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07/16/2010 13:25 3217831516 -1 NEW FAX! SPACE COAST PAGE 03/03
<br /> Fom Request or Taxpayer i Give fern to the
<br /> (Rev. OCCber 2007) er. Do not
<br /> Iderlitlficatian plumber and Certification 1 request` send to the IRS.
<br /> eztir•M .r tna Treasury
<br /> internal Revenue sanice
<br /> ( !Varna ('•4 Fhpwn on yci !- Ornf tax return)
<br /> o I
<br /> • ° pace ^ cast • F and S a f ety !nc
<br /> D 1 Ejc n^p nsrre. If y -rapt r. -r.., 7ht-'
<br /> a
<br /> a c • I Check =- ppropr'•a12 box: ❑ IndNiduai /Sole proprietor 0 Corporation ❑ Partnership @:err t
<br /> : - U Limited company. Enter the !2t classification (Cxdiare Gad entity, Ccorcoration, P= rshl ?
<br /> I'y P Ss part ,e N) I 0 P¢p e_
<br /> G = 1---, Other (see irsirJeiias) r
<br /> Address ( number, street, and apt or suite no.) Reoueter's name And address (optional)
<br /> 0 420 Manor Drive
<br /> .7 City, state, and ZIP code
<br /> r Merritt Island, FL 32952
<br /> 8 List account numbers) hero (optional)
<br /> Part 1[ Taxpayer Identification NumberJTtN)
<br /> Enter your TIN in the appropriate box. The 1N 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 (5SN). However, for a resident i i
<br /> alien, sole proprietor, or dlsregarded entity. see the Part I instructions on page 3, For other entities, it is
<br /> your employer identmcait'on number (~1N). If you do not have a number, see How to get a 77N 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 IIr., p1cyer !dent c:sedon number
<br /> number to enter. I 59 1 3444060 _
<br /> Part Il Certification
<br /> Under penalties of perjury, I certify that:
<br /> 1. The number shown on this forrn is my correct taxpayer identification number (or I am waiting for a number to be lesued to me), and
<br /> 2. I ?m not subject to backup withholding because: (a) I am exempt from backup withholdln3, 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. nitizen or other U.S. person (defined balovr).
<br /> Certification ! nstructions. You must cross out item 2 above if you have been nctified by the IRS that you are currently subject to backup
<br /> withholding because you have failed to report ell interest and dividends on your tax return. For real estate transactions, rem 2 dons not apply.
<br /> For morgags interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
<br /> arrangement (IRA), and generally, payments other than interest and dividends, you aro not required to sign the Certirication, but you must
<br /> provide your correct TIN. See the instructions on page 4.
<br /> Cty.t Signatu re of
<br /> /� i 0 AA o r e I u.E. person V-- 7)--- ��^ datte 0- ei LV
<br /> General Instructions Definition of a U.S. person. For federal tax purposes. you are
<br /> Section references are to the Internal Revenue Code unless considered a U.S. person if you ere:
<br /> otherwise noted. • An individual who Is a U.S. citizen or U.S. resident alien,
<br /> e 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 retum 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 detlned in Regulations section
<br /> transactions, mortgage interest you paid, acquisition or 301, 701 -7). .
<br /> abandonment of secured property, cancellation of debt, or Special rules for partnerships. Partnerships that conduct a
<br /> cortributi,::s yo:i made to an IRA. trade or business In the United States are genersliy 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 T1N 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 ars a partner is a foreign person, a,,d pay the withholding tat;.
<br /> waiting for a number to be issued), Therefore, it you are a U.S. parson that Is a partner in a
<br /> 2. C that you are not subject to backup v /ithholdln or partnership conducting a trade or business in the United States,
<br /> i g' provide Form W -9 to the partnership to establish your U.S.
<br /> 3. Claim exernplion 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 certirying that as a income.
<br /> U.S. person, your allocable share of any partnership income from The parson who gives Form W -9 to the partnership for
<br /> a U.S. trade or business is not subject to the withholding tae; on purposes of establishing fts U.S, status and avoiding withholding
<br /> foreign partner_' share of effectively connected income. on its allocable share of net income from the partnership
<br /> Note. If a requester givers 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 forrn if it is following cases'
<br /> substantially similar to this Form W -9.
<br /> • The U.S. owner of a disregarded entity and not the entity,
<br /> Cat. No. 10231X Form W -9 (Rev. 10,.2007)
<br />
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