Farm W-9 (Rev. December 2011) Dipertriere er IS Pew flame Awns SeMoe Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not None to the Rid or type Se. Specific Instructors on cape 2. Name las tax NOM . f al. 9•iess erica deferent from oboe, Al 5 ch.d, apropist• box for WNW Um clareManiors propriMer 0 C Conwnson 0 S Corpsman 0 Pernershia • Trust/sew. company. Freer rho tax oleastraten (C..--C arpason, SeS arena) PeterInereleol ►a frlibUCtkillil P• ❑0 EXOTP One re infivklueVaele 0 United iablity 0 Clew Se st neribr, eel. Intin. a *a mnia.) , k 4/ 0 0 RE/) ti l attbriet / 89 Rasa. name end Sawa (Wend) Day, suet end ZIP code 5r" 5rT us to 00 g a t'' Ur. ant (unbolt{ hue kotion4 Part I Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on the 'Name the to avoid backup withholding. For Individuals, this Is your social security number (SSN). However. for a resident alien, sole proprietor, or disreganded entity. ere the Part I instructions on page 3. For other entities, his your employer identification number (EIN). If you do not have a number, see How to get • TIN on page 3. Note PI the account is in more than one name, see the chart on page 4 for guidearries on whose number to enter. Sects epory reerber ire yyr .3 Employes kkinescabal number P II Certification Under penalties of perjury. I certify that 1. The number shown on this form is my correct taxpayer idendfloatkai number (or I am waiting for a number to be Issued to me), and 2. I am not subject to beat* withholding because: (a) I am exempt from backup withholding. or (b) I have not been notted by the internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividend., or (e) the IRS has notified me that Ian no longer subject to backup withholding, and 3. I am a U.S. citizen or oth