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Giveformtothe

requester. Do NOT

sendtotheIRS.

nameandaddress(optional)

number(s)here(optional)

For Payees Exempt From Backup

DepartmentoftheTreasury

InternalRevenueService

Name(Ifajointaccountoryou

Form

(Rev.

W-9

November1999)

RequestforTaxpayer

IdentificationNumberandCertification

onpage2.)

PartnershipOther

Specific Instructions

changedyourname,see

t

i

l

p

o

n

p

s

e

e

y

r

t

r

e

a

P

TaxpayerIdentificationNumber(TIN)

TINintheappropriatebox.For

(See the instructions

Withholding

on page 2.)

numbertobe

thisisyoursocialsecuritynumber

However,ifyouarearesidentalienORa

soleproprietor,seetheinstructionsonpage2.

Forotherentities,itisyouremployer

identificationnumber(EIN).Ifyoudonothavea

number,see

Social security number

OR

Employer identification number

onpage2.

thanonename,

HowtogetaTIN

Iftheaccountisinmore

thechartonpage2forguidelinesonwhose

numbertoenter.

PartIIICertification

Underpenaltiesofperjury,Icertifythat:

Requester’s

Listaccount

PartII

waitingfora

Note:

see

(c)

backupwithholdingasaresultofafailuretoreportinterestordividends,or

notifiedmethatIamnolongersubjecttobackupwithholding.

IhavenotbeennotifiedbytheInternal

Youmustcrossoutitem

Certification instructions.

withholdingbecauseyou

theIRShas

2

doesnotapply.

individualretirement

arrangement(IRA),andgenerally,paymentsotherthaninterestanddividends,youarenotrequiredtosigntheCertification,butyoumust

provideyourcorrectTIN.(Seetheinstructionsonpage2.)

Sign

2

aboveifyouhavebeennotifiedbytheIRSthatyouarecurrentlysubjecttobackup

havefailedtoreportallinterestanddividendsonyourtaxreturn.Forrealestatetransactions,item

Formortgageinterestpaid,acquisitionorabandonmentofsecuredproperty,cancellationofdebt,contributionstoan

(b)

all

and

Thenumbershownonthisformismycorrecttaxpayeridentificationnumber(orIamissuedtome),

1.

2.

Iamexemptfrombackupwithholding,or

(a)

Iamnotsubjecttobackupwithholdingbecause:

RevenueService(IRS)thatIamsubjectto

Here

Purpose

required

theIRS

Signature

personwhois

5.

Date

Persons

2.

requester,or

required(seethePartIIIinstructionson

page2fordetails),or

YoudonotcertifyyourTINwhen

YoudonotfurnishyourTINto

will

the

withholding.Paymentsyoureceive

subjecttobackupwithholdingif:

1.

be

TheIRStellsyouthatyouaresubject

4.

to

backupwithholdingbecauseyoudidnot

reportallyourinterestanddividendson

yourtaxreturn(forreportableinterestand

dividendsonly),or

Cat.No.10231X

FormW-9torequestyourTIN,you

mustusetherequester’sformifitis

substantiallysimilartothisFormW-9.

Ifrequestergivesyouaformother

TheIRStellstherequesterthatyou

3.

Note:

than

furnishedanincorrectTIN,or

youmust

withholdandpaytotheIRS31%ofsuch

paymentsundercertainconditions.Thisis

called“backupwithholding.”Payments

thatmaybesubjecttobackupwithholding

includeinterest,dividends,brokerand

barterexchangetransactions,rents,

royalties,nonemployeepay,andcertain

paymentsfromfishingboatoperators.Real

estatetransactionsarenotsubjectto

backupwithholding.

Ifyougivetherequesteryourcorrect

TIN,makethepropercertifications,and

reportallyourtaxableinterestand

dividendsonyourtaxreturn,payments

youreceivewillnotbesubjecttobackup

that

withholdingunder3above(forreportable

interestanddividendaccountsopened

after1983only).

Certainpayeesandpaymentsare

exemptfrombackupwithholding.Seethe

PartIIinstructionsandtheseparate

Instructions for the Requester of Form

W-9.

Penalties

yourcorrecttaxpayer

identificationnumber(TIN)toreport,for

example,incomepaidtoyou,realestate

transactions,mortgageinterestyoupaid,

acquisitionorabandonmentofsecured

property,cancellationofdebt,or

contributionsyoumadetoanIRA.

UseFormW-9,ifyouareaU.S.person

(includingaresidentalien),togiveyour

correctTINtothepersonrequestingit(the

requester)and,whenapplicable,to:

Youdonotcertifytotherequester

youarenotsubjecttobackup

ofform.

tofilean

mustget

A

informationreturnwith

What is backup withholding?

makingcertainpaymentsto

W-9

Form

(Rev.11-99)

PartI

Enteryour

individuals,

(SSN).

Specific Instructions

onpage2.)

Businessname,ifdifferentfromabove.(See

Checkappropriatebox:

Individual/Sole proprietorCorporation

Address(number,street,andapt.orsuiteno.)

City,state,andZIPcode

2.

correct(oryouarewaitingforanumberto

beissued),

Certifyyouarenotsubjecttobackup

useanappropriateForm

Iftherequesterdiscloses

MisuseofTINs.

orusesTINsin

criminalpenaltiesincludingfines

and/or imprisonment.

violationofFederallaw,the

requestermaybesubjecttociviland

criminalpenalties.

must

a

FailuretofurnishTIN.

yourcorrectTINtoa

Ifyoufailtofurnish

withholdingifyouareanexemptpayee.

reasonablebasis

thatresultsinnobackupwithholding,you

aresubjecttoa$500penalty.

Criminalpenaltyforfalsifying

Ifyoumakea

respect to withholding.

falsestatementwithno

Claimexemptionfrombackup

3.

withholding,or

information.

certifications

youto

requester,youare

subjecttoapenaltyof$50foreachsuch

failureunlessyourfailureisdueto

reasonablecauseandnottowillfulneglect.

Civilpenaltyforfalseinformationwith

persons

W-8.

Willfullyfalsifying

oraffirmationsmaysubject

prefers

foreign

foreign

Ifyouareaforeignperson,IRS

youuseaFormW-8(certificateof

status).AfterDecember31,2000,

CertifytheTINyouaregivingis

1.

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