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<br />Form W -9 Rev. 1.2'002)
<br />Specific Instructions
<br />Name. If you are an individual, you must
<br />generally enter the name shown on yaur
<br />social security card. However, ifyou have
<br />charged your last name. for instance, due to
<br />marriage wittout informing the Social Security
<br />Administration of the name change. ants!'
<br />your first name, the last name shown an your
<br />social security card, and your new last name.
<br />If the account is in joint names, list first and
<br />than circle the name of the person or entity
<br />whose number you enter in Part I of the form.
<br />Sole proprietor. Enter your individual
<br />name as shown on your social security card
<br />on the "Name" line. You may enter your
<br />business, trade, or "doing business es (DBA)"
<br />name on the "Business name" line.
<br />Limitediability company (LLC). If you are
<br />a single -mamba LLC (including a fcreign LLC
<br />with a domestic owner) that is disagaded as
<br />an entity separate from its owner under
<br />Treasury regulations section 301.7701 -3,
<br />enter the owner's name an the "Name'
<br />line. Enter the LLC's name on the "Business
<br />name" lire.
<br />Other entities. Enter your business name
<br />as shaven on required Federal tax documents
<br />on the "Name" Tine. This name should match
<br />the name shown on the charter or other legal
<br />document creating the entity. You may enter
<br />any business, trade, or DBA name on the
<br />"Business name" line.
<br />Exempt from backup wrthhcaldfr g. If you
<br />are exempt, enter your name as described
<br />above, then check the "Exempt from backup
<br />withholding" box in the line following the
<br />business name, sign and date the form.
<br />Individuals (including sole proprietors) are
<br />not exempt from backup withholding.
<br />Corporations are exempt from backup
<br />withholding for certain payments, such as
<br />interest and dividends. For more information
<br />on exempt payees, sea the Instructions for
<br />the Requester of Form W -9.
<br />If you are a nonresident alien or a foreign
<br />entity not subject to backup withholding, give
<br />the requester the appropriate completed
<br />Form W -8.
<br />Note. if you me exempt from backup
<br />withholding you slaor8d still complete this
<br />ktrm to avoid possible ammeorr backup
<br />witfrlrcidng.
<br />Part I— Taxpayer Identification
<br />Number (TIN)
<br />Enter your TIN in the appropriate box
<br />If you are a resident alien and you do not
<br />have and are not eligible to get an SSN, your
<br />TIN is your IRS individual taxpayer
<br />identification number (IT1N). Enter it in the
<br />social security number box. If you do not
<br />have an 111N, see How to get a TIN below.
<br />If you are a sole proprietor and you have
<br />an EIN, you may enter either your SSN or
<br />EIN. However. the IRS prefers that you Lse
<br />your SSN.
<br />If you are an LLC that is disregarded as
<br />an entity separate from its owner (see
<br />Limited liebirity company (LLC) above). end
<br />are owned by an individual. enter your SSN
<br />(cr "pre -LLC" EIN, if" desked). If the owner of
<br />e disregarded LLC is a oarperation,
<br />partnership, etc., enter the owners EIN.
<br />Note: See the chart on this page for Rather
<br />cdariircatim of name and TIN combinations.
<br />How to get a TIN. If you do not have a TIN,
<br />apply for one immediately. To apply for an
<br />SSN. get Foam SS-5, Application for a Social
<br />.Security Card, from your local Social Security
<br />Administration office. Get Farm W -7,
<br />Minnesota Option Structure Lease
<br />2005
<br />PlIge
<br />Application for IRS Individual Taxpayer
<br />Identification Number, to apply for an ITIN, or
<br />Form SS -4, Application fir Employer
<br />Identification Number, to apply for an EIN.
<br />You can get Forams W -7 and SS-4 from the
<br />IRS by calling 1 -BOO- TAX -FORM
<br />(1- 808 - 822 -3676j a from the IRS Web Site at
<br />wwwars.gov.
<br />If you are asked to complete Form W -9 but
<br />do not have a TIN, veite "Applied For" in the
<br />space for the TIN, sign and date the form,
<br />and give it to the requester. For interest and
<br />dividend payments, and certain payments
<br />made With respect to readily tradable
<br />instruments, generally you 'nil! have 60 days
<br />to get a 11N and give it to the requestrter
<br />before you are subject to backup withholding
<br />on payments. The -day rule does not apply
<br />to other types of payments. You will be
<br />subject to backup withholding on all such
<br />payments until you provide your TIN to the
<br />requester.
<br />Note: Writing Applied Fcr'means Mat you
<br />have already applied for a TIN or that yeti
<br />intend to apply for are son.
<br />Caution= A disregarded domestic entity that
<br />has a foreign eerier must use the appropriate
<br />Form tV -Q
<br />Part n-- Certification
<br />To establish to the withholding agent that you
<br />ere a U.S. person, or resident alien, sign Form
<br />W -9. You may be requested to sign by the
<br />withholding agent even if items 1, 3, and 5
<br />below indicate otherwise.
<br />For a joint account, only the person whose
<br />TIN is shown in Part I should sign (when
<br />required). Exempt recipients, see Exempt
<br />from beckw lefthhoitdng above.
<br />Signature requirements. Complete the
<br />certification as indcated in'1 through 5
<br />below.
<br />1. Interest, dividend and barter
<br />exchange accounts opened before 1284
<br />and broker accounts considered active
<br />during 1983. You must give your correct TIN,
<br />but you do not have to sign the certification.
<br />2. Interest, dividend, broker. and barter
<br />exchange accounts opened after 1983 and
<br />broker accounts considered inactive during
<br />19113, You must sign the certification or
<br />backup withholding will apply. If you are
<br />subject to backup withholding and you are
<br />nurely providing your correct TIN to the
<br />requester, you must cross out item 2. in the
<br />trtification before signing the form.
<br />3. Real estate transactions. You must .
<br />sign the certification. You may cross out
<br />item 2 of the certification.
<br />4. Other payments. You must give your
<br />correct TIN, but you do not have to sign the
<br />certification unless you have been notified
<br />that you have prenriausly given an incorrect.
<br />TIN. "Other payments" include paymats
<br />made in the course of the requester's trade
<br />or business for rents, royalties goods (other
<br />than bills for merchandise) medical and
<br />health care senriees l ncluding payments to
<br />corperations), payments to a nanemployee for
<br />services, payments to certain fishirg boat
<br />crew members and fishermen, and gross
<br />proceeds paid to attameys ( including
<br />payments to corporations).
<br />S. Mortgage interest paid by you,
<br />acquisition or abandonment of secured
<br />property, cancefation of debt, qualified
<br />tuition program payments (under section
<br />629), IRA or Archer MSA contributions or
<br />distributions, and pension distributions.
<br />You must give your correct TIN. but you do
<br />not have to sign the certification.
<br />-50-
<br />Lu
<br />Privacy Act Notice
<br />Section 6109 of the Internal Revenue Code
<br />requires you to give your correct TIN to
<br />persons who must file information returns
<br />with the IRS to repel interest. dividends, anc
<br />certain other income paid to you, mortgage
<br />interest you pad. the acquisition or
<br />abandonment of secured property,
<br />cancellation of debt, or contributions you
<br />made to an IRA or Archer MSA. The IRS use
<br />the numbers for identification purposes and
<br />to help verify the accuracy of your tax return.
<br />The IRS may also p-ovide this information to
<br />the Department of Justice for civil and
<br />criminal litigation, and to cities, states. and
<br />the District of Columbia to carry out their tax
<br />lees.
<br />You must provide your TIN whether or not
<br />you are required to file a tax ratan. Payers
<br />must generally withhold 30% of taxable
<br />interest. dividend, and certain other payment•
<br />to a payee vitro does not give a TIN to a
<br />payer. Certain penalties may also apply.
<br />What Name and Number To
<br />Give the Requester
<br />Mr this type out account
<br />Give name and SSTs of.
<br />1. Manual
<br />2. Two er roue
<br />IniNdtels part
<br />accuunq
<br />3. Custodian acaciru et
<br />a rnlnrr Nnrerm tan
<br />W Miners Ace
<br />4. a. The u r ual
<br />revocable salmis
<br />trust granter Is
<br />also trustee
<br />b. 5d -wired test
<br />account thrt le noI
<br />a legal a vain Met
<br />undo' state Iaw
<br />5. Sale prepru#orshlp
<br />The Medial
<br />The actual mina of the
<br />excel 4, If cembned
<br />Rinds, Ire Ma IRilNdi 1
<br />on trio rx:murt 1
<br />The rnrrx
<br />The garter- trustee'
<br />The actua COM '
<br />The offer ,
<br />for this type of account
<br />Give panne arta MN ot:
<br />5. Sole popN_torshlp
<br />7. Avalti hilt, white, a
<br />persur1 trust
<br />5. Caparale
<br />I. Assocenc n, club,
<br />relgbus, 'limitable,
<br />edur iltnal, at other
<br />taa.exanpt
<br />rrganlrahpn
<br />10. Partrelsttlp
<br />11. A Crater orregtslaed
<br />nominee
<br />12. Accent with the
<br />repartnat d
<br />. mane In the name
<br />a public entity fstren
<br />IS a state a 11Sa1
<br />danmert,sehdd
<br />tulrt, a prison) that
<br />receives ag etitural
<br />program payrnerts
<br />The Darer 1
<br />Lege ertlly a
<br />TheCapxation
<br />The otganlmim
<br />The patnerelp
<br />The bubbler a meanie
<br />The pubic entry
<br />'Lea mist and circa Ire name cf the person why
<br />numter you rumen, U only ene paean an aplrt
<br />ao:ncult Ise an SSN, ire person's unbar must be
<br />Nmished.
<br />'Circle the maxis name oral funerals mnar's SSN.
<br />'YW must show your IndlvhuaI name, hut you may
<br />aso enter yea bu5rw_Ss rr "CM' name You may use
<br />either you SSN er ElN pf you hate OM.
<br />Lbt ire. and adobe nacre a the legal trust, estate
<br />tr pert_lat test (no not trash the TIN tf the personal
<br />reResentnthe or truslm urines the legal catty liar Is
<br />not duxJgneled In the menet tub)
<br />Nate: if no names circled when more than
<br />one natter is listed the number wit be
<br />considered to be that of the fast name listed.
<br />Final Date: 050617
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