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Form W-9(Alternate)Alternate Form as Authorized onOriginal W9
Request for Taxpayer Identification Numberand Certification ***
Give form to therequester. Do notsend to the IRS.
SeeSpe
cificInstruction
Name (as shown on your income tax return)
N/A
Entity name, if different from above
Check appropriate box: Individual/Sole proprietor Corporation Partnership
Limited liabilitycompany. Enterthe taxclassification(D=disregardedentity,C=corporation, P=partnership)
Other(seeinstructions)Special Organization w/ exemption/exception recognition in law
**
Exemptpayee
Address (Mailing address )
C/O Mailing address :
Requesters name and address (optional)
City, state, and ZIPcode
Optional Information
**Entity not subject to 1099/1098 Information Return Filing or Witholding. Number is not required by lawforwarded for recognition purposes.
Part I Identification Number (TINIf required as an individual taxpayer)
Enter your number in the appropriate box. If a TIN is provided, it must match the name given on Line 1 toavoid backup withholding. For individual taxpayers, this is your social security number (SSN).For otherentities, it is possibly an employer identification number (EIN). If you do not have a number, see How toget a TINon page 3. (Check Box if not an Individual Taxpayer Identification Number: )
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whosenumber to enter.
Social security numberN/A
or
Employer identification number
N/A
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Part II Certification
I certify that:
1. If a numbe r i s shown on this form, it is the entity correct identification number (or awaiting a number to be issued), and
2. The ent it y i s not subject to backup withholding because: (a) It is exempt from backup withholding, or (b) It has not been notified by theInternal Revenue Service (IRS) that it is subject to backup withholding as a result of a failure to report all interest or dividends, or (c) theIRS has notified that it is no longer subject to backup withholding, or (d) it is not an individual taxpayer [Ref 1998 Restructuring Act].
3. I am ei ther a United States of America inhabi tant or citizen or other U.S.A. person (defined below).
4. The entity is in congruence with the laws of the United States of America [U.S.A. person] and is not subject to 1099/1098 Information Return Filin
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backupwithholding because you have failed to report all interest and dividends on your tax return. For..payments other than interest and dividends,you are not required to sign the Certification, but you might have to provide your correct TIN. See the instructions on page 4.
SignHere
Signature Date
General InstructionsSection references are to the Internal Revenue Code unlessotherwise noted.
Purpose of FormA person who is required to file an information return with theIRS must obtain your correct taxpayer identification number (TIN) toreport, for example, income paid to you, real estate transactions,mortgage interest you paid, acquisition orabandonment of securedproperty, cancellation of debt, orcontributions you made to an IRA.
Use IRS Form W-9 only if you are a U.S. person (includinga resident alien), to provide your correct TIN to the personrequesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct (or you arewaiting 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 aU.S. person, your allocable share of any partnership income from aU.S. trade or business is not subject to the withholding tax onforeign partners share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 torequest your TIN, you must use the requesters form if it issubstantially similar to this Form W-9.
Definition of a U.S. person. For federal tax purposes, you areconsidered a U.S. person if you are:
An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created ororganized in the United States or under the laws of the UnitedStates,
An estate (other than a foreign estate), or A domestic trust (as defined in Regulations section301.7701-7).
Definition of a U.S.A . person. For the purposes of this form, youare considered a U.S.A. [United States of America] person as:
A person recognized in the 1st
law of the United States of America,the Declaration of Independence of July 4, 1776, [*** Separate and
equal Station]
A citizen or free inhabitant recognized in the 2nd law of the UnitedStates of America, the Articles of Confederation of November 15, 1777
An entity organized in congruence with those laws of the UnitedStates of America.
Ref: http://uscode.house.gov/download/pls/organiclaws.txt
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Page 2Form W-9 (Rev. 10-2007)