W9 form

Form W-9 (Rev. March 1994) Department of the Treasury Internal Revenue Service. Request for Taxpayer
Identification Number and Certification Give form to the requester.
DO NOT send to IRS.

Name (If joint names, list first and circle the name of the person or entity that you enter in Part l below. See instructions on page 2 if your name has changed.)
.

Business name (Sole proprietors see instructions on page 2)
.

Please check appropriate box:Individual/Sole proprietorCorporationPartnershipOther

Address (number, street, and apt no. or suite no.
. Requester's name and address (optional)

City, state, and Zip code
.

Taxpayer Identification Number (TIN) List account number(s) here (optional)

Enter you TIN in the appropriate box. For individuals this is your social security number(SSN). For sole proprietors, see instructions on page 2. For other entities it is you employer identification number (EIN). If you do not have a number, see How To Get a TIN below. Note: If the account is more than one name, see the chart on page 2 for guidelines on whose number to enter. SSN
OR
EIN >

For payees exempt from backup Withholding (See Part ll instructions on page 2)

Certification

Under penalties of perjury, I certify that:
1. The number shown on this form is my correct identification number (or I am waiting for a number to be issued to me). and
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 Service that I am subject to backup withholding as a result of failure to all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding.
Certification Instruction.- You must cross out item 2 above if you are currently subject to backup withholding because of underreporting interest or dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, the acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (Also see Part lll instructions on page 2)

Sign
Here Signature Date

Section references are to the Internal Revenue Code Purpose of Form.--A person who is required to file an information return with the IRS must get your correct TIN to report income paid to you, real estate transactions, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, contributions to an IRA. Use Form W-9 to give your correct TIN to the requester (the person requesting your TIN) and, when applicable, (1) To certify the TIN you are giving is correct (or you are waiting for a number to be issued), (2) to certify you are not subject to backup withholding, or (3) to claim exemption from backup withholding if you are an exempt payee. Giving your correct TIN and making the appropriate certifications will prevent certain payments from being subject to backup withholding. Note: If a requester gives you a form other than a W-9 to request your TIN, you must use the requester's form if it is substantially similar to this Form W-9. What is Backup Withholding?-- Persons making certain payments to you must withhold and pay to the IRS 31% of such payments under certain conditions. This is called " backup withholding. " Payments that could be subject to backup withholding include interest, dividends, broker and barter exchange programs, rents, royalties, nonemployeess pay, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding.
If you give your requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return, your payments will not be subject to backup withholding. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, or 2. The IRS tells the requester you furnished an incorrect TIN, or 3. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 4. You do not certify to the requester you are not subject to backup withholding under 3 above (for reportable dividend and interest accounts opened after 1983 only), or 5. You do not certify you TIN. See the Part lll instructions for exceptions. Certain payees and payments are exempt from backup withholding and information reporting. See the Part ll instructions and the separate instructions for the requester of Form W-9. How To Get a TIN.--If you do not have a TIN, apply for one immediately. To apply, get Form SS-5, Application for a Social Security Card (for individuals), from your local office of the Social Security Administration, or Form SS-4, Application for Employer Identification Number (for business and all other entities), from your local IRS office. If you do not have a TIN write "Applied For" in the space for the TIN in Part l, sign and date the form, and give it to the requester. Generally you will then have 60 days to get a TIN and give it to the requester. If the requester does not receive your TIN within 60 days, backup withholding, if applicable, will begin and continue until you furnish your TIN

Cat. No. 10231X
Form W-9 (Rev. 3-94)

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