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<br />TRANSACTION REPORT
<br />SEP/25/2007/TUE 03:54 PM
<br />
<br />P.Ol/Ol
<br />
<br />
<br />RECEIVER
<br />99948377
<br />
<br />Farm W-9 '.
<br />
<br />(AllY. .-...y 2005)
<br />DooA"_1 ar.. TlRSUIY
<br />.....~.,.. .
<br />~ NalnIii (es shown on )IOU' Incoma fa re~
<br />m '
<br />iP
<br />Co 8usinIIS$ 1IItI11e, if dIIr,"", 110m abaYe
<br />15
<br />.:
<br />J:D
<br />
<br />II
<br />
<br />t ' City, state, Ilnd ;zIP Qlda
<br />.
<br />
<br />~ Li5t -=xmI1lIIlnber(8) hen! 4cPlIona'
<br />crJ
<br />
<br />
<br />ECM
<br />
<br />
<br />TYPE/NOTE
<br />OK
<br />
<br />Request for Taxpayer
<br />'Identification, Number and CertIfIcation
<br />
<br />. 1nc111IlduaII
<br />Check epproprfale tIOlC: 0, Sale pmprietDr
<br />
<br />Adcte8!l tlumIter, street, and ept. Or S\IlIe nD.)
<br />
<br />GlVebnn to 'the
<br />NqUider. Do not
<br />senclb the IRS.
<br />
<br />, . ExeaftflDm IllIdIIp
<br />o DCfw. .;................. 0 ~
<br />, ~$ nlmellnd addta& (apIAI)
<br />Citl of Zephyrhills
<br />2~~~y~~~1~~~Ft 33542
<br />
<br />FAX 81~-780-0005 p-hone 813-780-0000
<br />
<br />o Corponlllon 0 PIl1nc_
<br />
<br />EntIiI" yow TIN In the 8IIPI'Clf)Ifate bole. The llN pnMdId nUt match 1he name given on U1$11u ImIid ~
<br />badwp wIthhokrmg. For individuals. 1hIs Is )ct.r eCldsl securily runber (SSN). HoweV8l'. far a resldent ~
<br />aIen. lIClIe "'....mmr. or dlsNQa...ll.d entiy. IIee the P.r I hstnJctIone 01'1 piIge 3. For other erllities. it" ' '
<br />)IIlUr employer ldentllfcalfon numbIr tBfIt. If ~ do not h8ve a ntmber. see How m get.a TIN (1ft plge 3. or
<br />Note. If the at:aJUIJt Is 1n'1IIOtJI thsn one name, see the dJatt on page.4 tbr guidelines ~ whor;e ncmber 1 ~ 1denIliadIocI~.":,,, .1 .
<br />UJ em.r. '. . LL..:LLL.LLl-LL
<br />IIDII Certification . '. '
<br />Under petllllies of perjury, I certify f18t:
<br />1. The number shawn on this form is my carnlCt taxpayer Identificatiun number (or I am WIIilin5l far al'lUnlber to be issued fD ,...; end
<br />2. . I am not ~ 10 beckIp wIlhholdlng bec:ause: fI) , am' exempt fl'am bcIcup wIlHKlIlIng, CII' tb) , have PDt been nodIed by _Intemal
<br />, Rewenw Servk:e (IRS) 1haI1 am subject 10 bac:IqJ wIlhhaIdIng as a III&UIt of a faDtn 1D RIpQIt .. intenlst ar dividends, or (c) the ~ has
<br />. nollfled me that I am no longer sublect to ~ withholding, lIIld '
<br />3. I am a U.S. person ('n:Iuding a U.s. leSldent aIen)..
<br />~ hstruc;tions. You must cross out item 2 8bcM! If you have been nClllll8d by the IRS that you tR amently subject to ~
<br />wIlhhoIcing ~ you haW f8Ied to repc:ll't aII,lnlentst and dMdende on your 1Euc feUn. Far rat esf3le fransactlot IS, item 2 doeS not epply.
<br />For ~ Interest plilId, acquIsI\Ian or abandonment of SllCUIIld property, ~ d debt, cortiJuIians 110 IIfl h:fMduaI....uent
<br />~..~ (IRAJ. end genenllly, payrnlHlI$ alher then intEn=t ... dMdends, you are not MqUhd to &ign the CertIlIcaIIGn, but,m must
<br />pavlde yew correct TIN. (See the inItructions on pIgll 4~
<br />
<br />IlIign ] ....... of
<br />Here u.s. ....-...
<br />
<br />Purpose of Fonn . ,
<br />A penson lVho is requfr8d to fie an infurmation mum with 1he
<br />IRS. must obtain your CXlIreCt taxpayer Idehllflcatlon number
<br />, (f1N) to r8JlOft.' for e1cample, income psld to you, real estate
<br />1rBnsactlons. mortgage Interest you paid, acqUIsItIon or
<br />abandoIment of seand prcps:ty, cancella60n of debt, or
<br />CXlf'IIIfbdtioi you made to an 1M.
<br />us. person. Use Fann w-g any if you ar8 a U.S. person
<br />(including a resident alien), to provide your correct TIN to the
<br />. person requestil'1g it (the ~lIeStet) 8nd, when appflCable, to:
<br />1. Certify inat the llN yoU III"e giving Is correct (or you are
<br />waiting for a number 10 be issued), , .
<br />2. Certify that you are not subject10 backup wlthhQIdlng,
<br /><< , . ,
<br />S. Claim exemption from backup withholding if you are a
<br />U.S. exempt payee. '. . .
<br />. Note. If a ~ gives you a form ather than Foni7 W-9fo
<br />. teqUetst your '77N" you must use the ~ form if it is
<br />SUbstanti~ similar to,thls Fo1m W-9. ' .
<br />, For federal tax purpose$ you are cOOsIdered a person if you
<br />are:, . .
<br />· 'An individual who Is a citizi:n ~ resident 01 the United
<br />~, .
<br />. .a n"=I~A......k""'" """",__..:__ _____.. __ ____ _'_AZ__
<br />
<br />
<br />1l r ldentltlcsllon Number IN
<br />
<br />D*'"
<br />
<br />"
<br />
<br />· Any. estale (ather tI1an a foreign estate) or trust See
<br />Regutalions sections 301.7701-6(8) and 7(a,) for s;IdIIIonaI
<br />, information.
<br />Fontign pei8on.lf you 8I'B a foreign person, do not Use
<br />. Form. W-9. Inslead. Uge the appropriate Form W-8 (see
<br />Publication 515. WIIhhoIding;of Tax on ~ Al'1E!nS
<br />.and Foreign Entities).. ,. , .
<br />Nor..esiclent BIen who betonle!t a resident aIIerL
<br />Generally, only a nonreeldent a&en individual rT1lIY use the
<br />terms of a tax tr8ldy ~ redlice or eIImnaIe U.s.. 1aX on
<br />certain t;ypes of income. HowlMlr; most talc tnaatieS contain a
<br />provision known as a -.mnu clause. . EXceptions spedIied
<br />In the saving cIau8e ~ permit an exemption from tax 10
<br />continue for c:eftaIn types of income even IIfter'the recipient
<br />, has otherwise become a U.S. ..dent Ellien for tax: p~
<br />If you ar'Il a U.s. resident a1i... who Is relying on an
<br />exception contained In the saving cI:wse of a 1aX treaty to
<br />cfairn an exelll....l.from U.S.1ax oncer1aln types of Income,
<br />you must Bttach a statement to Form W-91hat specifies the '
<br />following five items: , . "
<br />,. The treaty country. G~, tills mUst be the same
<br />1reaty uncIer whlct1 you cIairned exemption from tax as a
<br />nonresident alien. ' '
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