Fonn W•9

[Rev, Octbb6r 2018) Identific

Request for Taxpayer
ation Number and Certification
Give Form to the
requester. Do not
De~nt of the Tn:asul')I send to the IRS.
lntl!mal RMooa Servi~ ► Go to www,f1'.gov/FormW9 for Instructions and tho fates1 Information.
1 Nan\o (as shown on your Income tax return). Name Is required on this lino: do not ltave this lino blank,

N Pi"U,SH- ~IX\ lM Pt i':?XZ.\Jl

2 Business nama/dlsragarcled entity nlllne, tt different from abovo

(')
.. 3 Cheol< llpp!Opl'iate box for foderol tax classification of the person whose name Is entertd on line 1, Check
only one of the 4 Exomptione (codes appl)I onl)I to

als 0 foHow1ng seven boxes.

lndividuaVsole proprietor or D C Corporation 0 S Corporation 0 Partn~p 0 Trust/eafate

certaln entl\11!$, ll01 individuals; see
fnstructJons on paQe 3):

. .,
Cl C
si1gle-member LLC Exempt payee code (If al'l'J)
---
!:i 0 Llmlted llabllty oompeny. Enter 1he tax classification (C...-C corporation, g,,g corporaljon, P..Partnershlp) ►---
Do not check Exemption from FATCA reportr,g
Note: Check the appropi1ate box- In l he llne above tor the tax classification of the single-member owner.
ii
.t ~
LLC 11Ille U.C is classified as a single-member LLC that Is dlsr09arded from the owr,e,: unless tM owner
anoUler LLC 1hat Is not disregarded from the ownedor U.S. federal tax purposes. Otherwise, a
Is disregarded from the owner should check the appropriate box for the !alt classlffcation of Its owner.
or the LLC Is code Qr any)
single-member LLC that

i n
Cl Other (see lnstructioosl ► ~..- - -... CJ.3J
Q,
U) 5 Address (number, street, and apl. or suite noJ See instructions. Requesters name and address (optionaO
~
en '30\ LON6 OP-.~ 1)~\\Je
6 City, ~ te.-and ZP code
P~ , O N I (:PtL,t,pO (< N lA qLfSbb .
7 Ust account m.rnber{s) here (optiona~

...
•:r.1 , Taxnayer Identification Number (TIN)
Enter your TIN In 1he appropriate box. ~ TIN provided must match 1~e name given on line 110 avoid
backup Withholding. Forlndlvlduals, th1s1s generallyyoursoclal securi1y for
resident alien, sole proprietor, or disregarded entity, see the Instructions
number(SSN). However, for a
Part I, later. For o1her
entities, It is your employer identiffcation number (EIN). If you do not have a number, see How to get a
oo, -I'··I'',
I Social security number

D '1' 'f'
_,o It lo IgI
l:)

TIN, later. Fo=r--=-....,..,,.......,=-..,,...---=,-----'-,

Note: If the account ls in more than one name, see the lnstnictions for line 1. Also see What Name and I Employer ldentific;atlon nimber
Num/:;>er To G/Ve the Requester for guidelines on whose number to entei-.

Certification
Under penaffies of pe~wy. I certify that
to be issued to me); and
1. Toe number shown on this form is my correct taxpayer jdentification number (or I am waiting for a number
have not been notified by the Internal Revenue
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, c,r (b) I
or (c) the IRS has notified me that l am
Service ORS) that I am subject to backup withholding as a result of-a fallure to report all interest or diVldends,
no longer subject 'to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating 1hat I am exempt from FATCA reporting is correct.
are currently subject to backup withholding because
Certiftcation instructions. You must cross out item 2 above if you have been notified by the IRS that you
you have failed to repo,t all interest and dMdends on your tax rewm. For real estate transactions, Item 2
does- not apply. For mortgage Interest paid,
arrangement QRAJ, and generally, payments
acquisition or abandonment of secured property, canoeliatlon of debt, contributions to an individual retirement
TIN. See 1he instn.Jctlons for Part II, latei-.
other than int~rest and dividends, you re not required to sign the certification, but you must provide your correct

Sign Slg,nature of ~
Here US.person ► - /
General Instruct ions
Section.references are to the Internal Revenue Code unless otherwise
noted.
Future developments , For the latest information about developments
related 10 Fonn W-9 and its instructions, such as legislation enacted
after they were published, go to www.lr.s.gov/FormW9.
Purpose of Form
An individual orentity (Form W·9 requester) who is required to file an
information return with the IRS must obtain your correct t<l)(payer
identification number (TIN) which may be your social security number
(SSN), indhlidual taxpayer Identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report 011 an information return the amount paid to you, or other
amount reportable on an Information return. Examples of Information
returns include, but are not rimited to, the followfng.
• Form 1099-INT Onterest earned or paid)
Cat. No. 10231X
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099·6 (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real es1ate transactions)
• Fonn 1099-K (merchant card and third party network trahsactlons)
• Form 1096 (tlome mortgage interest), 1098-E (student loan interest),
1096-T ~uition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only if you are a U.S. person Qncludlng a resident
aften), to provide your correct TIN.
If you do not retum Form W-S to the requester with a T1N, you might
be subject to /,ackup withholding, See What is backup withholding,
later.
Foon W-9 (Rev. 10-2018)
 Pag e~

Fonn W-'J (Rev. 10-2018)

, you:
Example. Mfc le 20 of the
exem ptio n from tax for schd
U.5. -Chl na inco me. tax treat
lars hip in7° me rec erv t S :y t
yC:!<>ws an

Stat es. n ?r . • . h~ s1a

in the Unit ed
In
•:=\us
2.J
By signing the filled -ouH orm stud ent temp orar ily pres ent s rf his or h
g ls corr ect (or you are wait
ing for a den t alien for tax purp ose
1. Cert ify that the TIN y.0u are givin stud ent will bec ome a resi , para grap
stat es exce eds 5 cale nda r year s. How ever
the Unit ed
.-Ch ina trea ty (dat ed Apn
l 30, 1984) ~ lows
num bllr to be issued), or the first Prot ocol to the U.S
2. Certify that you are not subj
ect to back up with hold ing, 0 con tinu e to app ly evenafte r t~e C/:unese
the prov ision s of Artie~ 201
exem pt of lhe Unit ed States. A Chin
you are a U.S. ese
up with hold ing if t allen
3. Claim exemption frocn back fying that as a U.S. person, y_o ur stud ent beco mes a resi den
ptio n (und er para grap h 2
~f the first
you are also certi for this exce
payee. If applicab le, e or b,usmess stud ent who qual lfles exe mpt ion from tax
hip Inco me from a U.S. trad this exce ptio n to claim an
allocable share of any part ners 01 pro!DcoO and Is relyi ng on atta ch to FOITTI
tax on forei gn part ners ' shar e or fello wsh ip Inco me wou ld
Is not subject to the· with hold ing on his or her scho larsh ip lnfon mati on des crib ed above
to
and that Inclu des the
effectiVely connected Income, Indic ating W-9 a stat eme nt
ente(ed on this form Qf any)
4 Certify that FATCA code{s) See What Is supp ort that exe ~ptr on. requ este r the
~ repo rting , is corr ect. or a fore ign entit y, give the
that you are exem pt from the
FA
lon.
Jf you are a non resi den t alien 823 3.
er 1nto rmat W-8 or Form
FATCA reportiilg, later, for furth othe r . appr opri ate com plet ed Form
and a requ este r gives you a formrs form 1f
Note: 11 you are a U.S. person you mus t use the requ este
than Form W-9 to requ est your TIN, Ba ck up Withholding ain pay men ts to you
tt is subs tanti ally slmllar to this
Form W-9. ing? Pers ons mak lng cert
Wha t Is bac kup with hold pay to the IRS 24% of sac
h
Oefl nlflo n of a U.S. pers on.
For federal tax purp oses, you are mus t und er cert arn cond ition s with hold and
"bac kup with hold ing. • Pay men ts that may be
you are: d
considered a U.S. person If paym ents . This (s calle mpt lnter£l:SI.
citiie n or U.S. resident alien
; ing inclu de inter est, !3X- e.xe
• An individua l who is a U.S. subj ect to bac kup with hold ang e tran sact ions , rent s, roya lties ,
crea ted or bart er exch
pany , or asso ciati on divi,:iencls, brok er and 'l'181'lt carf=l and
• A partne,:ship, cor:J?Of8tiQl'I, com
Stat es; mad e in sett lem ent of p,iYJ
or unde r the laws of the Unit ed none mplo yee pay, paym ents ain pay men ts from fish ing
boa t
organized In the United States third.par ty netw ork tran sact ion~ , and cert
ign-estateJ;°or are not su&J ect to bac kup
• Ari esiate (other than a fOl'e .770 1-7) . oper ator s. Real esta te 'tran sact ions
dom estiC "trUs t (as defin ed 1n Regulations sec1Jon 301 with hold ing.
• A t a trad e or men ts you .
. Partnerships that con duc bac kup witn hold ing on pay
Spec ial rules for partnerships generally required to pay a with hold ing You will not be subj ect ,to er
ed Stat es II!'!! give the requ este ryou rcer rect TIN, mak e-th e prop
bu$lhess In the Unit re9elve Jfyo u on you r
foreign part ners ' share of effuc
tivel y
rt all· you r taxa ble rnterest and divi den ds
tax under section 1446 on ~Y such business., Further, in certa in cases certi ficat ions , and repo
coM ecte d taxa ble Inco me from
been received, the rules unde
r sect ion 1446 tax return. hold ing if:
where, a Form W-9 tias not be sub ject to bac kup with
to pres ume that a part ner is a foreign pers on,
and Payments you receive wiD
require a partn ersh le
Therefore, if you are a U.S.
pers on to the requ este r,
pay the sect ion 1.446 With hold ing tax. in the 1. You do not furnish you r TIN ions for
ip cond!Jciing a trad e-or business your TIN wt)e n requ ired (see the inst ruct
that is a partner in a partnersh 2. You do not cert ify you r
State s, prov ide Ferm W-9 to the parfneFShip to establlsh ils),
United
1446 with holding on your shar
e of Part If for deta rrec t TIN,
U.S. status and avoid section r that you furn ishe d an Inco
3. The IRS tells the requ este hok fmg
partnershlp income. W-9 to the are sub ject to bac: l<up wlth
Wing pers on mus t give Form 4. The IRS tells you that you s.on you r tax
In the case s below, the follo its U.S. statu s and avoi ding you did not repo rt all ycu r inte rest and dMd end ·
of esta blish ing beca use
partnersh ip for p u ~
the part ners hip est and divid end s only ), or
8har e of neti nco me from retu rn (for repo rtab le inter to
wlthholdir,g on its allocable u~ r that you are not sub
ject
a trade or busi ness in the Unit ed Stat es. 5. You do not certify to the req rest and divi den d
4 abo ve (for repo rtab le inte
concluctin g
the U.S. own er backt1p with holding und er
ed entit y w ith a U.S. own er,
• In the case -of a disregard 3 only ).
y and not the entit y; acco unts ope ned afte r 198
of~ disregarded entit r U.S. owner, are exe mpt from bac kup
with hold ihg.
• In the case of a gran tor trus
t with a U.S: gran tor or othe Certain paye es and paym ents the sep arat e Inst ruct ions for the
own er of the grantortrust and e code , later , and
,generalty, the U,S. 9fW11or ·o, other U.S. See.Exempt p,aye mor e lnfo nna tion .
not the trust; and R~u este r of Form W-9 for
, -the U.S. trus t hips, earlier.
(other than a gran tor trust)_ Also see Spec ial ll.l{es for partne/S
• In lhe case of a U-$..1rust the bene ficiaries of the trus t.
r trust ) and not g?
(other than a_granto
a forelgn person or the U.S. bran
ch of a Wh at is FATCA Re po rtin
Fo~ ign pe,s on. If you are_ ted aS' a U.S. pers on, do not use plian ce Act (FATCA) requ
ires a
foref91) -"8n k that has elected-t
o be trea
8233 (see The Forei~n A~ nt Tax. Com rt all Unit ed Stat es
ppro priat e Form W-B or Form finan cial Insti tutio n to repo
Form ,Vf-9 . !!)Stead, use the,a lent Allen s and Fore i"n part lclpa ting fore19n
ified Unit ed Stat.e s pers ons,
Cert ain
resic
Pub, 515, Wrthholding ofTa
x on Non ,. acco unt hold ers that are spec rting . See Exemption from
FAT CA
Entities). ' pt from FAT CA repo
payees are exem ions fur the Req uest er of
Fon n
a erally, only a Inst ruct
me$ ~Jd ent alien . Gen 1'8f'0rting cod7 later , anc nne
Non t'Mlc lenta ll1m wl\o beco tax tl"ea ty to redu ce
may use the term s of a W-9 for mor e infor mati on.
n~ de nt alien lndM duiil s of inco me. How ever, mos t tax
in type
9r e~n ate U.S,·tax on certa
tr~ ~ c<;>ntain a J>!'OVfslon
know n as a •saving clause.•
ex~
Exceptions
ptio n from tax to
Updating Your Information to who m ou
se may pe,m lt an info rma tion to any pers on
spe<:ffied In the saVJOg clau e has otherwise You mus t provide upd ated mpt ta ee
inco me ·even afte r the paye If you are no long er an exe
continuecfor c~rtal_n types1:>f tax purp oses. claim ed to be an exe mpt paye e
futu re from thfu
resid ent alien 'for rtable paym ents in the
becomJ! a U.S. and antic ipate rece iving repo
who is relying on an exce ptlon ated info rma tion if
If '}'911 <1r11 ·a U.S. ~ld ent ali,en a tax trea ty to clafm an exem ptioh may nee d to prov ide upd
person. For exam ple, you S corp orat ion or H you no
se pf elec ts to be an
contained In the saving clau s of income, ycu mus t atta ch a state men t you are a C corp orat ion that Form W-9 if
from l.J.S. tax on Cf!l'lal!" fype tax pt. lo addi tron , you mus t furnish a new
to Fenn W-9 that specifies.
the Jol!Qwfng five Items. long er are exem
t for exam ple if th.e gran tor of
for the acc oun a
e treaty unde r
erally, this mus t be the sarn allen. the nam e or TIN chan ges ' •
1~;p,e treaty country. Gen nonr esid ent gran ter trus t dies .
=
wh1 )'.O\I claimed exem ption from tax as a
the inco me.
2. The 'treaty article addressing Penalties
on ) in the tax trea ty thai
cont ains the
fall to furn ish you r correct
TIN to a
~a e~ :~: ~~ ~~ ~:p \=. Fail ure to furn ish TIN. If you re
exem ption are subj ect to a pen al!¥ or $50 for each such faJJu
qualifies for the :que ster , yo~ ul neg lect.
fro~ 1:;_ type a(ld amount of inco mei hat
• ~ your failu re Is due to reas onab le cau6 6 and not to willf
eot to • .
pti s of rma tion with
,,_,. ,.h e exern
5. Sufficient facts to j•_,,, , ', on from tax unde r the term C,vl f penalty for fals e Info son ab~ sis tha ~~ in9 .
If you
the treaty arficle. eme nt with no rea
mak e a false stat to a $ 500 pen alty ~ n no ·
ing, you are subj ect
back up with hold

u
Fom1 W-9 (Rev. 10-2018) Paga3

Criminal penalty for falsifying Information. Wlllfully falsifying IF the ontlty/person on line 1 ls THEN ohcck the box for • .•
certifications or atllrme.tion.s may subject you to crimlnal penalties a(n) ...
Including fines and/or Imprisonment.
M1$us. of TINs. If the request• dlsc;l0$e$ or uses TIN$ in violation of • Corporation Corporation
federal law, the requester may be subject to civil and criminal penalties. • Individual lndividuaVsole proprietor or single-
• Sole proprietorship, or member LLC
Specific Instructions • Single-member limited liability
company (LLc) owned by an
Une1 lndlvldual and disregarded for U .S.
You must emer one of the following on this line: do not leave this fine federal tax purposes.
blank. The r\a/1'\e should match the name on your tax return.
• LLC treated as :i partnership for Limited liability company and enteI
If this Form W-9 is tor a joint account (other than an account U.S. federal tax purposes, the appropriate tax classification.
maintained by a foreign financial lnstitut1on (FFm, list first, and then • LLC that has flied Fprm 8832 or (P= Partnership; C= C corporation;
circle, the name of the person or entjty whose number you entered in 2553 to be taxed as a corporation, or S= S corporation)
Part I of Form W-9. If you are ~ i n g Form W-9 to an FA to document or
a joint account, each holder of Iha account that rs a U.S. pell!on must
• LLC that is disregarded as an
provide a Form W-9.
entJty separate from its owner bul
a. Individual. Generally, enter the name shown on your tax return. If the owner is another LLC that is
you have changed your last name without informing the Social Security not disregarded for U.S. federal tax
Administzallon (SSA) of the name change, enter your first name, the last purposes.
name as shown on your social security card, and your new last name.
• Partnerstip Partnership
Note: mN applicant Enter your imfividuat name as It was enlen:d on
your Form W-7 application, Une 1a. This should also be the same as the • TrusVestate Trust/estate
name you entered on the Form 1040/1040A/1040EZ you filed with your
application.
Une 4, Exemptions
b. Sole proprietor or single-member LLC. Enter your individual If you are exempt from backup withholding and/or FATCA reporting,
name as Shown on your1040/1040Af1040EZ on line , . You may enter enter in the appropriate space on line 4 any code(s) tlJat may apply to
· yol.r business, Ira.de, or "doing business as· (OBA) name on One 2. you .
c. Partnarghip, LLC that ls not a.sln;9te-member LLC, C Exempt payee oode.
corporation, or S corporatlol\. En1er the entity's name as shown on the • Ger,erally, individuals Oncludlng sole proprietors) are not exempt from
entlty'e tax reun on ine 1 and arry business, trade, or OBA name on backup withholding.
llne2. • Except as provided below, corporations are exempt from backup
d . Other entltie$. Errter your name as shown on required U.S. fedenil withholding for cet'tllln payments., including interest and dividends.
tax documents on Dne 1. This name should match the name shown on the • Corporations are not ex.empt from backup withholding for payments
charter or other legal document creating the entity. You may enter any made In settlement of payment card or third party netwoli< transactions.
business, trade, or OBA name on Una 2. • Corporations are not exempt from backup withholding with respect to
e. Dlsragarded entity. For U.S. federal tax purpose$, an entity that Is attorneys' fees or gross proceeds paid to attorneys. and corporations
disregarded as an entity separate from its owner is treated as a that provide medical or health care services are not exempt with respect
"disregarded entity." See Regulations section 301.no1-2(c)(2)(iiQ. Enter to payments reportable on Form 109!>-MISC.
the owner's name on line 1.!he name of the entity entered on Une 1 The following codes Identify payees that are exempt from backup
should never be a dlsragarded entity. The name on line 1 should be the withholding. Enter the appropriate code in the space in ine 4.
natne shown on the income tax. retum on which the income should be
reported. For example. if a foreign LLC that Is treated as a disregarded 1 -An organization exempt from tax under section 501 (a), any IRA, or
entity for U.S. federal tax purposes has a single owner that is a U.S. a custodial acoount under section 403(b)(7) If the account satisfies the
person, the U.S, owner's name is required to be provtded on line 1. If requirements of section 401 (1)(2)
the direct owner of the entity is also a dfsregarded entity, enter the first 2-The United states or any of Its agencies or instrurnentalltles
~ r that is not disregarded tor federal tax purposes. Enter the 3-A state, the Dlstrict of Columbia, a U.S. commonwealth or
disregarded errtfty's name on line 2, "Business name/disregarded entity possession, or any of their political subdivisions or instrumentalities
name." lfth"~wner of the cfasregarded entit,y Is a foreign person, the
owner must complete an appropciate Form W-8 i nstead of a Form W-9. 4-A foreign go'lemment or any of its political subdlvisions, agencies,
'This Is the case ~ If the foreign persoo has a U.S. TIN, or Instrumentalities
5-A corporation
Une2 6-A dealer In securities or commodities required to register In the
If you have a business name, trade name, OBA name, or disregarded United States, the District of Columbia. or a. U.S. commonwealth or
entity name, you may errter rt on line 2. possession
Une3 7-A futures commission merchant regisrered with the Commodity
Futures Trading Commission
Cheek the appropriate box on ffne-3 for the U.S. federal tax
classification of the person Whose name is entered on line 1. Check only 8-A real estate ln'lestment trust
one box on r111e 3. 9-An enlityreglstered al all times during the tax year under the
Investment Cornpany Act of 1940
10-A common trust fund operated by a bank under sectlon 584(a)
11 -A flnanclal Institution
12-A middleman known in the investment community a.s a nominee or
custodlah
13-A trust exempt from tax under section 664 or described in section
4947
FOfln W-9 (Rev. 10-2018)
Page4
The following chart shows types of paymen ts that may
be exempt M-A tax exempt trust under a section 4O3(b) plan or
from backup withhold ing. The chart eppfies to \tie exempt section 457(g)
payees fisted plan
above, 1 through 13,.
IF the paymen t Is for . • • Note: You may wish to consult with the financial institutio n
THEN the paymen t is exempt requesti ng
this form to determin e whether the FATCA code and/or
for ••• exempt p11yee
code should be comptat ed.
lnterest and dividend paymen ts All exempt payees except Line 5
for7
Enter your address (number , street. and apartme nt or
Broker 1ransactions Exempt payees 1 through 4 and 6 suite number) .
This Is where1.he requeste r of this Form W-9 will mail
thf'Ol.lgh 11 and all C corporat ions. your informat ion
returns. If this address differs from the one the requeste
S corporat ions must not enter an r already has on
file, write NEW at the top. If a new address is provided
exempt pay~ code because they , there ts stiU a
chance -the old address wm be used until the payor changes
are exempt only for sales of your
address In their records.
noncove red securttie s acquired
prior to 2012. Line 6
Barter exaiang e transact ions and exempt payees 1 through 4 Enter your city, state, and ZIP code,
patronag e dMdend s
Paymen ts over $600 required IX> be Generall y, exempt
Part I. Taxpa yer Ident ificati on Numb er (TIN)
payees
reported and direct .sales 01181' Enter your TIN in the apptopr late box. If you are a residem
1
1 through 5" you do not he11e and are not eligible to get an SSN, your
alien 1!11d
ss,000 TIN is your IRS
Individua l taxpaye r identiflca bon number (ITIN). Enter
it in the social
Pe,yments made In settleme nt of security number box. If you do not have an mN, see How
Exempt payees 1 through 4 to get a TIN
pay,J'l81l t card
or third party networl< below.
transact ions If you are a sole proprieto r and you have an EIN, you may enter
either
your SSN or EIN.
' See Form 1O99-MI SC, Miscella neous Income, and Its
lns1Nctio ns. If you are a single-m ember LLC 1hat ls disregar ded as an entity
2 separate from its owner, enter the owner's SSN (or BN,
However, the following ~ent s made to a con>ora tion and if the owner has
r~ortab le on Form 1099-MI SC are not exempt from back\Jp one). Do not enter the cfisregarded entity's EIN. If the
LLC is classlfle d as
withhora mg: medical and health care paymen ts attorney
s' fees gross
a corporat ion or partners hip, enter the entity's SN.
proceed s paid to ~ attorney reportab le under ~ o n
6045(1}, ~ Note: See What Name and Number To Give the Rilquest
er, later, for
paymen ts for se,v,ces paid by a federal executiv e agency. further clarificat ion of name and TIN combina tions.
•
exempti on fTom FATCA reportin g code. The following How to get a TIN. If you do not have a TIN, apply for
cocles identify one Immedia tely.
payees that are exempt from reporting under FATCA. These codes To apply for an SSN, get Form SS-5, Appllcat lon for a Social
apply to persons .submitt ing this form for ae<:ounts maiotain Security
ed outside Card, from your local SSA office or get this form onllne
of the United States by certain foreign financial institutio at
ns. Therefor e, If www.SS A.gov. You may also get this form by calling 1-800-7
you are onlY $\Jbmitti ng th!s fom, Jor an account you hold 72-1213 .
i n the United Use Form W-7, App0cat ion for IRS lndMdua l Taxpaye
States, you may leave this field bjwik. Consult with the person r Identific ation
Nu.m ber, to apply for an ITIN, or Form SS-4, Applicat ion
requesti ng 1tii.s form if you are uncertai n ff the financial for Employe r
institutio n is Identifica tion Number, to apply for an EIN. You can apply
subject to these requirem ents. A requeste r may indicate for an EIN
that a code is onllne by accessln g the IRS website at www.lrs.gov/Bus
not required by providin g you with a Form W-9 with " inesses and
Not Applicab c~cking on Employe r Identifica tion Number (SN) under
any similar lndicatlo n)-writte n or printed on the line for a FATCA le" (or Business . Go to www.irs-.gov/F011T1s to view, downloa d,
Starting a
exempti on code.. or print Form
W-7 and/or Form SS-4. Or, you can go to www.frs.gov/Ord
))lace an order and have Form W-7 and/or S$-4 mailed
erForms to
A-An org;anization ex.empt from tax under section 501(a) to you within 10
or any business days.
indi\lidua l retireme nt plan as defined in section no1 (a){37)
B-The United States or aJ'ly of its agencies or instrume ntalities If you are asked to complet e Form W-9 but do not have
a TIN, apply
for a TIN and write "Applied Fol" in the space for the TIN,
C-A state, the District of Columbi a, a U.S. common wealth sign and date
or the form, and give it to the requeste r. For interest and dividend
possess ion, or any of their political subdivisions or instrume
ntalities paymen ts, and certain paymen ts made with respecl to
0-Acorp oration the stock of which is regularly traded readily tradable
on one or Instrume nts, generally you will have 60 days to get a TIN
more estabfish ed securities markets , as desonbe d in Regulati and give it to
ons the requeste r before you are subject to backup withhold
ing on
seciion 1.1472-1(cX1)(i) paymerr ts. The 60-day rule does not apply to other types of
paymen ts.
E-A corporat ion that Is a member of the same expande You wiil be subject to backup withhold ing on all such
d affiliated paymen ts until
group as a corporat ion describe d in Regulati ons section you provide your TIN to the requester.
1.1472-1 (c)(1)(i)
F-A dealer in securities. commod ities, or deriVative fmanclal Note: Entering "Applled For" means that you have already applied
for a
instrume nts (including notional principa l contract s, fu!J.Jres, TIN or that you intend to apply for one soon.
forwards ,
and options) that is registere d as such under the laws of the Caution : A diSfegar ded U.S. enti\y that has a foreign owner
United must use
States or any state the appropri ate Form w-a.
G-A real estate investme nt trust
H-A regulate d investm ent compan y as defined In section
Part II. Certif icatio n
851 or an
entity registere d at au limes during the taX year under To establish to the withhold ing agent that you are a U.S.
the Investment person, or
Compan y Act of 1940 resident alien, sign Form W-9. You may be requeste d
to s ign by the
withhold ing agent even if item 1, 4, or 5 below indicates
I-A common 'trUst fund as defined in section 584(a) otherwis e.
For a joint account , only the person whose TlN ls shown
J-A bank as defined in section 58'1 in Part 1
should sign (when required ). In the case of a disregar
K-Abro ker ded entity the.
peraon id~ntifled on line 1 must sign. Exempt payees.
L-A trust exempti rom tax under section 664 or describe code. earher.
see .exenii,tpayse
d in section
4947(aX1l Signatu re requirem ents. Comple te the certifica tion as
indicate d in
items 1 through 5 below.
Fomi W-9 (Rev. 10-2018)
Pago5
1. Interest, dividend, and barter exchange accounts opened
beto,e 1 ~ and broker accounts consldeted active du,1ng 1~3. For this type of account: Give name and EIN of:
You must glV8your correct11N, but yol.l do not have1o nlgn the 14. AlleoUnl ~ tho Oepa,tmenl ol The publlo enflty
certification. A.grlclllure In \he name of a public
2. Interest, dMdi:md, broker, and barter exchange accounts •~dty (lluch • • atate or local
opened after 1983 and broker accounts comildered Inactive during 90vemrnon1., &ahool dlslrlct, or
1983. You must sign the certif'1Callon or back!Jp withholding will apply. If prison) that ,_Ives agrlcultu,al
you are subJeot to backµp witt'lholdlng and you are merely providing progmm p1ymeri\a
your comiot "TIN to the requester, you muet cross oul Item 2 In the 16. 0..nlor mt 11Ung under tho Fom,
certification before signing the tonn. The ~ t
1041 FlUng Mothod Of 1ht Opllonal
3. Real ~ t e transactions . You must slgn tha certification. You may Fonn 1099 Filing Method 2 is..
croas out 1\em 2 of the certlfk:3\lon. Regutallont Hctlon 1 ,671 ""(bl(2)(i)(B))
4. othar payments. You must give your correct TIN, but you do not 1
l.i$t nr11t and circle the name of the perron whose number you fuml$h,
have to :sign the certifi~tlon unless you have been notified that you If only one peraon on a Joint account has an SSN, that person's numbef'
have preV10ualy given an Incorrect TIN. "Other payments" Include must be furnished.
payments made ln the cour8e of the requester's 1rade or business for
rents, royalties, g ~ {other than bills for merchandise) , medical and t Circle the mlnor'a name and furnish the mlnor's SSN.
health care nrvices (including payments to corporations), payments to • You must show your individual name and you may also enter your
a nooemployee for serv\et1$, payments made In settlement of payment business or OBA name on Iha "Business name/di&rega rded entity"
care! and third party networl< transactlons, payments"to certain fishing name One. You may use either your SSN or EIN (if you have one), but the
boat crew members and flshe.r mon, and gross proceeds paid to IRS encourages you to use your SSN.
attorneys Qncluding payments to corporations) ,
~ List first and c,rcle the name of the trust, estate, or pension trust (Do
S. Mortgage Interest paid by you, acquisition or abandonmen t of not furnish the "TIN of the personal representattve or trustee unless the
secured property, cancellation of debt, qualified tuition program legal entity itself is not desi"gna{ed In the account title.) Also sae Special
payments (under section 529), ABLE account& (under-sectio n 529A), rules for partnetshlps, earUer.
IRA. Coverdell ESA, Archer MSA or HSA contributions or
•Nots: The granter also must provide a Form W-9 to trustee of trust.
distributions , and pension distributions . You must give your correct
TIN, but you do not nave to sign the oertlfication. Note: If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
What Name and Number .To Give the Requester
Secure Your Tax Records From Identity Theft
Forthls'1YP& i:,faeeount: ' Give name and SSN of:
ldentlly theft occurs when someone uses your personal information
1. Individual Th& lndMdual such as your name, SSN, or other identifying lnformation, without your
2. l'wo or men lnd1vidu:ils Qont 1he actual owner ot 11\e :wcount or, It permission, to commit fraud or other crimes. An identfty thief may u~
acco~ oltler U,an 1111 account combir,cd funds, lh• fin!\ indMdual on your SSN"to get a job or may flle a tax retum using your SSN to receive
maintained by an FFI the ,account' a refund.
3. Two or more U.S. pa,sons Each holder of the a,;count To reduce your risk:
(lo.nt account maintained by an FF1) • Protect your SSN.
4. Custodial account of a minor Theml,,.,... • Ensure your employer Is protecting your SSN. and
(\Jnlfonn Gift to Minors~ • Be careful when choosing a tax preparer.
5. a. The usual r811'0Cl1ble savings 1ruSt The granter-wstee' If your tax records are affected by identity theft and you receive a
(9ran\ot Is &190 1r'IIS1N) notice from the IRS, respond right aw.ry_ to the name and phone number
b . So-<:alled INst=Ul\t that IS not Th<> actual owner1 printed on the IRS notice or letter.
a legal 0( valid trust under slate law
If your tax records are not currently affected by identity theft but you.
e. Sole proprWcnlllp or distt,gardod The owner~ think you are at rtsk due to a lost or stolen purse or wallet, questionable
entity owned by an indh1idual credit card activity or credit report, contact the IRS Identity Theft Hotline
7. Gtamor trust-t,r,ng ooder Optlon&1 The grantor- at 1-800-908-44 90 or submit Form 14039.
FOnn 1099 fl1inll MethOd 1 (iliie For more infDm\Btion, see Pub. 5027, Identity Theft lnfurmalion for
Regulallons scc:lion 1.871-4(b)l2)© Taxpayers.
W'i VICllms of identity theft who are experienclng economic harm or a
For thts 'type of account G~ name and EIN of: systemic problem, or are se'81<ing help in resolving tax probl~ that
8. Olsregardlld entity not owned by an iheownor have not been resolved through nonnal channels, may be er.gible for
Taxpayer Advocate SeNlce (TAS) assistance. You can reach TAS by
1ndlVidual calling the TAS toll-free case intake nneat 1-¥ir7-777-4n 8·or TTY/TOD
e. A validwst. es!Bte. or pension trust Legal entitl 1-800-829-40 59.
10. Corporation or U.C electi,g The corpora!IOn Protect yourself from suspicious emails or phishing ·schemes.
coq>Orata .alatUS oo Form 8832 er Phlstiing is the creation al'ld use of email and websites designed to
Form2553 mimic legitimate business emails and websites. The most common act
is sending an email to a user falsely claiming to be ~ established
Toe orgarvzalion
11. AssOtjatjon. club, religious.
Gl)ar!tabla, edueatio/1al. or other fax.
legitimate enterprtse in an.attempt to ~m tJ:ie
user into surrendemg
private informaUon ttiat w,11 be used for identify theft.
exempt o~ization
12. PartnerviiP or mll)li-membcr LLC The par1nerShip
13. A broks'or rogisterad nominee lhe broker or nominee
FOO'Tl W-9 (Rev. 10-2018)
The IRS does not Initiate contacts with taxpayers via emails, Also, the
IRS does not request personal detened Information through emall or llllk
taxpayers for the PIN numbera, passwofdS, or similar secret access
Information for their credit card, bank, or other financial accounts.
If you receive an unsolicited einall claiming to be from the IRS,
foiward this message to phlsh/ng@lrs.gov. You may also report misuse
of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (TIGTA) at 1-800-366-4484. You can
forward suspicious emails to the Federal Trade Commission at
spam@vc&.gov or report them at www.ftc.gov/complalnt You can
contact the FTC al www.ftc.gov/ldth eft or 8TT-IDTiiEFT (877-438-4338).
If you have been the victim of Identity theft, see www./dentJtyTl'left.gov
and Pub. 5027.
Vislt www.irs.gov/ldentJtyTheft to learn more about identity theft and
how to reduce your 11sk.
Page 6
Privacy Act Notice
Sec:Uon 6109 or the Internal Revenue Code requires you t o provide your
correct TIN 1o persons (Including federal agencies) Who ate required to
file Information ratume with the IRS to report Interest, dividends, or
certain other Income paid to you; mortgage Interest you paid; the
acquisition or abandonment of secll{ed property; the cancellatlon of
debt; or contr1bullon11 you made to an IAA. Archer MSA, or HSA. The
person collecting this form uses the Information on the form to file
Information returns with the IRS, reporting the above information.
Routine uses of this information include giving It to the Department of
Justice for cMJ and criminal lit!gallon and to cllfes, states, the Distrrct of
Columbia, and U.S. commonwealths and possessions tor use in
administering their laws. The Information also may be disclosed to other
countries under a treaty, to federal and state agencies to enforce civil
and criminal laws, or to federal law enforcement and Intelligence
agencies to combat terrorism. You must prollide your TIN whether or
not you are required to file a tax return. Under section 3406, payers
must generally withhold a percentage of taxable Interest, dividend, and
certain other payments lo a payee who does not give a llN lo the payer.
Certain penalties may also apply for providing false or fraudulent
information.