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Form im-i9
<br /> Request for Taxpayer Give Form to the
<br /> (Rev.December 2014)
<br /> Identification Number and Certification
<br /> Departmentof the requester.Do not
<br /> Int RevenueTreasuryervice�
<br /> send to the IRS.
<br /> 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank.
<br /> smartLINK,Inc.
<br /> N 2 Business name/disregarded entity name,if different from above
<br /> a
<br /> rn
<br /> is
<br /> c.
<br /> 3 cc 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to
<br /> 0 Individual/sole
<br /> sole proprietor or ❑ C Corporation certain entities,not individuals;see
<br /> a c single-member LLC S Corporation' ❑ Partnership 0 Trust/estate Instructions on
<br /> a
<br /> page 3):
<br /> ` o
<br /> 0 Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)a Exempt payee code(if any)
<br /> o, Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the fine above for 9
<br /> c e the tax classification of the single-member owner. Exemption from FATCA reportin
<br /> a 0 Other(see instructions)D code(ifa any)
<br /> 5 Address(number.street and des to accounts ma •d outride the u.3J
<br /> v apt.or suite no.)
<br /> m 16 E 11TH ST
<br /> Requester's name and address(optional)
<br /> ar 6 City,state,and ZIP code
<br /> m
<br /> rn Newport,KY 41048
<br /> �:�m7 List account number(s)here(optional)
<br /> al 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 se
<br /> backup withholding.For Individuals,this is generallyyseem*number I
<br /> resident alien,sole proprietor,or disregarded entity,see the iart I instructionnums onr(page 3.For otherSSN).However, or a I I —
<br /> entities,it is your employer Identification number(EIN).If you do not have a number,see How to get a
<br /> T!N on page 3.
<br /> Note.If the account is in more than one name,see the instructions for line 1 and the chart on or
<br /> guidelines on whose number to enter.
<br /> page 4 for Plover identification number I
<br /> MU8 1 - 3 7 5 2 6 7 8
<br /> Certification
<br /> Under penalties of perjury,I certify that:
<br /> 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
<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 Revenue
<br /> 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 notified me that I am
<br /> no longer subject to backup withholding;and
<br /> 3. I 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
<br /> because you have failed to report all interest and dividends on your tax retum.For real estate transactions,item 2 does not apply.For mortgage
<br /> interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement ORA).and
<br /> generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the
<br /> instructions on page 3.
<br /> Sign Sure of � /�
<br /> Here U.S.person It. i/ /!�
<br /> / ,�� Date 0.
<br /> 9S 1— //4
<br /> General Instructioy�
<br /> "`S •Form 1098(home mortgage interest),1098-E(student loan interest),1098-T
<br /> Section references are to the Internal Revenue Code unless otherwise noted, (tuition)
<br /> Future developments.Information about leve •Form 1099-C(canceled debt)
<br /> as legislation enacted after we release it)is at wwww.irs g affecting/w9 ��W 9(such •Foran 1099 A(acquisition or abantlonment of secured property)
<br /> Purpose of Form Use Form W-9 only if you are a U S.person(including a resident alien),to
<br /> provide your correct TIN.
<br /> An individual or entity(Form W-9 requester)who is required to file an information
<br /> If you do not return Form W-9 to the
<br /> return with the IRS must obtain your correct taxpayer identification number requester with a on you might be subject
<br /> which may be your social securitynumber (TIM to backup withholding.See What is backup withholding?on page 2.
<br /> number(MN),adoption ( 'individual taxpayer identification By signing the filled out form,
<br /> numb
<br /> identification,number taxpayer identification number(ATIN),or employer you:
<br /> (EW),torert on en information return the amount paid to 1.Certify that the TIN you are giving Is correct(or you are waiting for a number
<br /> you,or other amount reportable on an information return.Examples of information to be issued),
<br /> returns include,but are not limited to,the following: 2.Certify that you are not subject
<br /> backup withholding,or
<br /> •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup vvithhotding if you are a U.S.exempt payee.If
<br /> •Form 1099-DN(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of
<br /> types of Income,prizes,awards,or grossproceeds) any partnership income from a U.S.Itrade or business is not subject to the
<br /> •Form 1099$(stock(various mutual fund sales and certain other or withholding tax on foreign partners' here of effectively connected income,and
<br /> brokers)
<br /> by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are
<br /> •Foran)O99 S exempt from the FATCA reporting,is correct.See What/s FATCA reporting?on
<br /> (proceeds from real estate transactions) page 2 for further information.
<br /> •Form 1099-t((merchant card and third party network transactions)
<br /> Cat.No.10231X Form W-9(Rev.12-2014)
<br /> .
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