Blamk w9

Form w-9 I1
(Rev. September 2007)

Request for Taxpayer Give form to the
requester. Do not
Department of the Treasuv
Identification Number and Certification send to the IRS.
Infernal Revenue Serv~ce
N
0,
I Name (as shown on your Income tax return)
m
0) Business name, if different from above
a
$ Check appropriate box: Individual/Sole proprietor Corporation Partnership

3 Limited liability company. Enter the tax classification (D=d~sregardedentity, C=corporation. Pxpartnership) t ....... F:P",;t
2
4- 4-
C t k (see insbuctim) b
Address (number, street, and apt. or suite no.) Requester's name and address (optional)
.
a,
.-
5
City, state, and ZIP code
I
g
a
fi I --
List account number(~)
here (optional)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid security number
backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer identification number
number to enter.
fi
Under penalties of perjury, I certify that:
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
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
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
notified me that I am no longer subject to backup withholding, and
3. 1 am a U.S. citizen or other U.S. person (defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign signature of
Here U.S. person b Date b
General Instructions Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
Section references are to the Internal Revenue Code unless
otherwise noted. An individual who is a U.S. citizen or U.S. resident alien,
A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an information return with the States,
IRS must obtain your correct taxpayer identification number (TIN) An estate (other than a foreign estate), or
to report, for example, income paid to you, real estate domestic trust defined Regulations section
transactions, mortgage interest you paid, acquisition or ,7701-7).
abandonment of secured property, cancellation of debt, or
Special rules for partnerships. Partnerships that conduct a
contributions you made to an IRA.
trade or business in the United States are generally required to
Use Form W-9 only if you are a U.S. person (including a pay a withholding tax on any foreign partners' share of income
resident alien), to provide your correct TIN to the person from such business. Further, in certain cases where a Form W-9
requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that
1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
2. Certify that you are not subject to backup withholding, or
provide Form W-9 to the partnership to establish your U.S.
3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you are also certifying that as a income.
U.S. person, your allocable share of any partnership income from The person who gives Form W-9 to the partnership for
a U.S. trade or business is not subject to the withholding tax on purposes of establishing its U.S. status and avoiding withholding
foreign partners' share of effectively connected income. on its allocable share of net income from the oartnershio
Note. If a requester gives you a form other than Form W-9 to conducting a trade or business in the United states is in the
request your TIN, you must use the requester's form if it is following cases:
substantially similar to this Form W-9.
The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 (Rev. 9-2007)

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Form w-9 I1

(Rev. September 2007)

$ Check appropriate box: Individual/Sole proprietor Corporation Partnership

Cat. No. 10231X Form W-9 (Rev. 9-2007)

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