Print or type

Request for Taxpayer

Form

W-9

See Specific Instructions on page 2.

(Rev. November 2005)

Identification Number and Certification

Department of the Treasury Internal Revenue Service

Name (as shown on your income tax return)

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

List account number(s) here (optional)

Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 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 entities, it is

Give form to the requester. Do not send to the IRS. Social security number –– Requester’s name and address (optional) Employer identification numberNote. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. – Certification Business name, if different from above Check appropriate box: Individual/ Sole proprietor Corporation Partnership Other Exempt from backup withholding Part I Part II

your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or

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 has notified me that I am no longer subject to backup withholding, and
  • 3. I am a U.S. person (including a U.S. resident alien).

    • Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 4.)

    Sign

    Signature of

    Here

    U.S. person� Date

    Purpose of Form

    A person who is required to file an information return with the IRS, must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.

    U.S. person. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:

    1. Certify that the TIN you are giving is correct (or you arewaiting for a number to be issued),

  • 2. Certify that you are not subject to backup withholding, or
  • 3. Claim exemption from backup withholding if you are a
  • U.S. exempt payee.In 3 above, if applicable, you are also certifying that as a
  • U.S. person, your allocable share of any partnership incomefrom a U.S. trade or business is not subject to the withholding tax on foreign partners’ share of effectively connected income.

    • Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

    For federal tax purposes, you are considered a person if you are:

  • ● An individual who is a citizen or resident of the United States,
  • ● A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, or
  • ● Any estate (other than a foreign estate) or trust. See Regulations sections 301.7701-6(a) and 7(a) for additional information.

    • Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners’ share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income.

    The person who gives Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States is in the following cases:

    ●The U.S. owner of a disregarded entity and not the entity,

    Cat. No. 10231X Form W-9 (Rev. 11-2005)