Form Taxpayer to the (Rev. December 2011) Department of the Treasury Certification the IRS. Internal Revenue Service to Request for Give Form requester. Do not Identification Number and send to Name (as shoyyn on your income tax return fr 04' Business name/disregarded entity name, if different from above Check appropriate box for federal tax classification: 1: Individual/sole proprietor J C Corporation u S Corporation 0 Partnership 0 Trust/estate Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) 1 J Other (see instructions) 00. Address (nu ber, street, and apt. or suite no.) Requester's name and address (optionai) CO 6/00 City, state, and ZIP code List account number(s) here (optional) Vi EFTA01592623