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Form
<br />(Rev. August 2013)DeportmentDepnent of the Treasw y
<br />Internal Revenue Ssrvios
<br />W-9
<br />Request for Taxpayer
<br />Identification Number and Cart co
<br />on
<br />Give Form to the
<br />requester. Do not
<br />send to the IRS.
<br />nxdivkdual/eoie proprietor 0 C Corpor
<br />®S Corporation [� Partnership 0 Trust/estate
<br />xemptions (
<br />):
<br />Exempt payee code Qt any)
<br />ion from FATCA reporting
<br />code (it any)
<br />liability company. Enter the taxclass ticatkfn (CaC corporation, SzS corporation, P=partnership) ►
<br />Patitdre*s (number basest, and a
<br />7733 ilociper Road
<br />e ark address (o3ptlnel)
<br />City, state, and ZIP code
<br />Neat Palm Beach, FL33411
<br />numbers) here (o
<br />Taxpayer Identification Nu be iaTIN)
<br />Enter your TIN in the appropriate box, The TIN provided must match the name given on the "Name" lin
<br />to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other
<br />entities, R is your employer identification number (El N). If you do not have a number, see How to get a
<br />T)N on page 3.
<br />Nob, If the account is in more than one name, see the chart on page 4 for guidelines on whose
<br />number to enter.
<br />rtificatlon
<br />Udder pelf deities of perjury, I certify that:
<br />1. The number shown on this form is my correct taxpayer identlfication number (pr I am waiting for a number to be issued to me), and
<br />2. I 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 />779
<br />60
<br />3. I am a U.S. citizen or other U.S. person (defined below), and
<br />4. The FATCA Codes) entered on this form (if any) Indicating that 1 am exempt
<br />Certification instructions.. You must cross out item 2 above if you have been
<br />because you have failed to report ail interest and dividends on your taxreturn.
<br />interest paid, acquisition or abandonment of secured property, cancellation of
<br />generally, payments other than interest and dividends, you are not required to
<br />instructions on page 3.
<br />Sign
<br />Here
<br />from FATCA reporting is correct,
<br />notified by the IRS that you are currently subject to backup withholding
<br />For real estate transactions, item 2 does not apply. For mortgage
<br />debt, contributions to an individual retirement arrangement (IRA), and
<br />sign the certification, but you must provide your correct TiN. See the
<br />Signature of
<br />U.S. person re
<br />General Instructions
<br />Section references are to tate internal Revenue Code unless o
<br />Future dwNopmente. The IRS has created a page on IRS.
<br />about Form W-9, at www irtgov/w9. information about an
<br />affecting Form W-9 (such se legislation enacted atter we r
<br />on that page.
<br />Purpose of F
<br />A person who le required to Nie an information return with the IRS must obtain your
<br />correct taxpayer identification cumber (TiN) to report, for example, Income pall to
<br />you, payments made to you in settlement of payment card and third party network
<br />transactions, real estate transactions, mortgage interest you Pald, acquisition or
<br />abandonment of secured property, cancellation of debt, or contributions you made
<br />to an IRA.
<br />Use Form W-9 only M you area U.S. person (including a resident alien). to
<br />provide your correct 11N to the person requesting ft (the requester) and, when
<br />applicable, to:
<br />t. Certity that the TEN you are giving is correct (or you are waiting for a number
<br />to be Issued),
<br />2. Certify that you are not subject :o backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt payee. if
<br />applicable, you are also certifying that as a U.S. parson. your allocable share of
<br />any partnership Income from a U.S. trade or business is riot subject to the
<br />c
<br />Date ►
<br />3-2014
<br />withholding tax on foreign partners' share of effectively connected
<br />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 />Note. If you are a U.S. person and a requester gives you a form other than Form
<br />W-9 to request your TIN, you must use the requester's Corm if It is substantially
<br />similar to this Form W-9.
<br />Definition of a U.S. person. For federal tax purposes, you are considered a US.
<br />person If you are:
<br />• An individual who Is a U.S. citizen or U.S. resident alien,
<br />• A partnership, corporation, company, or association created or organized i
<br />United States or under the laws of the United States,
<br />• An estate (other than a foreign estate), Or
<br />* A domestic trust (as defined in Regulations section 301.7701-7).
<br />Special rales for partnerships. Partnerships that conduct a trade or unless In
<br />the United States are generality required to pay a withholding tax under section
<br />1446 on any foreign partners' share of effectively connected taxable Income from
<br />such business. Further, in certain cases where a Form W-9 has not been received,
<br />the rules under section 1446 require partnership to presume that a partner is a
<br />foreign Person, and pay the section 1446 withholding tax. Therefore, It you are a
<br />U.S. person that is a partner in a partnership conducting 1 trade or business Th the
<br />United States, provide Form W-9 to the partnership to establish your U.S. status
<br />and avoid section 1448 withholding on your share of partnership income.
<br />No.10231X Form W-9 (Rio. 8-2013)
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