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<br /> F orm W Request for Taxpayer Give ibrrrt to the
<br /> (Rev. October 2pp7) identification Number and Certification requester. Do not
<br /> Department of the Th send to the IRS.
<br /> Internal Revenue Service
<br /> Name (as shown on your income tax retum)
<br /> ° NNi
<br /> dl Business name, if different from above
<br /> RE*C -Lr' 1 I F‘Q£ y 5 W -1rL�5
<br /> 0
<br /> at C Check appropriate box: ❑ Individual/Sole proprietor 9<orporation ❑ Partnership /1
<br /> Z. ❑ Limited liability company. Enter the tax classification (D= disregarded entity, C .orporatk n, P=partnership) ► ..4i. 1---1 Exempt
<br /> 0 0 ❑ other (see rezone) ►
<br /> s. Address (number, street, and apt. or suite no.) Requester's name and address (optional)
<br /> a2:73 F Zz••-dl °r/w.t
<br /> City, state. and ZIP code
<br /> Pe ISRsei,..1t -FL .- n l
<br /> 33 List account numbers) here (optional)
<br /> to
<br /> Part 1 Taxpayer identification Number (TIN)
<br /> Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid social security number
<br /> backup withholding. For individuals, this is your social security number (SSN). However, for a resident
<br /> alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other entitles, It Is
<br /> your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or
<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. 2.0 .: 04414183S
<br /> Part II Certification
<br /> Under penalties of perjury, I certify that:
<br /> 1. The number shown on this form is my correct taxpayer identification number (or 1 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
<br /> 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
<br /> notified me that I am no longer subject to backup withholding, and
<br /> 3. I am a U.S. citizen or other U.S. person (defined below).
<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
<br /> withholding because you have failed to report all interest and dividends on your tax retum. For real estate transactions, item 2 does not apply.
<br /> For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
<br /> arrangement (IRA), and generally, payment other than Interest and dividends, you are not required to sign the Certification, but you must
<br /> provide your correct TIN. See the instruct ns on age 4.
<br /> Sign Signature of r i
<br /> Here p•rson Date D. — - IC)
<br /> us. ►
<br /> General Instructions Definition of a U.S. person. For federal tax purposes, you are
<br /> considered a U.S. person if you are:
<br /> Section references are to the Internal Revenue Code unless
<br /> otherwise noted. • An individual who is a U.S. citizen or U.S. resident alien,
<br /> • A partnership, corporation, company, or association created or
<br /> Purpose of Form organized in the United States or under the laws of the United
<br /> A person who is required to file an information return with the States,
<br /> IRS must obtain your correct taxpayer identification number (TIN) • An estate (other than a foreign estate), or
<br /> to report, for example, income paid to you, real estate • A domestic trust (as defined in Regulations section
<br /> transactions, mortgage interest you paid, acquisition or 301.7701 -7).
<br /> abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a
<br /> contributions you made to an IRA. trade or business in the United States are generally required to
<br /> 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
<br /> resident alien), to provide your correct TIN to the person from such business. Further, In certain cases where a Form W -9
<br /> requesting it (the requester) and, when applicable, to: has not been received, a partnership is required to presume that
<br /> 1. Certify that the TIN you are giving is correct (or you are a partner is a foreign person, and pay the withholding tax.
<br /> waiting for a number to be issued), Therefore, if you are a U.S. person that is a partner in a
<br /> 2. Certify that you are not subject to backup withholding, or partnership conducting a trade or business in the United States,
<br /> provide Form W -9 to the partnership to establish your U.S.
<br /> 3. Claim exemption from backup withholding if you are a U.S. status and avoid withholding on your share of partnership
<br /> exempt payee. If applicable, you are also certifying that as a income.
<br /> U.S. person, your allocable share of any partnership income from The person who gives Form W -9 to the partnership for
<br /> a U.S. trade or business is not subject to the withholding tax on purposes of establishing Its U.S. status and avoiding withholding
<br /> foreign partners' share of effectively connected income. on its allocable share of net income from the partnership
<br /> 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
<br /> request your TIN, you must use the requester's form if it is following cases:
<br /> substantially similar to this Form W -9. • The U.S. owner of a disregarded entity and not the entity,
<br /> Cat_ No. 10231X Form W -9 (Rev. 10 -2007)
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