Document oMpZBG1j2zVVL1jJ2orbb1X18

W-9Form Request for Taxpayer (Rev. December 2014) Department of the Treasury Internal Revenue Service Identification Number and Certification 1 Nam e (as shown on your income tax return). Nam e is required on this line; do not leave this line blank. Give Form to the requester. Danot send to the IRSI 2 B usiness nme/disregarded entity name, if different from ahqi'e a C to - t<w s= t 3 Cfieck appropriate box for federal tax classification; check only one of the following seven boxes: J23Individual/sole proprietor or Q C Corporation ,Q S Corporation Q Partnership Q Tmst/estate /V ln ^le -m e m be rlLC I- ] Umited liability company. Enter the tax classification (C=C corporation, S = S corporation, P=partnership) Note. For a single-member L LC that is disregarded, do not check LLC; check the appropriate box in the line above for 4 Exem ptions (codes apply only to certain entities, not individuals; see Instructions on page 3): ' Exempt payee code (if any) Exemption from FA TC A reporting the tax classification of the single-member owner. code (if any) i Q- o '3 au. CO PI Other (see instructions) 5 Address (number, street, and apt. or suite no.) 6 City, state, and Z IP code (AppHes to accounts iro in tain ad o u tsid e 10 U.S.) Requester's name and address (optional) CO A lfr e d , MY 1 4 5 0 2 - Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to gef a TIN on page 3. Social security number (f) L\Z - 5 0 - i 1 95 or guidelines on w hose number to enter. 11 lE T lll Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer 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 (IRS) that I am subject to backup withholding a s a result of a failure to report all interest or dividends, or (c) the IR S has notified me that l am no longer subject to backup withholding; and1 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATC A code(s) entered on this form (if any) indicating that 1am exempt from F ATC A reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IR S that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, 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. See the instructions on page 3. S ig n +iere ^Signature <of Im l MU.S. person Date* 1 General Instructions Section references are to the Internal Revenue Code unless otherwise note Future developm ents. Information about developments affecting Form W -9 (such as legislation enacted after we release it) Is at www.irs.gov/fw9. Purpose of Form An individual or entity (Form W -9 requester) who Is required to file an Information return with the IR S must obtain your correct taxpayer identification number (FIN) which may be your social security number (SSN), individual taxpayer identification number (IT1N), adoption taxpayer identification number (ATiN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of Information returns Include, but are not limited to, the following: Form 1099-INT (interest earned or paid) Form 1099-DIV (dividends, Including those from stocks or mutual funds) Form 109 9-M ISC (various types of income, prizes, awards, or gross proceeds) Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) Form 1099-S (proceeds from real estate transactions) Form 1099-K (merchant card and third party network transactions) Form 1098 (home mortgage interest), 1098-E (student loan interest); 1098-T (tuition) 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 (including a resident alien), to provide your correct TIN. if you do not return Form W -9 to the requester with a TIN, you m ight be subject to backup withholding. S e e W hat Is backup w ithholding? cn<page 2. B y signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FA T C A code(s) entered on this form (if any) indicating that you are exem pt from.the F A T C A reporting, is correct. See W hat is FA T C A reporting? on p a g e 2 for further information. Cat. No. 10231X Form W -9 (Rev. 12-2014)