i axpayer IQentfttoatlon Number (TIN)
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number
<br />backup with holdiFor Individuals, this is generally your t security number (SSNHowever, for a
<br />resident alien, solea proprietor, or disregarded entity, see thea Instructions for Part I, later. For other
<br />entities, it Is your employer identification number (EIN). It you do not have a number, see Now to get a
<br />77N, later. or
<br />Note: If the account Is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number
<br />Number To Give the Requester for guidelines on whose number to enter. ml
<br />Under penalties of perjury, i certify that:
<br />1. The number shown on this form Is my correct taxpayer identfficatlon number (or I am walling for a number to be issued to me); and
<br />2. 1 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
<br />Service QRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that i am
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below); and
<br />4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting Is correct.
<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 withholding because
<br />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,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
<br />other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
<br />s)9n Signature of a� R� l��[
<br />Here U.S. person ►
<br />Date ►
<br />General Instructions • Form 1099 -DIV (dividends, including those from stocks or mutual
<br />(ands)
<br />Section references are to the Internal Revenue Code unless otherwise f Form 1099-MISC various
<br />noted. ( types of income, prizes, awards, or gross
<br />proceeds)
<br />Future developments. For the latest information about developments . Form 1099-B (stock or mutual fund sales and certain other
<br />related to Form W-9 and its instructions, such as legislation enacted transactions by brokers)
<br />after they were published, go to wwwJrS.gov1FormW9.
<br />• Form 1099-S (proceeds from real estate transactions)
<br />Purpose of Form • Form 1099-K (merchant card and third party network transactions)
<br />An individual or entity (Form W-9 requester) who is required to file an • Form 1098 (home mortgage interest), 1098-E (student loan Interest),
<br />information return with the IRS must obtain your correct taxpayer 1098-T (tuition)
<br />identification number MN) which may be your social security number • Form 1099-C (canceled debt)
<br />(SSN), individual taxpayer Identification number (ITIN), adoption
<br />taxpayer Identification number (ATIN), or employer identification number • Form 1099-A (acquisition or abandonment of secured property)
<br />(EiN), to report on an information return the amount paid to you, or other Use Form W-9 only If you are a U.S. person (including a resident
<br />amount reportable on an information return. Examples of information alien), to provide your correct TIN.
<br />returns Include, but are not limited to, the following. Ifyou do not return form W-9 to the requester with a 77N, you might
<br />• Form 1099 -INT (interest earned or paid) be subject to backup withholding. See What is backup withholding,
<br />later.
<br />Cat. No. 10231X Fors W-9(Rev. 10-2O8)
<br />W-9 Request for Taxpayer
<br />Give Form to the
<br />Fom,
<br />(Rev.
<br />October 2018) Identification Number and Certification
<br />1
<br />requester. Do not
<br />Department
<br />of the Treasury
<br />send to the IRS.
<br />Internal Revenue Service ► Go to www.lrs.gov/Form W9 for instructions and the latest information.
<br />1 Name (as shown on your Income tax return). Name is required on this line; do not leave this line blank.
<br />2 Business nameJdisregarded entity name, if different from above
<br />y3
<br />Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the
<br />4 Exemptions (Codes apply only to
<br />following seven boxes.
<br />certain entries, not indivlduaLs; see
<br />p
<br />❑ Intliv'rduaVsola proprietor or ❑ C Corporation 171S Corporation ❑Partnership ❑ Trust/estate
<br />Instructions on page 3):
<br />m
<br />single -member LLC
<br />Exempt payee code (if any)
<br />'_2
<br />❑ Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ►
<br />`o
<br />Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
<br />Exemption from FATCA reporting
<br />1 u N
<br />LLC If the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
<br />another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single -member LLC that
<br />coda (if any)
<br />_
<br />.0
<br />is disregarded from the owner should check the appropriate box for the tax olassificatlon of Its owner.
<br />❑ Other (see Instructions) ►
<br />n.us)
<br />y
<br />5 Address (number, street, and apt or suite no.) See Instructions.
<br />Requester's name and address (optional)
<br />8200 NW 93rd Street
<br />ro
<br />6 City, state, and ZIP code
<br />Doral F) 33166
<br />7 List accoum numbers) here (optional)
<br />i axpayer IQentfttoatlon Number (TIN)
<br />Enter your TIN In the appropriate box. The TIN provided must match the name given on line 1 to avoid I Social security number
<br />backup with holdiFor Individuals, this is generally your t security number (SSNHowever, for a
<br />resident alien, solea proprietor, or disregarded entity, see thea Instructions for Part I, later. For other
<br />entities, it Is your employer identification number (EIN). It you do not have a number, see Now to get a
<br />77N, later. or
<br />Note: If the account Is in more than one name, see the instructions for line 1. Also see What Name and I Employer identification number
<br />Number To Give the Requester for guidelines on whose number to enter. ml
<br />Under penalties of perjury, i certify that:
<br />1. The number shown on this form Is my correct taxpayer identfficatlon number (or I am walling for a number to be issued to me); and
<br />2. 1 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
<br />Service QRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that i am
<br />no longer subject to backup withholding; and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below); and
<br />4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting Is correct.
<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 withholding because
<br />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,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
<br />other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.
<br />s)9n Signature of a� R� l��[
<br />Here U.S. person ►
<br />Date ►
<br />General Instructions • Form 1099 -DIV (dividends, including those from stocks or mutual
<br />(ands)
<br />Section references are to the Internal Revenue Code unless otherwise f Form 1099-MISC various
<br />noted. ( types of income, prizes, awards, or gross
<br />proceeds)
<br />Future developments. For the latest information about developments . Form 1099-B (stock or mutual fund sales and certain other
<br />related to Form W-9 and its instructions, such as legislation enacted transactions by brokers)
<br />after they were published, go to wwwJrS.gov1FormW9.
<br />• Form 1099-S (proceeds from real estate transactions)
<br />Purpose of Form • Form 1099-K (merchant card and third party network transactions)
<br />An individual or entity (Form W-9 requester) who is required to file an • Form 1098 (home mortgage interest), 1098-E (student loan Interest),
<br />information return with the IRS must obtain your correct taxpayer 1098-T (tuition)
<br />identification number MN) which may be your social security number • Form 1099-C (canceled debt)
<br />(SSN), individual taxpayer Identification number (ITIN), adoption
<br />taxpayer Identification number (ATIN), or employer identification number • Form 1099-A (acquisition or abandonment of secured property)
<br />(EiN), to report on an information return the amount paid to you, or other Use Form W-9 only If you are a U.S. person (including a resident
<br />amount reportable on an information return. Examples of information alien), to provide your correct TIN.
<br />returns Include, but are not limited to, the following. Ifyou do not return form W-9 to the requester with a 77N, you might
<br />• Form 1099 -INT (interest earned or paid) be subject to backup withholding. See What is backup withholding,
<br />later.
<br />Cat. No. 10231X Fors W-9(Rev. 10-2O8)
<br />
|