FORM (i- 80(Fa29. 08781.
<br />If you as asked t0 complete Form W -9 but do not have a TIN,
<br />write 'Applied For" in the space for the TIN, sign and date the
<br />form, end glue it to the re"ater. For Interest and dividend
<br />payments, and certain payments made Min respect to readily
<br />tradable Instruments, generally you will have 60 days to gal a
<br />TIN and give 11 to the requester borer* you ere sublecl to backup
<br />wilhhokling on payments. The 60 -day Me dose not apply to
<br />other types of Pa nle. You wig be BUblecl to backup
<br />Withholding on ell ouch payments unlll you provide your TIN to
<br />the requester,
<br />Note. Entering nApplled For" means that you have already
<br />applied for a TIN or that you Intend to apply for one soon.
<br />Caullon: A disregarded domestic entity that has a tomign owner
<br />must use the appenprinfe Form W -a.
<br />Part II. Certiflcatlon
<br />To establish to the withholding agent that you are a U.S. person,
<br />or resident egen, alga Fort W -9. You may be requested to sign
<br />by do withholding agent even It Items 1, 4, and 6 below Indicate
<br />otherwise.
<br />For a Joint account, only the person whose 11N Is shown In
<br />Part I Should sign (When required). Exempt payees, see Fxonpt
<br />Pays* on page 2.
<br />Signature roqutromenta. Comploto the celtlikallon so Mtlicated
<br />In 1 through 6 below.
<br />1. Interest, dividend, and barter exchange accounts
<br />opened before 1884 and broker accounts wholdomd active
<br />during 1803. You must give your correct TIN, but you do not
<br />have to sign the certification.
<br />2. Interest, dividend, broker, and boner exchange
<br />accounts opened after 11183 and broker accounts considered
<br />Inaelive dudeg 1883. You must sign the ceNflcalloin of backup
<br />wtlhl0 ding will apply. If you are subject to backup wllNlolding
<br />and you are merely providing r correct TIN to the requester,
<br />you must cross out Item 2 In the you ceNfncalfore before along the
<br />o
<br />tm.
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