Form W-9 (Rev. December 2011) Department el the Treasury Intemsl Revenue Sauce Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. (.4 S I. Name (a sho)r on your Income tax ret.i7, ttc Business neme/cfieregerded entity name, if different from above Check appropriate box for federal tax classWicatiorx 0 Individual/sole proprietor K C Corporation 0 S Corporation 0 Pannershop 0 Trust/estate Limited liability company. Enter the tax classification (C=C corporation, S-S corporation, Pe partnership)* C4(5142 jej O Exempt payee 0 Other (see instructions) b Address (number. street and apt or suite no.) 6/O0 6040 ok artegit, City, slats, and ap code 57-: Thoma-s US(/ t l eg r List scooted number(*) here (optiond) Part I Requester's name and address (optional) Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on the 'Name" line l ocial security number to avoid backup withholding. For Individuals, this Is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I Instructions on page 3. For other entitles, it is your employer identification number (SIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Part Certification I Employer identMcatIon number 6 _ v, -A9 fi Under penalties of perjury, I certify that: 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 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 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 ha