Form Ohm Docarbw2011) Doperrnere Fiera W-9 drhi Tann Request for Taxpayer Identification Number and Certification Gin Form to the requintor. Do not send to the IRS. RwaiusSenice ni I Check ! E 8 E —....--....-- i 0 1 t cE Nam be shown on your income traretuml M iali t . ..PAL Dusan nettercieregwoeci wary nem, i different Ircm Wove 'maroons.* box for fatal tax clesacatIon: 0 Indaballace protestor 0 C Ccrocration [SCorporstion O Pwarartia 0 trustiestets O unshed say carany.Ener the tax ciassicetion (CaC corocretkn. S.-S m onk. ). P;pannership) e O *Mr bee instructionde Exernx Paves Address:7:w° . emerd a rrAr a sk e sti, 3 Rea iest r (oat name and ockfrecs ens coy. Vitt red ZIP eir Dole 110644j (fiti/ CO/P1' LW wawa numberlaihro (abut Part I Taxpayer Identification Number (TIN) Enter your TN in the appropriate box. The TIN provided must match the name given on the Nene line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident elan, sole proprietor, or disregarded entity, see the Part 1 Inatnictions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a 77N on par 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. I Socief security number Employer identification number Port II Certification Under penalties of periwig, I catty that 1. Tice number shown on this fonn is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I em not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Scrubs (IRS) that I am subject to beckon withholding as a result of a blurs to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. 1 am a U.S. c