|
• Aak r•►
<br /> Form W-9 Request for Taxpayer Give Form to the
<br /> (Rev.August the
<br /> Identification Number and Certification requester.Do not
<br /> Internal ev of the Treasury send to the IRS.
<br /> Internal Revenue Service
<br /> Name(as shown on your income tax return)
<br /> amcAc"3 c-
<br /> N Business name/disregarded entttt name,if d Brent from above
<br /> m
<br /> rn
<br /> rL Check appropriate box for federal tax classification:
<br /> o IIbb�� Exemptions(see instructions):
<br /> 0 ❑Indtvidual/sole proprietor �C Corporation ❑S Corporation ❑ Partnership ❑Trustiestate
<br /> C I _
<br /> o Exempt payee code(if any)
<br /> a ❑ Limited liability company.Ester the tax classification(C=C corporation,S=S corporation,P=partnership)lb-
<br /> 0 Exemption from FATCA reporting
<br /> to is
<br /> c c code(if any)
<br /> ILn ❑ Other(see instructions)►
<br /> Address(number,street,and apt.or suite no.) Requester's name and address(optional
<br /> nooc S44t 6
<br /> m City,state,and ZIP codeCO pA
<br /> p�
<br /> 'rolAfln.Clr1, SO
<br /> List account number(s)here(optional)
<br /> Taxpayer Identification Number(TIN) .
<br /> Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line Social security number
<br /> to avoid backup withholding.For individuals,this is your social security number peg However,fora _m _
<br /> resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other
<br /> entities,it is your employer identification number(EIN).If you do not have a number,see How to get a
<br /> 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 Employer Identification number
<br /> number to enter.
<br /> � - :31414
<br /> Certification
<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. 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
<br /> 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
<br /> no longer subject to backup withholding,and
<br /> 3. 1 am a U.S,citizen or other U.S,person(defined below),and
<br /> 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct.
<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 withholding
<br /> 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
<br /> interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and
<br /> generally,payments other than' terest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the
<br /> instructions on page 3.
<br /> Sign signature of A �-
<br /> Here U.S.person► Date► D*
<br /> 01,6
<br /> General Instruction withholding tax on foreign partners'share of effectively connected income,and
<br /> Section references are to the Internal Revenue Code unless otherwise noted. 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are
<br /> exempt from the FATCA reporting,Is correct.
<br /> Future developments.The IRS has created a page on IRS.gov for information Note.If you are a U.S.person and a requester gives you a form other than Form
<br /> about Form W-9,at www4s govM9.Information about any future developments W-9 to request your TIN,you must use the requester's form if it is substantially
<br /> on that page.
<br /> affecting Form W-9(such as legislation enacted after we release it)will be posted similar to this Form W-9.
<br /> Definition of a U.S.person.For federal tax purposes,you are considered a U.S.
<br /> Purpose of Form person if you are:
<br /> A person who is required to file an information return with the IRS must obtain your 'An individual who is a U.S.citizen or U.S.resident alien,
<br /> correct taxpayer identification number(TIN)to report,for example,income paid to •A partnership,corporation,company,or association created or organized in the
<br /> you,payments made to you in settlement of payment card and third party network United States or under the laws of the United States,
<br /> transactions,real estate transactions,mortgage interest you paid,acquisition or .An estate(other than a foreign estate),or
<br /> abandonment of secured property,cancellation of debt,or contributions you made
<br /> to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7).
<br /> Use Form W-9 only if you are a U.S.person(including a resident alien),to Special►alas for partnerships.Partnerships that conduct a trade or business in
<br /> provide your correct TIN to the person requesting it(the requester)and,when the United States are generally required to pay a withholding tax under section
<br /> applicable,to: 1446 on any foreign partners'share of effectively connected taxable income from
<br /> 1.Certifythat the TIN you are giving such business.Further,in certain cases where a Form W-9 has not been received,
<br /> Y 9 fig is correct(or you are waiting for a number the rules under section 1446 require a presume to be issued), equ partnership to a that a partner is a
<br /> foreign person,and pay the section 1446 withholding tax.Therefore,if you are a
<br /> 2.Certify that you are not subject to backup withholding,or U.S.person that is a partner in a partnership conducting a trade or business in the
<br /> 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If United States,provide Form W-9 to the partnership to establish your U.S.status
<br /> applicable,you are also certifying that as a U.S.person,your allocable share of and avoid section 1446 withholding on your share of partnership Income.
<br /> any partnership income from a U.S.trade or business is not subject to the
<br /> Cat.No.10231X Forth W-9(Rev.8-2013)
<br />
|