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Published by it, 2022-07-07 17:53:06




for Campaigns & Initiatives


We own and operate our own facility

We are a full service offset, digital and wide format printing
plant, with a fulfillment center, manufacturing operation for
custom products and warehousing, and full service mailing.


Certified by WBENC EPA approved vendor
(WBE and SBA/WOSB) for Commonwealth of
Member of Graphic Certified G7 Master Facility
Colorspace compliant
International Union, Certified Printing and
Mailing Vendor for the
Label 274C Commonwealth of
Certified Printing and Rhode Island, 53432
Mailing Vendor for the and RI MBCN 1913

Commonwealth of BBB A Plus Rating
Massachusetts, OFF44

Green E Windpower
Certified Renewable Energy

Standard Modern Company, Inc.



PHONE: 508.586.4300 • FAX: 508.584.4566 • TOLL FREE: 800.742.4123


Link to FTP site and on-line ordering, job tracking,delivery confirmations and client inventories

We look forward to working with you . . .

Thank you for your interest in Standard Modern Company, FAC I L I T Y :
Inc. We provide custom solutions in print, mail, fulfilment,
signage, and promotional products to meet your unique Standard Modern Company, Inc.
requirements. Our goal is to ensure the best end user 186 Duchaine Boulevard
experience, as seamless as possible. New Bedford, MA 02745

For your convenience, enclosed within this Welcome Packet is Main Phone: 508.586.4300
the necessary information we need to establish your account. Toll Free: 800.742.4123
Fax: 508.584.4566
• CUSTOMER INTAKE FORM [email protected]
• W9 FORM [email protected]

We look forward to working with you and providing excep- CEO: Linda Smith
tional customer service and the highest quality product. Sales Director: John Doherty
Business Manager: Julianne Smith


Standard Modern Company, Inc. • Accounts Receivable Department
Attn: Julianne Smith • 186 Duchaine Boulevard • New Bedford, MA 02745

Phone: 774.425.3536 | Email: [email protected]


Phone: 800.742.4123 | Email: [email protected]

STANDARD MODERN | 800.742.4123 | [email protected]




Standard Modern Co., Inc
186 Duchaine Blvd

New Bedford, MA 02745


174 Duchaine Blvd
New Bedford MA 02745

TO L L F R E E N U M B E R: 800-742-4123
FAX: 508-584-4566

GENER AL EMAIL: [email protected]

TAX ID: 04-2547371
D U N S N U M B E R: 001002989
E S TA B L I S H E D : 1974

C E R T I F I C AT I O N S :

WBENC Certificate Number: 2005110349
WOSB Certificate Number: WOSB170590

RI Sec of State ID: 001679505
SDO Certificate Expiration: 10/27/22
Minority Business Certification #: MBCN 1913
GCUI/Teamsters Union Label: 274C
Allied Trades Council Union Label: 20


Rockland Trust
288 Union Street
Rockland, MA 02370

Routing Number: 011304478
Account Number: 2929003495


STANDARD MODERN | 800.742.4123 | [email protected]


Candidate Full Name: CANDIDATE / INITIATIVE INFORMATION Candidate Home Zip Code:
Candidate Home State: Candidate Phone:
Name Party Affiliated:

Candidate Home Street Address:


Candidate Home City:

Candidate Email:

Current Office Held: Office Sought:

FEC# (if applicable):

Select Classification: C A M PA I G N AGENCY BOTH

Agency Name: Committee Names:

Agency Main Phone: Treasurer:

Street Address: Street Address:

City: State: Zip Code: City: State: Zip Code:

Agency Buyer Contact:

Agency Buyer Email: CAMPAIGN OFFICE
Campaign Office:

Agency Buyer Phone: Street Address:

Agency Accounting Contact: City: State: Zip Code:

Agency Accounting Email: Campaign Office Email:

Agency Accounting Phone: Campaign Office Phone:

STANDARD MODERN | 800.742.4123 | [email protected]




Purchasing Contact Name:

Purchasing Contact Email: Purchasing Contact Phone: Purchasing Contact Fax:

Accounting Contact Name: ACCOUNTING CONTACT
Accounting Contact Email: Accounting Contact Phone: Accounting Contact Fax:


I would like my invoices sent via: MAIL EMAIL BOTH
Street Address for Invoices:

City for Invoices: State for Invoices: Zip Code for Invoices:

Email for Invoices:

My company is tax exempt YES NO My invoices require YES NO
(If yes, please attach exempt forms): a purchase order:

INTERNAL Account: Sales Rep.:
USE ON LY Terms: Sales Code:

STANDARD MODERN | 800.742.4123 | [email protected]


W-9Form Request for Taxpayer Give Form to the
Identification Number and Certification requester. Do not
(Rev. October 2018) send to the IRS.
Department of the Treasury ▶ Go to for instructions and the latest information.
Internal Revenue Service

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.

2 Business name/disregarded entity name, if different from above

Print or type. 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to
See Specific Instructions on page 3. following seven boxes. certain entities, not individuals; see
instructions on page 3):
Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate Exempt payee code (if any)
single-member LLC

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that code (if any)

is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions) ▶ (Applies to accounts maintained outside the U.S.)
5 Address (number, street, and apt. or suite no.) See instructions.
Requester’s name and address (optional)

6 City, state, and ZIP code

7 List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN) Social security number

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 generally your social security number (SSN). However, for a or
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other Employer identification number
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
TIN, later. –
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.

Part II Certification

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. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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 for Part II, later.

Sign Signature of Date ▶
Here U.S. person ▶

General Instructions • Form 1099-DIV (dividends, including those from stocks or mutual
Section references are to the Internal Revenue Code unless otherwise • Form 1099-MISC (various types of income, prizes, awards, or gross
noted. proceeds)
Future developments. For the latest information about developments • Form 1099-B (stock or mutual fund sales and certain other
related to Form W-9 and its instructions, such as legislation enacted transactions by brokers)
after they were published, go to • Form 1099-S (proceeds from real estate transactions)
• Form 1099-K (merchant card and third party network transactions)
Purpose of Form • Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-T (tuition)
An individual or entity (Form W-9 requester) who is required to file an • Form 1099-C (canceled debt)
information return with the IRS must obtain your correct taxpayer • Form 1099-A (acquisition or abandonment of secured property)
identification number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption Use Form W-9 only if you are a U.S. person (including a resident
taxpayer identification number (ATIN), or employer identification number alien), to provide your correct TIN.
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information If you do not return Form W-9 to the requester with a TIN, you might
returns include, but are not limited to, the following. be subject to backup withholding. See What is backup withholding,
• Form 1099-INT (interest earned or paid) later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)

Barter exchange transactions and Exempt payees 1 through 4 a nonemployee for services, payments made in settlement of payment business or
cbPaoraadtractnredIw.thmTiredampxbapertryas nayenetdwrfoisrIkhdeterramnnestnai,cfatiincodnasg,trpoiosasynmpreNonctuesemtdoscbpereatiadrint(ofTisIhNing) name line. Y
Form W-9 (Rev. 10-2018) patronage dividends IRS encoura
Payments over $600 required to be Generally, exempt payees Page 3 aEtntotrenreyyosu(irnTclIuNdingthpeayamppenrotsprtoiacteorbpooxra. tIifoynosu). are a resident alien and 4 List first an
reported and direct sales over not furnish th
Criminal penalty for falsifying information. Willfully falsifying $5IF,0t0h0e1 entity/person on line 1 is 1 through 52 IspybisRneaoeed5Acyculo.iu,muvdMwCrirdeieo.toounydnvratntospelguttrr(aamdouhxgepanbpelevdelaerieEryntrybaeSt,nerosAcdreix,dea.cAaesnItfrnrticeoctypeinohfnailcueol5iaadrt2dtteiM9iboool)iynnS,gnAiAoyonbotBufloeuhmLdr,atEeobHvabeeacgStrcq,eaA(cuqtnITociausIIounTNaitnnIl)iNSi.ottfSsirE,neisNbn(douetu,eernttyuridaooHiiettbunoirioarsnwnsnTotedIthNprocoertngioissomegoyntrceoaai5nuamT2tlr 9IoINRAfS), legal entity it
certifications or affirmations may subject you to criminal penalties THEN check the box for . . . disItfryiboutaiorensa, saonlde preonpsrioetnordaisntdribyuotuiohnasv.eYaonuEmINu,syt oguivme ayoyuerncteorrreeicthter rules for part
including fines and/or imprisonment. a(n) . . . TyIoNu,rbSuSt Nyoour dEoINn.ot have to sign the certification. *Note: The g
Form W-9 (Rev. 10-2018) Misuse of TINs. If the requester discloses or uses TINs in violation of Page 2pP•aayyCmmoeernnpttoscraamtridaodnoer Note: If no n
federal law, the requester may be subject to civil and criminal penaPltaiegse.2 in settlement of ECxoermpoprtaptiaoynees 1 through 4 WseIphfayaroatuteNafrreaomamsitiensgoalew-nnmeder,mNebnuetermrLtLhbCeetohrwantTeisor’dsiGsSrSeivNgae(rodrtehEdIeNas, Riaf nteheeqnoutiwteynserthears number will
Form W-9 (Rev. 10-2018) third party network
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for FaoTrmIN1a0n99dFwilirnitgeM“Aetphpodlie1d(sFeoer” in the space for the TIN, sign and date
theRfoegrmula, taionnds gseivcetioitnt1o.6t7h1e-4re(bq)(u2e)(is) ter. For interest and dividend If your tax
pay(mA))ents, and certain payments made with respect to readily tradable notice from t
Example. Article 20 of the U.S.-China income tax treaty allows an1 its printed on th
•SeSeinFgolerm-m1e0m9b9-eMr lIiSmCit,eMd ilsiacbeillliatyneous Income, and instructions.
If your tax
exemption from tax for scholarship income received by a Chinese 2cHoomwpeavneyr,(LthLeCf)oollwowneindgbpyaaynments made to a corporation and think you are
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suap.pIonrdt itvhiadtueaxl.eGmepntieorna.lly, enter the name shown on your tax return. If
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Victims of
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1. Certify that the TIN you are giving is correct (or you are waiting for a fweidthehraolldtainxgp:umrpeodsiceasl.and health care payments, attorneys’ fees, gross Taxpayer Ad
number to be issued), tsttsshhhtttuuueeedddfpUeeeirrnnnnsoitttttvePtbwisederiimoolclStnobpotsameoctcrooeeaoflssrmtAiloeayrexttrpichceareelseereiesdUd2ese.s0inSndt5tt.e-oiannCclctaihteoahliennnleinaetodiUnnftarnutferhoietayeerttedytoUaa(Srxandspitapt.aeptHutedleryodpsSwe.oAtvUesapeevtnrneesidlsraei3,.ffr0pAtheU,airsC1r.aSt9hohg.8irenrl4aaheC)wpesahrhe,lislnto2htewaiossysfeinsSopEyanreUeo•2t•n•ppuoppofatxhqan5obruuratypte.eohuStLLLt5tyerjrlmeeiaypceeeLLLtm.e3odscyresoqpCCCfstweiU,teetsotesustoiytnndrtnnodiettteihoeoporhhretiegnbsspeetasguenaarer.tledaatyapathrttfdihmsfrtsoarlaetihrebasdoisartrSosisaauadtydaenxeeesdmtynsbfxedsapaeoetiomfrsdloftsrprrxerseifeFtroovlmoheiauueqeaasatAivmrcemtvdbrgusniiTpbipeerdnUmafipraFiaoCysagiLtrye.tntsoitdSsrhLctoAmcptgttftereoi.Cnohouerimasnsedorryfeirwrisnee,gapndtfmtoriaa8hndepsretofutesbis8oayehelnohrrd.y3tawrreriuairrpmasAft2pietbbnnoiasilitopfofnuclhrrotofoafeneoraotegerrnrtai,qxrrrimgdknttcuFaanae.goebno(LotfirCnPfohadsulirriemnaoreltm=eniSefcaena.udiarP=ttcnxscWTnehepmoaecuchddSerp-rciuloaaetet9FrufnlncuyoliriwAaftnteownipoisnibTvaiyrnrttrliesspseCilthnoidloahcthiocutiAmiawtttticyri“hepiuga.oahaiaNec;ntleTtntotiiioaoCongeinhopnl6dxmttnc=enestca0sAhysc)tripoinC4.ins.aepltdaa5uoTetptneccs(tdhnhafliyssooio)eec,iocdrfnraiapaUdiueoecnbnoieftdsnasdosldrneeitairtidte”eeotiifenisd,n(oyoti.nefr;r calling the T
student who qualifies for this exception (under paragraph 2 of the firstea••xnAeyPTm—sraipumArsttninitol/aeonerrsrscgitnhaoaditpdneiceiza.attioionn) 1-800-829-4
1. Certify that the TIN you are giving is correct (or you are waiting for a2. Certify that you are not subject to backup withholding, or written or printePdaorntntehreshliinpe for a FATCA Protect you
number to be issued),3. Claim exemption from backup withholding if you are a U.S. exempt exempt from taxTurunsdte/erssteactetion 501(a) or any Phishing is t
protocol) and is relying on this exception to claim an exemption from taxinLdiniveidu4a,l rEextireemmepntipolnansas defined in section 7701(a)(37) mimic legitim
payee. If applicable, you are also certifying that as a U.S. person, your on his or her scholarship or fellowship income would attach to FormIf Byo—uTahre UexneitmedptSftraotmesboarcaknuypowfiitthshaogldeinncgieasndor/oinr sFtAruTmCeAnrteaplitoiertsing, is sending an
allocable share of any partnership income from a U.S. trade or business legitimate en
enCte—r Ainstthaetea,ptphreoDprisiatrtiectspoaf cCeolounmlbiniea,4aaUn.ySc. ocdoem(sm) othnawtemaaltyh aopr ply to private inform
2. Certify that you are not subject to backup withholding, oris not subject to the withholding tax on foreign partners' share of
W-9 a statement that includes the information described above topyoosus.ession, or any of their political subdivisions or instrumentalities Privacy
effectively connected income, and
Section 6109
3. Claim exemption from backup withholding if you are a U.S. exempt4. Certify that FATCA code(s) entered on this form (if any) indicating correct TIN t
file informati
that you are exempt from the FATCA reporting, is correct. See What is certain other
acquisition o
payee. If applicable, you are also certifying that as a U.S. person, yourFATCA reporting, later, for further information. debt; or con
person colle
Note: If you are a U.S. person and a requester gives you a form other information r
Routine uses
allocable share of any partnership income from a U.S. trade or businessthan Form W-9 to request your TIN, you must use the requester’s form if Justice for c
Columbia, an
it is substantially similar to this Form W-9. administerin
countries un
is not subject to the withholding tax on foreign partners' share ofDefinition of a U.S. person. For federal tax purposes, you are and criminal
effectively connected income, andconsidered a U.S. person if you are: agencies to
not you are r
• An individual who is a U.S. citizen or U.S. resident alien; must genera
certain other
4. Certify that FATCA code(s) entered on this form (if any) indicating• A partnership, corporation, company, or association created or Certain pena
organized in the United States or under the laws of the United States; information.

that you are exempt from the FATCA reporting, is correct. See What is• An estate (other than a foreign estate); or
ndaivmideeansds,hborwonkeornaynodubr a1r0te4r0e/1x0c4h0aAn/g1e0t4r0aEnsZaocntiolinse, 1re. nYtosu, rmoyaaylteienst,er ExDe—mAptcporapyoereatcioondteh.e stock of which is regularly traded on one or itnhsetrrueFmqoureentshttsies,rgtbyeepnfeeorroaelflyyaoycuocuaoruwenisltl:uhbajveect6t0o dbaaycGskiuvtoepgnweaittmhaheToaIlNdnindagnEdoINngiovef: it to
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lineY2o.u will not be subject to backup withholding on payments you y9o.uApvraolivdidtreusyt,oeusrtaTtIeN, otroptehnesiroenqturuesstter.Legal entity4
cttcrahaeexdaxcr.rdetrtiifoeevOictrceutauohritmrfnieoy.orenotnehsutn,esgtraiointlvenideeglsairtn.ehleEpdenoo1rtr.ceetuTqramhuylileoseysunnotrteauncrmraryteemoaaxusetaihrnabocgsluoetlsrhdrihneemotceewtanrnTettcisItoNhtyn.,athYmnreeodaqunkduaemiirmvetiadhdeyeesUenhpn.dSortsoew.profneeandronyenyoratuhlre sbeacctikounp1w.1it4h7h2o-l1d(icn)g(1. )(i)
bPuasyinmeessn,tstraydoeu, roercDeBivAenwamilleboensluinbeje2c. t to backup withholding if:
• A domestic trust (as defined in Regulations section 301.7701-7). If you are a nonresident alien or a foreign entity, give the requester the• EE—xcAepcot rapsoprarotivoindethdabt eisloawm, ceomrpboeraotifotnhseasraemeexeemxppatnfrdoemd abfaficlikautepd

FATCA reporting, later, for further information.Special rules for partnerships. Partnerships that conduct a trade or gwroituhphoalsdiangcoforpr ocreartiaoin dpeasycmreibnetds,inincRleugduinlagtionntesressetcatinodn d1.iv1i4d7e2n-d1s(c. )(1)(i)
appropriate completed Form W-8 or Form 8233.• FC—oArpdoeraatlieornisnasreecnuoritiesx,ecmopmt mfroomditbieasc,kourpdweritivhahtoivldeinfignafnocr ipaal yments
business in the United States are generally required to pay a withholding inmsatrdueminenstestt(lienmcluednitnogf npoatyiomneanl tpcrianrcdipoarl tchoirndtrpaacrttsy, nfuettuwreosrk, ftorarwnsaardcsti,ons. 1N0o. tCeo:rpEonrtaetrioinngor“ALLpCpleieledctFinogr” means thTahet ycoorupohraavtieonalready applied for a
TINcoorrptohraatteysotuatuinsteonndFotorma8p8p3l2y ofor r one soon.
Note: If you are a U.S. person and a requester gives you a form othertax under section 1446 on any foreign partners’ share of effectively
Backup WithholdingSaa•nttadtCoteoronsprepotyioorsrna’asntfei)yoetnhssstaaotatriersegrrneoogstissetpexrreoemcdepaetsdfrssoupmcahibduatncodkauetprtotwhrneitehlayhswo,lsdaoninfdgtchwoeirtUphonrrietaestpdioencst to CauFtoiromn2: 5A53disregarded U.S. entity that has a foreign owner must use
connected taxable income from such business. Further, in certain cases 1th1e. Aaspspocroiaptiroina,tecluFbo,rrmeligWio-u8s.,

than Form W-9 to request your TIN, you must use the requester’s form ifwhere a Form W-9 has not been received, the rules under section 1446

require a partnership to presume that a partner is a foreign person, and

it is substantially similar to this Form the section 1446 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

Definition of a U.S. person. For federal tax purposes, you areU.S. status and avoid section 1446 withholding on your share of

partnership income.

considered a U.S. person if you are:In the cases below, the following person must give Form W-9 to the
e1.. YDoisuredgoanrodtefdurennisthityy.oFuorrTUIN.St.ofethdeerraelqtuaexspteurr,poses, an entity that is The organization
dt“sPhdhiseaio32srrueort..eglwITYdIgahonfanroeuedrerdreIvd'RdesdeodeSrnatnbaeatsoemnielatlstlaesin)ct,”nintseitfrliSyiertneyegyeqeasou1eruRde.preesTaTtgdhreIauNeretlaentnwhttaifiaohrtmyoten.myensToosrhuietefesqfctuhunotrieiaownrmeniensdneeh3tr(e0isotid1eysn.ea7etlrin7ntneh0teaieen1t1rce-ien2odsds(rhcartooer)s(unc2ucat)lld(tiiTniioibIe)Nn.e1sE, tnfhoteerr
thGat—pArorveidael emsteadteicianlvoershtmeaelntht tcraurset services are not exempt with respect PacerhxeatmritIpaIbt.loerC,geaednuizrcatattiioifonincal,aotr ioothner tax-
What is backup withholding? Persons making certain payments to youentTithyerefoglilsotwerinedg caot dalelstimidesntdifuyrpinagyethees ttahxatyaeraer euxnedmerptthferoInmvebsatcmkeunpt
toHp—ayAmreengtuslarteepdorintavbelsetmonenFtocrmom1p0a9n9y-MasISdCe.fined in section 851 or an To establish to the withholding agent that you are a U.S. person, or
1re2s. iPdaertnntearsliheipn,osrimgnultFi-omrmemWbe-r9L.LYCou maTyhebpearretnqeursehsitped to sign by the
must under certain conditions withhold and pay to the IRS 24% of suchFCowro1Imit—m—hWhpAAoa-n9clndoy(oiRnmrAeggmvca..tnEo1oinn0zf-tat2e1rt0riu9o1ts4n8ht0)eefuxanepdmparpostpdfrrieoafmtienetcadoxdinuensidneectrthioseenscp5ti8ao4cne(a5)in01li(nae),4.
nam4.eTshheoIwRnS otenlltshyeoinuctohmateytoauxarreetusrunbojencwt thoicbhatchkeupincwoitmhheoslhdoinugld be any 1w3i.thAhborlodkienrgoar greegnistteerveednniofmitienmee 1, 4, orT5hebberlokwerinodr incoamteinseoetherwiseP.age 5
rbeepcoartuesde. yFoour edxidamnoptler,eipfoartfoarlel iygonuLr LinCtetrheast iasntdredaitveideansdas doinsryeoguarrdtaexd
partnership for purposes of establishing its U.S. status and avoiding IRA, or For a joint account, only the person whose TIN is shown in Part I
• An individual who is a U.S. citizen or U.S. resident alien;withholding on its allocable share of net income from the partnership townhopiitrnehderhampotoalpdrrltisony.ygRne.eeetawpl aoeyrsk,tapttraeayntmrsaaencnsttiasocnmtsioa, ndasendainrceseenrtottalteinsmupebanjeytmcoteftnpotasbyafmrcoekmnutpfcisahridnganbdoathcyoy1cooELNtpcrepUFo9apho34ouurvl8urno4756eoinaitsM..nesdr3ts————iinintafsnuetROsee.iceef—etrcsroeAAAAooeoY:eetddatsyhsrurYr5AasohtsmsodffcursSeitauoloueoiouoTmueigtrtfiotrecuanbuttartraumeneoneppstaexljtlraimdebmeengtdorTauetddeachrestnissraIyb1naexdNtteaf,2itmyneo9glegtcrtttiesceiot8rohtmowooecstieoiCrese3efgrmvmneonbiprsassostnetctmtaDahmthhiniimrs(nufgnctenneitisp.sheicrtrnkmdsumoiaultYceratiuesrmwneicseibtieoetpcisccqigotetrhonbsursoteitunudoweotnieitnrfooomehn.tkitnroimschrfunits,edefsrhuuaeitnCcseecr.ehslfatrlottrroaieYtrroanoctmw,ertlashglyochunmidyeosiemiucam.stvooitn.hny,neoeFufombgocatoutAidiyhtmutnuarrnasTiioeeotd,sbtnhuiCugpestnofadasriiAsosrsnctvc4pcylitaakreigco0ceaotoeuninro3rnrUcrbuqoetpcr(dsametue.bsdiahSaielwesci)derrels.wnteepaienoiutcndcTnilhrtnumbtaoseeIhdhotnNtdmtrdeoo/itrittito,tirovihlmufefseidrrbiiinreeetscumliouieynasgidoaiContxtegcipnte2snwetoiyctohrtwsmirnomitoeevnnaei,uuoivraep.ltqmalmtinlidYtdyhutgnadohobiepoe4oepnudtuse5anuohpgrnitry7tcrielio)mnyyne(.iegt.ggeas)Ify,
conducting a trade or business in the United States. ernetiutyrnfo(froUr r.Sep. oferdtaebrlael itnatxerpeusrtpaonsdesdhivaidseandsisngolnelyo),wonrer that is a U.S. 1csp4ohe.dorAAseucgoF,lcrdnoeiocarusuidrniltgltehituennwrirset.(iitwifthniyehttpdhheeeenoDnonraeefmlpqianaueceritcorme1fodeaumn)p.ntuuItons:bftltichsiegnc.aTEshexeeopmfGuapbivtldiecpiseanrnyeateigmteyaser,daseneddeeEEnxItNeitmyo,ptfth: peayee
dptoabhwiecsaer5crncsed.oekogiYuurrnaenpot,rhctudtswathedtoeiodtoiwhpsUehennn.nonSeootlert.idttdoocyidn'efwasigsrtfnthrtnuieeefeayngrrm'edas1tonere9ndtr8tioaeth43ymndeaoielsfrbinoneoailreqsylvsfu)r2ee.oee,d(qsa“fetouBerdriaurrielrsstetdhriapneaxteogtosrapytsbrauodebnrueplapedaomrrsioeeneevnt/sneitdd.iortieeEystds,rnsetetuogeanbnarntjeretdldihrcneedttehditve1oeid.fniIerftsnittdy Sigennatittyur(seucrehqaus iaresmtateenotrsl.oCcaol mplete the certification as indicated in
• A partnership, corporation, company, or association created or• In the case of a disregarded entity with a U.S. owner, the U.S. owner itemgosv1ernthmreonutg, hsc5hoboel ldoiswtr.ict, or

of the disregarded entity and not the entity;

organized in the United States or under the laws of the United States;• In the case of a grantor trust with a U.S. grantor or other U.S. owner,
generally, the U.S. grantor or other U.S. owner of the grantor trust and FnoarmCmeeW.r”t-a9Iifn(tRhpeeavy.oe1w0en-s2e0ar1no8df) tphaeymdiesrnetgsaarrdeeedxeenmtiptyt fisroamfobraecigknuppewrsitohnh,otldhieng.
afoLTSRrbwhoieeTnoimAnseqhveleuseieEbsroe,x2afmtso1echstlmueekeltohserupwctrpotSoacifnuspwpoFgegaemiotyhccehrepimhvha1eleaeol3nrctrWl.dteuoiils-fndea9htgsnehof.,feoawoTlarpfrshotpmepetrryreaooc,pirrpghatenrnansieiardnptrotfseetaofhhrprpFsiemppoaosslayrni, pneasaeFyfxoeoerermmsthplWiest t-e9d.
IWfFytohhueahpatavyeimsaeFbnutAsisinTefoCsrsA.n.a.mRee, tpraodertnianTmHgeE,?NDBthAenpaamyem, eonr tdiisrexgeamrdpetd
eTnhteityFnoaremigen, yAocucomuanyt TenaxteCr iotmonplliiannec2ef.oArc.t.(F. ATCA) requires a
not the trust; and prison) that receives agricultural

• An estate (other than a foreign estate); or• In the case of a U.S. trust (other than a grantor trust), the U.S. trust program payments

(other than a grantor trust) and not the beneficiaries of the trust. 15. Grantor trust filing under the Form The trust
1041 Filing Method or the Optional
• A domestic trust (as defined in Regulations section 301.7701-7).Foreign person. If you are a foreign person or the U.S. branch of a Form 1099 Filing Method 2 (see
Regulations section 1.671-4(b)(2)(i)(B))
foreign bank that has elected to be treated as a U.S. person, do not use

Special rules for partnerships. Partnerships that conduct a trade orForm W-9. Instead, use the appropriate Form W-8 or Form 8233 (see
Pub. 515, Withholding of Tax on Nonresident Aliens and Foreign ICLpapnhictaaneecryrtecoeeickeusi3snptthtaaaethnrienodaglpeddxpfeioverriorsmdepetipghrnitanadfttrfeopainmrabaeyonmFsxcpAieoaeTnnlcCtisinlfiAinseetrdiet3upUtofinooAfroirtntlielrnttedh7goxe.SerSUetmaep.tSpeoet.rsEtfpexpaaedelylmereUsrepaonstlniittoseean.xdxCcfSreeotpramttateiFnsATCA
BocrWlenraope-s9kosberiffotroiicxntrragmaotnincoosonrlaiedncoeeitfn,io3tflohan. ertsempra,etariosnondn.thwehIonssetruncatmEtihoxerneosimsufgpeohntr tp1teh1areeyaedRneedosqna1ullelitnhCsetreoc1ruo.ogrCpfhhoF4eroacartkmPnioadongnse6l.y3 1 List first and circle the name of the person whose number you furnish.
business in the United States are generally required to pay a withholdingEntities). UIFpthdeaetnitnityg/pYerosounronInlinfoe r1mis ateSTixoHceomEnrNppotcrphaateiyocenkestchmoeudbsetobnxeocftoaerun.ste.e.rthaeny If only one person on a joint account has an SSN, that person’s number
BpYcapy•••aaoanleoatr(udrruitICSnsmoneaoo)aomndrernln.raieedupvt..gxiisopacF.detctorirouphCaopdraabatpriilvecntooereixogvndeaarieretdpnemonetocrredpsreauxaslhinepvetisi,pimdonay,angpcoottteturriheodpmapnaitosnyaerfeyaotleeannrcbmdieftleesaydtotpiooutaEnpaonmCIybnroarxeimoptdeerenooermrimecrepvaoxaonntinobpvdoenvotrietusSdmeya2rlpareoti0ppecniLlaon/1uedotLysntg2rproeoChssep.deneloeerosalcnyfarptuau1enftrttroodouitieotrhrpiwxineernsreo,sihaffemouorolateorgormpcmsmhritqfoaoyp4uyttforhiaoirouiseyusniednneigfole- must be furnished.
Pr$Pglteofci•5hanerpon,eayedd0oSgmmnien0rvneittnrpa0eoieradgama1nrdalulnttetrlesaraayet-ulnxomoi(satedLrvatpneLexTsddumCrIriieNer$bpd)xes6eooieccs.0rswmhtre0elasnipmgsnaer.taegldi.etrqeeIdsnbusdeoyiardflveoidaaedfrndobrtitrihtloiUoetybn.aSe,c.ycoo1Guuetnmhntre;uorfsuoatglrlfyhue,rx5nea2ixmsehpmalepn,teipfwathyFeeoegrsmranWto-r9oiff a 2 Circle the minor’s name and furnish the minor’s SSN.
p1PtCurF••o2UeaaaSnai5rqyny.veliSLLe5mlmusieulLLs.3aeerepsCCFfcseetnneotoydteittntroosrhoerbcmeanu,aramealsafryttr1utylodtafhe0aratduadfna9xoiolesxiuea9rasrrdri-ftsphneeiMfhlaueaaisTisrIdrlssSdesupIpNtdeaFbCoaptu.lojsr,ecieatneIerMmnofcrmfstettryoie,opsrotr8nsnoocmur8hteerea3aifoatalpalwt2aftspiioilfnooeooonternnnrork,oaawfublutEslyot(LirePhxtnirIhomee=nciSsfmcariahP=t$eoueppa5symsdSptr0poetreplncueoifa,aaooercpnabyrrrctrdspneiieloathiedotoanrtiysrrepcoiaewtc;h1tsttcioaCitotsttioxmnhh=nuTsrhc)wcIpoCtNlohraauiullnlcsgtfdfcoauysohitinilirlafaou4pnigcnnroe.aedsgrIt.afileoetynincoott.neu. ;r
2mb•erHeanapcoLtkikowLteuyrCetapasvtbeefwhaplreail,tsathteorhihasnestoetdFlfadoiofstirlenrrloomemgmwg,e1aiyinn0trosdtg9uewo9pda-wiatMrhayenmsIenSsroaeuCbnbrutaejestracemstonatnoodateabelt$xeoe5bm0aa0pcsoptisrefprtnohoamarlattytbri.eoasncukalutnspdin no 3 You must show your individual name and you may also enter your
twhiethohwonldeinr gis: amneodthicearl LaLnCd htheaatltihs care payments, attorneys’ fees, gross business or DBA name on the “Business name/disregarded entity”
nporotcdeiserdesgapradidedtofoarnUa.tSto. rfnedeyerraelptoaxrtable under section 6045(f), and name line. You may use either your SSN or EIN (if you have one), but the
puayrpmoesnetss. for services paid by a federal executive agency. IRS encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do
paE••paxypeTPelmyreaupstrsottnttih/opeearensstrthsfaaroirtopeenmsexsFeuAmbTmpCtitAftrinoregmptohreirsptiofnorgrtimncgoPTfoduraruenrsat.dntcTe/ecehrrosesFtuhAafniotpTtelsCloAmw.ianTinghtecasoinedeecdsoodidueetssnidtifey not furnish the TIN of the personal representative or trustee unless the
yoLof iutnhaeereU4no,intEelydxseSutmbamtpeistttiibnoygnctsheirstafionrmforfeoirgannfinacacnociuanl tinysotuituhtoioldnsin. TthheerUefnoirteed, if legal entity itself is not designated in the account title.) Also see Special
SIftaytoeus,ayreouexmeamyplet afrvoemthbisacfikeuldp bwlaitnhkh.oCldoinngsualnt dw/iothr FthAeTpCeArsroenporting, rules for partnerships, earlier.
reenqtueersintintghethaipspforormpriiaf tyeosupaarceeuonncelirnteain4 iafntyhecofidnaen(sc)iathl aintsmtitauytiaopnpisly to *Note: The grantor also must provide a Form W-9 to trustee of trust.
Nonresident alien who becomes a resident alien. Generally, only a syuobuje. ct to these requirements. A requester may indicate that a code is You will not be subject to backup withholding on payments youhTahv8ei—spiAsrewrveihaoelureseslytahgteeivreiennqvueaesnstmitneceronotrfrtetrhcuitsstTFINor.m“OWth-e9rwpiallymaeinl tyso”uirncinlufodremation you with a Form W-9 with “Not Applicable” (or rceecrteiifviceaitfioynosu, gainvde rtehpeorretqaulleysoteurr ytaoxuar bcloerrinetcetreTsINt ,amndakdeivtidheenpdrsopoenr yourarphercaf1Ieaninenldha0y9evottamld—u—s,tennhr,rwseenAcArtcnmrsosmeniatcs.tyspeteroIeahieflnnmmonlNetttsiythteEamieoChetisdWsyrelood,veiarnmrgifecaaodiorngtetpdredroisutatdcssrhdhesnoter(eeesiestynrrvdssft(cceAuoisscloddnuctp.ewuhiddtf.asrfeioIestl,norflefrapgpbats1lhaoeelpnf9aytrfraeui4anommtywst0hmebemeeedniadsltelrthdsbesnduedqyftunmosruorteariiaetnnlsombdsetgshtaeceetietnshorhricnk’eprepsphausrrtaotoeyeanrnraovqtxdadtidruledtyeiiecsroeemehsndsoat)aees,rrenn)ctmrub,hgttnaupieeoodlsarrdsnfeieeynipycarm5eiaosadt8sehyuly4ssnmear(thtafnilseoal)dnrsatoton
tax under section 1446 on any foreign partners’ share of effectivelyFonoorrnemrliemWsii-nd9ae(tRnetevUa.l.i1Se0n.-t2ian0x1d8iov)nidcuearltmainaytyupseestohef intecrommseo.fHaotwaxevterer,amtyotsotrteadxuce eab•nxaeyGcmskeiupmnpteiiolrwaanrliltcyihn,ohdidonicedlda.ivitniiodgnu.)awlsri(titnecnluodrinpgrinstoeled pornotphreieltionres)foarrea nFoAtTeCxAempt from tax return.cbaELta1c1otru12noaidns——ttrentaceoreAAnrdyed6fmioswainutni(hadimrnindrcedclilemtuiyapmd,blaiasienrnnttrgysastktpnieantaeu,noytadwwimonfnondiesrnikhZnteIstPtrrhamteocneosicnndao,vecrea.tpisnootdnmrasget,irnopotnsacssy)om.pmreomnctusenetidotyscapesratiaadinntoofimshininege or
wrceohqneunrieerecataeFdpoartmratxnaWebr-sl9ehiihpnactsoonmpoertefbsruoememnesrtuehccahetivbaeupdsa,inrttehnseesrr.uiFsleuasrtfuhoneredr,iegirnnscpeeecrrttsiaooinnn,1ca4ans4ed6sbticMfscCcnerpooeeercdiIrennicsaflmteucttouityfriaidinimeisaofciniinuseleunaeaeeldgtacoladiaowofprfifoneinniUn,eTnrsttetan.IachhStNsoahieUeen.srleratr.ts.raaySneaesaIfdsi.faqpffnviio/rtvrdurioehnmotrieenyrsegvfsnapgiiaidmtrstcteeeliceilosasoaprqlnilnanuirfmuotesiuyssefakniaseomnsinleynifntgemooeacmbonwrryoiafenetwdmnysaafnsiuohxseaputtbroc.asebpemjlxreoijauvmsecasterc“rptertinetsteiosyoaaaltaoysontovnfiyeutni.rncesegtWtugir.oxovsoteiicllhceclnmflalserauainapmuliTplmdnytsIaiiNenoecyfa.aansxre”nillcemsifEpnreeifohxiexypnvmcaneitainoesiamolgptllpoantaptitteexitiohonsiotennaonrslwtoiefisse. inw•dAitEihv—xihdcAouelndaplitonrargegstafiropnerrimzocaveetinrdiotteanpdinelabxpneealmaoysmwpd,teecnfrfotoisnrm,peiodntracainxltuisoudennincdsgteiaoirrnnestee7erc7xet0esio1mtn(aapn5)t(d03f1r7do()aimv)idoberanacdnksyu.p Payments you receive will be subject to backup withholding if:psEPe41a539cnya.—4umteM7rreAertondytrtorItspu.gurs(aroTutgTpneaeIexdNrexientmriyptn,espactretheacfyesrntotiecoampeprnalptl5iaaIdr2dxtoi9bopue)ynr,ninAdayooetBtferuiLdfs,bEeieaocbcacxttacq.,iocuIqtfnoiiusyou6aoitn6luniio4tfsianeoNr(deroudrnutauedamrisetbcirsoarbinisndbedeeepcondrrtnoiioamng(lnTriseeae5nnImc2Ntat9oinoA)fdn),
pay the section 1446 withholding tax. Therefore, if you are a U.S. personfrom U.S. tax on certain types of income, you must attach a statement • BC—orTphoeraUtinointesdaSretantoest eoxreamnyptoffroitms abgaecnkcuiepswoirthinhsotlrduinmgefnotralpitaieysments
mCad—eAinsstaettetl,etmheenDtisotfripcat yomf Cenotlucmarbdiao,rathUir.dS.pcaortmymneotnwwoeraklthraonrsactions.
Specific Instructionsto Form W-9 that specifies the following five items. p•osCsoerspsoiorant,ioonr sanayreonf otht eeixr epmolpitticfarol msubbadcivkisuiponwsitohrhionlsdtirnugmweinthtarlietisepsect to
that is a partner in a partnership conducting a trade or business in theLwih1nic.ehTh1yeoutrecalatyimceodunetxreym. Gpetinoenrafrlolym, thtaisx atDto—rnAeycso’rfpeoersatoior ngrtohsessptorocckeoefdws hpiacihdistoreagttuolranrelyystr,aadnedd coonrpoonreatoior ns 1. You do not furnish your TIN to the requester,IRyoAu, CdovneortdheallvEeSaAn,dAarrcehneortMelSigAiboler tHoSgAetcaonnStrSibNu,tiyoonusr ToIrN is your IRS
must be the same treaty under mthoartepersotvaibdleismheeddisceacl uorrithieesalmthacrkaeretss, earsvidceesscarirbeendoitneRxegmuplattwioinths respect
as a nonresident alien. steocptiaoynm1e.1n4ts72re-p1(ocr)t(a1b)(lie) on Form 1099-MISC.
United States, provide Form W-9 to the partnership to establish yourYo2u. mThuestreenatteyraorntiecleofatdhderfeoslsloinwgintgheonincthoims lein.e; do not leave this line diinsdtrivibiduutiaolntasx, paanyderpiednesnitoifnicdatisiotnribnutmiobnesr.(IYToINu).mEunsttegr ivteinytohuer scoocrriaelct
ET—heAfoclolorpwoinragticoondtehsatidisenatimfyepmabyeresofththaet asraemeexemxppatnfdroemd abfaficlikautepd
bla3n.kT.hTehaertnicalme enusmhobueldr (moraltocchatthioen)nianmtheeotnaxyotruerattayxthreattucrno.ntains the gwroituhphoalsdiangc.oErpnoterratihoenadpepsrcorpibreiadteincRodeeguinlathioenspsaeccetioinnli1n.e1447. 2-1(c)(1)(i) 2. You do not certify your TIN when required (see the instructions forTsINec, ubruityynoumdboenrobtohxa.vIfeytousdigonnthoet hcaevrteifaicnatIiToInN., see How to get a TIN
Part II for details),WbehIlfoaywot.uNaraema seoleapnrodprNietuormanbdeyoruThoaveGainvEeINt,hyoeu Rmaeyqeunteersetiteherr
U.S. status and avoid section 1446 withholding on your share ofsaIvfinthgiscFlaoursme Wan-d9iitssfeoxrcaepjotiinotnasc. count (other than an account 1F——AAndoeraglearniznastieocnuerixtiems,pctofmrommotdaixtieusn,doerrdseercivtiaotniv5e0f1in(an),caianly IRA, or Give name and SSN of: Note: If no name is circled when more than one name is listed, the
partnership income.ma4i.nTtahineetdypbeyaandfoaremigonufnint aonf ciniacloinmsetituhtaiot nqu(FaFlifI)ie),slisfotrfitrhset, eaxnedmthpetinon number will be considered to be that of the first name listed.

fcriorcmlet,atxh.e name of the person or entity whose number you entered in Secure Your Tax Records From Identity Theft
3. The IRS tells the requester that you furnished an incorrect TIN,yourFSoSrNthoisr tEyIpNe. of account:
In the cases below, the following person must give Form W-9 to theatPhaje5ort.itnrISetouaaftcfyFiccoaoierrumtnincttWlf,eae.-ca9tcs. hItfohyoojuludsteaifrryeotpfhtrehoeveixdaecinmcgopFutinotrnmthfraWotm-i9staatoxUau.nSnd.FpeFreI rtshooedntoemcrmuuPmsastgeoenf2t 1. Ifndyiovuiduaarel a single-member LLC thaTthiesinddisivriedguarl ded as an entity Identity theft occurs when someone uses your personal information
cwpoaitnrhtdnhueocrldstihinnigpg afoontrrapitdsueraploloorscbeausbsolienf eseshssatariebnloitshfhenineUgtniiinttsecdoUm.SSet.afstretoasmt.usthaenpdaartvnoeidrsinhgipAynpsetsohardttxoauuumeEmev.ddmxhUeiieednIaannpnnaeimvsidtttsteitaeoiwtprsveadcnFlhiimethldolioSfo.arubprwtonAmnaaeomngrtlc(rt.eSWeaioocsGtdrSmanli-eleeA9xyyeynx).2opfoceooa0uruerfrerarroetessllhdasflescyoestsin,hhdtcteon5eeinanilannaacUltmtremasts.ahrSleeheeletc.inich-epwuCdUhenriiaahinntntfhrniyoicnatogyeroamcueedmtaata,ienrSerxeidnscstn,rp.foaheotaHumtoecrenrrwmoepesdywi.noivtonyUaeseoguoexvdnnruestdthfbrryriei,reeyfnosrpaehutSaUtawirynsorC.taaScaaolhagmi.lxralisronlleaahtrewSe,wpensttserha,uehcsmtare2uhntnaeril.osaiy.tIfsfyitn s2e. pTwaroaoter mfroorme initdsivoidwunaelsr,(joeinntter the owTnheer’asctSuSalNow(onrerEoINf t,hief tahcecoouwntnoerr, ihf as such as your name, SSN, or other identifying information, without your
permission, to commit fraud or other crimes. An identity thief may use
Nthoetefi:rsITt IPNroatpopcolicl taonth: eEnUt.eSr.y-Couhrininadtirveiadtuya(ldnaatemdeAapsrilt 3w0a,s1e9n8t4e)raeldloowns 4. The IRS tells you that you are subject to backup withholdinga cmorapinotarainteiodnboyrapnaFrFtInership, enter thteheenactictyo’usntE1IN.
ytohuerpFrorvmisiWon-s7oafpAprlticicaletio2n0, tlioneco1nat.inTuheistoshaopupldlyaelsvoenbaeftehretshaemCehiansesthee onea)c.cDouonnt)oottheenrttehratnhaendaicscreogunatrded enctoitmy’bsinEeIdNf.uInfdtsh,ethLeLfCirsitsincdliavsidsuifaileodnas your SSN to get a job or may file a tax return using your SSN to receive
a refund.
• In the case of a disregarded entity with a U.S. owner, the U.S. ownernsatumdeenyot ubeecnotemreds aonretshiedeFnotrmalie1n04o0f/t1h0e4U0Ani/t1e0d4S0tEaZteyso.uAfCilehdinwesiteh your
To reduce your risk:
asptupdliceantiownh.o qualifies for this exception (under paragraph 2 of the first • Protect your SSN,
• Ensure your employer is protecting your SSN, and
waiting for a go• feInnthetehraedlliycs,aretshgeeaorUdf .eaSd.ggeranrnatinttoytorartrnoudrstonwothtietthrhUea .eUSn..Stoit.ywg;nraenr toofrtohreogtrhaenrtoUr.Str.uoswt annedr,neycoWsaponaoupnrbcutm-orIppif.9p.rthtpyeroyoiboPasS'oocsaruparouoaosstsrtrltltriaie)attaasinhxnohartthepeaeeeennorstmrrer,dacswosetso,oeuphinnxcsrtmnrroeirhnpotSiarmnpeoen,tdorltlhlcpeLaeeyonyaotrtsiL,roneistlriooCidughdopninnrreieropto.Fc“n1hrsdnl1otuo0aaiornad4rttatmhiigl0ennfoiiieeslss/gdnWel1nln.toe-b0a-homEoxwn4u8ercnty0sseoeaitiaAhnmnebrpif/ferupsFoto1bistsioor0rnehiseimnnrn4regimcage0altLoesensoEtL8inm”-soZecCm2t,(neiDnl3tota.eyrt3dBwniEai'mmt.sedAynolis,betnnu)aceg,eaenlndrriomraiv1byermaeL.eoextDLYdeutetaahBCrmosoaceAi,unbnhpsCrdomntheltiiiovoaoqnvaemnwueiFydetnofe2ueorsr.oanotomelmtnner rttthhaeex because you did not report all your interest and dividends on your taxNf3u.orT(tjthoweieno:rtSocaerclaemcrooiWfuriecnhtaUamtt.iSoaN.ninaptomeafrinsenoeaadnmnsbdyeNaanunmFdFbTI)eINr TcEooamcGhbivhienoladttheioer noRsfe.thqeuaecsctoeur,nltater, for
or not the trust; andliBneda.2c.OkthuerpenWtitiietsh. Ehnotelrdyoinurgname as shown on required U.S. federal return (for reportable interest and dividends only), orHow to get a TIN. If
U.S. exempt
rson, your tWaxhdaotcisumbaenctksuopnwlinitehh1o. Tldhiinsgn?amPeerssohnosulmd amkaintcghctehretaninampaeysmhoewntns oton ythoeu T4o. Caupsptolydiafol racacnouSnSt Nof,
or business yagoemutinFdooorrnmotShSa-v5e,TAahpeTpmINliicn,aoatrpi2opnlyfofor raoSnoeciimalmSeedciuartietyly.
re of • In the case of a U.S. trust (other than a grantor trust), the U.S. trustcmhaurstteur nodr eorthceerrtleaginalcdooncduitmioennstwcirtehahtoinldg athnedepnatiytyt.oYtohue mIRaSy2e4n%teroafnsyuch Ca(rUdn,ifforormmGyifotutor lMocinaolrsSAScAt) office or get this form online at
ee What is bpuasyinmeesnst,st.raTdheis, oisr cDaBllAedna“bmaeckounplinweit2h.holding.” Payments that may be 5. You do not certify to the requester that you are not subject tow5.waw. T.hSeSuAs.ugaolvre.vYoocuabmleasyavainlsgos gtreusttthisTfhoermgrabnytocr-atrlulinstgee11-800-772-1213.
orm other • Be careful when choosing a tax preparer.
ster’s form if f(Foootrhereeigirgntnhbapannekrastgohrnaa.tnIhtfoayrsotureuleascrte)teaadnfdtoorneboiget ntthrpeeeabrtseeodnneafosicriaathrUiee.SsU.o.Spf e.thrbseroatnnru,csdhto.onf oat use“dstnntdowshdhhaiuopsieieivomitsbrrneh.iuedordjereeheglwaeDdmpgocastnnioatalhnrpsddedrrrtoelrtissdoroeneyvw'.,eysdggebRnbnde.ranaaereeoboreacstadwpnnmkkelaeueatoetaeindrpythrsyk,doeaet.ewap”nnintsintrniadtteraltiShcyeitinnbyttmohegyersaeomaas.aer1lrentFcdnRede.pstotieerniaTstaoragdgcehrnmUxautxeesiitln.ocaraen,Snehcndttaa.tifilaseourtunmfyonenrddai.ngmnedsreTceeeososhieirnetntnefaersrttcotatlewtahnotltntreiieahaownessmxmisnuacenptecbphnee,3antjturt0eyitiotoatrhimc1yspnxnoet.-oes7fetlteiri,ns7ponnnexert0taceaeesbes1yotnm1ra,efm-mertc2adpossdeken(,mhtcanuoroi)sestonp(nh2ufntyciaso)letlada(iihiruntilreyitiblde)nids.etegt1ahEsb,tn,anbehdttoeeiasrt If your tax records are affected by identity theft and you receive a
re Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (seerepYoortuedw.ilFl onrotexbaemspulbej,eicftatofobreaicgknuLpLwCitthhhaotlidsintrgeaotnedpaaysmaednitssreygoaurded
notice from the IRS, respond right away to the name and phone number
ed or printed on the IRS notice or letter.
d States;
If your tax records are not currently affected by identity theft but you
01-7). think you are at risk due to a lost or stolen purse or wallet, questionable
trade or credit card activity or credit report, contact the IRS Identity Theft Hotline
withholding at 1-800-908-4490 or submit Form 14039.
ertain cases For more information, see Pub. 5027, Identity Theft Information for
ection 1446 Us(egrFanotromr isWa-ls7o, Atrupsptelice)ation for IRS Individual Taxpayer Identification
erson, and
U.S. person backup withholding under 4 above (for reportable interest and dividendNubm. Sboe-rc,atolleadptrpulsyt faocrcoaunnItTtIhNa,t iosrnFoot rmThSeSa-c4t,uaAlpopwlincear1tion for Employer
ess in the accounts opened after 1983 only).ocB6ln.uicSelsiknnoinitelnieetygbspoysroow.napGncrEeioecdmteotbsoprysslohwianiypnwgeiowrntrhdI.ddieirviessiIdn.rRgeutSgaoifalivcwr/daFeetobidorsmnitseNtuaTomthevwbioewewwrwn(,Ee.dirrI3Nso.w)guonnlvod/aBedur,sSointraeprstrisninegst
lish your IdeanlteifgiaclaotirovnalNidutrmusbteurn,dtoerasptaptelylafwor an EIN. You can apply for an EIN
e of and
W-9 to the a
avoiding Form
rtnership Certain payees and payments are exempt from backup withholding.W7.-G7raanntdor/otrruFstofrilmingSuSn-d4e.r OOprt,ioynoaul can Tghoetgorawnwtowr* to
U.S. owner See Exempt payee code, later, and the separate Instructions for theplaFcoerman10o9r9deFirlinagndMehtahvoed F1o(sreme W-7 and/or SS-4 mailed to you within 10
.S. owner, Taxpayers.
r trust and Victims of identity theft who are experiencing economic harm or a
U.S. trust Requester of Form W-9 for more information.buRsiengeuslastidonasyss.ection 1.671-4(b)(2)(i)
ust. I(fAy))ou are asked to complete Form W-9 but do not have a TIN, apply
ch of a for aFToIrNthainsdtywpreiteo“fAapcpcloieudnFt:or” in the spGaciveefonratmhe TaInNd, sEiIgNn oafn:d date systemic problem, or are seeking help in resolving tax problems that
, do not use Also see Special rules for partnerships, earlier.t8h.eDfisorremga,radneddegnivtiteyintottootwhneerdebqyueanster.TFhoeroiwnnterest and dividend
8233 (see
eign paiynmdievindtusa,l and certain payments made with respect to readily tradable
ly, only a have not been resolved through normal channels, may be eligible for
y to reduce Taxpayer Advocate Service (TAS) assistance. You can reach TAS by
most tax calling the TAS toll-free case intake line at 1-877-777-4778 or TTY/TDD
eptions 1-800-829-4059.
m tax to Protect yourself from suspicious emails or phishing schemes.
s otherwise Phishing is the creation and use of email and websites designed to
ion mimic legitimate business emails and websites. The most common act
mption is sending an email to a user falsely claiming to be an established
statement ti9nh.seAtrrvueamqliudeentrstutsse,tr,gbeesentfaeotrerae,lolyyroypuoenuasrwieonislluthrbuasjvetect6Lt0oegdbaaalycesnktutiotpy4gweitthahToIlNdinagndongive it to
aty under 1p0.aCymoreponrtast.ioTnhoer 6L0LC-dealyecrtuinleg does not aThpepclyortpoooratthioenr types of payments.
ntains the What is FATCA Reporting?Yocuowrpiollrabte stuabtujescotntFoobrmac8k8u3p2 owrithholding on all such payments until
he terms of youFoprmro2v5id5e3 your TIN to the requester.

The Foreign Account Tax Compliance Act (FATCA) requires a1N1.oAtses:oEcniatteiornin,gclu“Ab,prpelliigeidouFso, r” means tThhaetoyrogaunhizaavtieonalready applied for a
legitimate enterprise in an attempt to scam the user into surrendering
pFroirvmatWe -i9nf(oRremv.a1t0io-n20t1h8a)t will be used for identity theft.
ernetciteyivfeorifUy.oSu. fgeivdeertahletarexqpuuersptoesreysouhrascoarrseincgt lTeINo,wmnearkethtahteisparoUp.eSr. participating foreign financial institution to report all United StatesTINchoarrittahbalte,yeoduucinatteionndal,tooraopthpelyr tfaoxr-one soon.

Pub. 515, Withholding of Tax on Nonresident Aliens and Foreignpceerrstiofinc,atthioenUs,.Sa.nodwrenpeor'rst naallmyoeuirstraexqaubirleedinttoerbeestparnodviddeivdidoenndlinseo1n.yIfour Caeuxteimonp:t Aorgdaisnrizeagtiaornded U.S. entity that has a foreign owner must use
inasctruusmtoedniatsl a(icncoluudnint gunndoetriosneacltpiorninc4i0p3a(lbc)(o7n) tirfatchtes,afcuctouurenst,sfaotriwsfaierdsst,he 1t2h.ePaarptnperrosphirpiaotremFuoltrim-mWem-b8e. r LLC
arnedquoirpetmioenns)tsthoaftsiescrteiognist4e0r1ed(f)(a2s) such under the laws of the United
tthaexdreirteucrtno. wner of the entity is also a disregarded entity, enter the first account holders that are specified United States persons. Certain1P3. aA rbrtokIeIr.oCr reegirstteirfeidcnaomtiinoeen

Entities).oPwanyemr ethnatst iysonuotredciserievgeawrdielldbfeorsufebdjercatl ttoaxbpaucrkpuopsewsi.thEhnotelrdtinhge if:

dnaism1re.egY.a”orIudf etdhdoeenonowttitnfyue'srrnonisfahtmhyeeodouinrsTrleiInNgeat2rod, et“hdBeuersneitnqiteuyseissstneaarf,moree/idginsrpeegrasrodne,dtheentity

Nonresident alien who becomes a resident alien. Generally, only aow2n.eYr omuudstocnoomt pcleertteifyanyoauprpTrIoNprwiahteenFroerqmuiWre-d8(isnesetetahde oinfsatruFcotrimonWs f-o9r.

TPhaisrtiIsI tfoher dceatsaeilse)v, en if the foreign person has a U.S. TIN.

nonresident alien individual may use the terms of a tax treaty to reduceLin3.eT2he IRS tells the requester that you furnished an incorrect TIN,
otrreealtiimesincaotentUai.nS.atpaxroovnisicoenrtkaninowtynpeass oaf“isnacvoimnge.cHlaouwsee.v”eEr,xmceopsttiotnasxeIbrfneeytt4ociut.auyrnTunhhs(aafeeomvrIyeReora,eSupybtdooeuiurldsltsaimnnbyeoaloestyusrienetnnhptaetaoemrtrertyesiato,tloutalrnynaaoddrlieuendresniivuna2ibdtm.ejeerenec,dstDtstBoaonAbndlanycd)a,kimvouiredp,ewonirdthdshisoornledgyinoagrudretdax

Lin5.eY3ou do not certify to the requester that you are not subject to

scpoenctiinfiueed fionrtcheertsaainvintygpcelsauosfeinmcoamy epeervmeint aanfteerxtehmepptaioyneefrohmastoatxhteorwiseCcbalhacaesccscokikuufinpcthtaswetiiootahpnphepoonrfleodtdphinreaigafpttueeenrrbsd1ooe9nxr84o3wnahobolnionslyeev)e.n3(affomorrertehispeoeUrnt.taSeb.relfeeddinoetnrearlleintseatx1a.nCdhdeivcikdeonndly
St2a—tesThoer aUnnyitsetdatSetates or any of its agencies or instrumentalities The partnership The IRS does not initiate contacts with taxpayers via emails. Also, the
3G——AAsrteaatel ,etshtaeteDiisntvriecsttomfeCnot lturumsbtia, a U.S. commonwealth or The broker or nominee IRS does not request personal detailed information through email or ask
taxpayers for the PIN numbers, passwords, or similar secret access
poHs—seAssrieognu,loatreadniynvoef sthtmeier nptocliotimcapl asnuybdasividseiofinnsedorininsetrcutmioenn8ta5l1itioersan information for their credit card, bank, or other financial accounts.
eConor4tmi—itnypsAtrarenfugoymirseAetiecngrttneaodlgiftoia1evt9sea4rl0nl mtimenetsodruarinnygotfhietstapxoyliteicaar lusnudbedrivthiseioInnvse, satgmeenncties,
If you receive an unsolicited email claiming to be from the IRS,
5I——AA ccoomrpmoroantiotrnust fund as defined in section 584(a) forward this message to [email protected]. You may also report misuse
6J——AA dbeaanlkeraisndseefcinueridtieins soercctoiomnm58o1dities required to register in the payees are exempt from FATCA reporting. See Exemption from FATCATo establish to the withholding agent that you are a U.S. person, or
UnKi—tedA Sbtraotkeesr, the District of Columbia, or a U.S. commonwealth or
poLs—seAsstriuosnt exempt from tax under section 664 or described in section resident alien, sign Form W-9. You may be requested to sign by the
4974—7(Aa)(f1u)tures commission merchant registered with the Commodity
Futures Trading Commission reporting code, later, and the Instructions for the Requester of Formwithholding agent even if item 1, 4, or 5 below indicates otherwise.
8—A real estate investment trust W-9 for more information.For a joint account, only the person whose TIN is shown in Part I
should sign (when required). In the case of a disregarded entity, the of the IRS name, logo, or other IRS property to the Treasury Inspector
General for Tax Administration (TIGTA) at 1-800-366-4484. You can
person identified on line 1 must sign. Exempt payees, see Exempt payee
code, earlier.

Updating Your InformationSignature requirements. Complete the certification as indicated in

You must provide updated information to any person to whom youFitoermmsW1-9th(Rroevu.g1h0-520b1e8l)ow.
forward suspicious emails to the Federal Trade Commission at
[email protected] or report them at You can
contact the FTC atht ewvwicwt.imftco.gfoidv/eindttihtyeftthoerft8, 7s7e-eIDwTwHwE.FIdTe(n8t7it7y-T4h3e8ft-.4Pg3aog3ve8)5.
If you have been
and Pub. 5027.
1. Interest, dividend, and barter exchange accounts opened
oneCberotxainonplainyee3s. and payments are exempt from backup withholding. before 1984 and broker accounts considered active during 1983.

become a U.S. resident alien for tax purposes.See Exempt payee code, later, and the separate Instructions for the claimed to be an exempt payee if you are no longer an exempt payeeFYoormu mWu-9st(Rgeivv.e1y0o-2u0r1c8o) rrect TIN, but you do not have to sign the

Requester of Form W-9 for more information. certification.

ypaoneudrsaoarnnet.iacFiopCraecteoxarrpemocprealievti,ionyngoturhemaptoaerytleancbetleesdptotaoybmpe reaonnvtisSdeicnuotprhpdeoafrtuaettduiorinen,ffoororrmmifaytthoioiusn nifotiIyo1nRao9pfxSTo2u8eph.r3dnamaeI.oenyraeYIeedtRteorssisSoaruunenffbdtomosefjottreoru,erctrsed1hstttq9eihtvnsou8eiPoide3gibrtIsenNaaictnnnctrnpidhetkdueied,aumrbbitpscterrboecowocnerakktioraritsefedhnli,crrh,dt,apaobaeactaltcaidtnaosncsisidnnlkoewwg,oubdoiorntaahrirbntrndstofatdseoatc,chrrxykomoepoeurnruaxapssfyctiaiiinewmohdrarenaiesitnlnharmtcvehhgriideaaroesorlleeeiduaancmligccynarehccagcptooiterlwasiuoumv.cnivnelcAaltitdsaeidslls.ipsnuoospgrr,ilnayth.sgekIf
longer are tax exempt. In addition, you must furnish a new Form W-9 iffycooerIurwftriyaficorcdouarttrriheeoiccnsetbmiTveIeeNfsoasrtneoagustehnigestnoorilneipcqghiuttiesehdhseitneefogmr,r@mayiiorl.suc.lgamoimuv.sintYgcorutoosmbsaeoyfuratolsimtoemtrhee2poIiRnrtStmh, eisPuasgee 4
the name or TIN changes for the account; for example, if the grantor of aGfocpofrerlo3atwMnhsn.eaes—RrraodIeRAluasfStoltuaierntsxesTpamtemaiacxxite2eoeA,muoldtsofprmgatethonimtner,suiasoacsitrclertsaotruittttoionihfoindcentsehar.(retITiRYoaIFGSonesu.TedpAcmerot)riuapoaslenttTr14tsr-ya0i8gdt30noe(0bttC-h)h3peoe6lmac6Tne-mr4eroti4asirfs8sicsu4ioaer.yntcYiotIaoinnotus.npYc4eao5cnu7to(mgr )ay
grantor trust dies.sNpoa4mt.eO@: tYuhoceeur.gpmoaavyymowreirsnehtpsto.orYtcotohunemsmuulatstwwgitiwhvewthy.efotcufi.rngaconovcr/rcieaoclmitnTpsIltNaitiu,ntbi.ouYntoyruoequcuadenostninogt

chtohanivsteafotcortmtshigteonFdtTheCetecarmet rwitniwfeicwwa.tfhitoecnt.hgueonrvl/teihdsesthFyeAoftuToChrAa8v7ceo7b-dIeeDeTanHnndEo/FotTirfie(8dx7et7mh-a4pt3ty8po-a4uy3e3e8).
Ihfcaoyvodeuephsrahevoveuiolbduesbelyengctihovemnvpialcenttiemindc.oof rirdeecnttTitIyNt.h“eOftt,hseerepwaywmwe.nIdtse”


Failure to furnish TIN. If you fail to furnish your correct TIN to acreatrudrnans.dIfththirids padardtryensestdwioffrekrstrfaronsmacthtieonosn,eptahyemreenqtusetsotecrearltraeiandfyishhiansgon

bfiolea,twcrrietewNmEeWmbatertsheantodpf.isIfhaernmeewn,aadnddregsrsoissspprorovcideeedd,sthpearide tiso still a

requester, you are subject to a penalty of $50 for each such failureacthtoarnnceeysth(einoclldudaindgdrpeasysmweilnl tbsetousceodrpuonrtailtitohnesp).ayor changes your

ad5d.rMesosrtingathgeeirinretecorerdsst .paid by you, acquisition or abandonment of

unless your failure is due to reasonable cause and not to willful neglect.spLeaicynumeree6ndtspr(oupnedretry,sceacnticoenll5a2ti9o)n, AoBf LdEebatc, cqouuanlitfsie(duntudietirosnepcrtoiognra5m29A),
9—An entity registered at all times during the tax year under the VisiFt owrwthwi.sirsty.gpoevo/IfdeanctcitoyuTnhte:ft to learn mGoriveeanbaomuteidaenndtitEyItNheofft:and
Investment Company Act of 1940 h1o4w. AtcocoreundtuwciethytohuerDreispka.rtment of
Agriculture in the name of a public The public entity Page 6

WcAhlsoaoIntsfeitesyaSoFpienAucieaTlaCdrurlAeesinfRoaretphpaUrtoen.errStssihn.iapgsrv,?eeiansrligeidr. celnatuasleieonfwahtoaxi111s021t———rreAAAemcfailnoyiadmtndiymclneioamngtl aiontnrsuotksicnttunoftluwioannnadiinmonptheereaaitnexvndecsbtyeemaexpnbtaetcniomkomunnmpduentriitsyoeacnstioann5o8m4i(nae) e or Prigevnotaviteycrn(smyuecAnht,acssctahosNtoaltodeistotrircilcotce, aolr
Sectpiorisno6n)1t0h9atoref ctheieveIsntaegrrnicaulltRureavlenue Code requires you to provide your
corrpercotgTraINm tpoaypmeersnotsns (including federal agencies) who are required to
13—A trust exempt from tax under section 664 or described in section
F4o9rm47W-9 (Rev. 10-2018)
The Foreign Account Tax Compliance Act (FATCA) requires a file information returns with the IRS to report interest, dividends, or
c1e5r.taGirnanotothr etrrusint cfiloinmg eunpdaeridthteoFyoormu; mortTghaegteruinstterest you paid; the
from U.S. tax on certain types of income, you must attach a statementparticipating foreign financial institution to report all United States acqu1i0s4i1tioFnilinogrMaebtahonddoorntmheeOnpt toiofnsael cured property; the cancellation of
debtF;oormr c1o09n9trFibiliuntgioMnesthyoodu2m(seaede to an IRA, Archer MSA, or HSA. The
account holders that are specified United States persons. Certain persRoenguclaotliloencstisnegcttiohnis1.f6o7r1m-4u(bs)(e2s)(i)t(Bhe)) information on the form to file

to Form W-9 that specifies the following five items.payees are exempt from FATCA reporting. See Exemption from FATCA
The following chart shows types of payments that may be exempt
from backup withholding. The chart applies to the exempt payees listed
reporting code, later, and the Instructions for the Requester of Form CRJi1mInfuoofLouosuliustnsrtimtmtcilnyefbaebioretfsiinuaootfe,,aafionrtltteuihcohpnelnsutopdaarhteennainrddsgsgoiaptvotnnoihnscewSgsitShaeiiteobNsstsoso,,eivotsthennhtaausienttmeffDoopsberr,eempurtrhsasaoyerettonimoDiu’nnsiesf.nnutrturincomitfsbohef.r
a2dCmiricnliesttehreinmg itnhoeri’rslanwams.eTahnedinffuorrnmisahtitohneamlsionomr’asySbSeNd. isclosed to other
1. The treaty country. Generally, this must be the same treaty underW-9 for more information.
Uwpdhaitcinhg yYoouur cInlafoirmmeatdioenxemption from tax as a nonresidentabove, 1 through 13. alien.THEN the payment is exempt
IF the payment is for . . .
for . . .
All exempt payees except
for 7
You must provide updated information to any person to whom you

2. The treaty article addressing the income.claimed to be an exempt payee if you are no longer an exempt payee

and anticipate receiving reportable payments in the future from this

3. The article number (or location) in the tax treaty that contains theperson. For example, you may need to provide updated information if
Interest and dividend payments caanm3bInRongoauYudeuStmssonnyitcuenecotrgrneiuimilemeecsinsnsasouienreustuo.eoartrnrYaalrscdlDegollhaoyeqeuBowmruswwAmsaibiry,tenaayothordayotuhermutouatettorlootserdyierfn,ufooiaeldetserndoiiipesvtaethmefihydreertaeo.caudrluexYae“ylrBanlroorawSnteuuualatSsrguamemiNSnenrnnueed.Sfo.sosNafstUrsncttpnoaanedrdtrxamoeyaeEmvoebraIideNnuglse/eteedm(aicinynifsnatcotyirdyeoiueoernrgasuienlaTs3stthrItoe4oNda,l0lveedei6gwendinv,efhtoioepnedennracretcethyeynie)teeo,dyrcrub,”sioruavrintl dthe
Cic4rlnneueeofLglorretitastrasfamltuiineffnraoinnrotrpstiistoitpethhnyanae.nratirtthdlsnpteieeeaclTrsyfisrImicNhmslieepnaonsyotfth,tstaeehdltaseoneroaslpaieimaegrpprn.esapaooyltyneefadeftohl wirrenephtptrorhruoeedsvstioade,ecneinsctsgaotnatufoitvanetelts,gteooiivtrrloeetprr.a)uefrAsnTatslIuesNiodoenutusoleetnrtneluhetseSstsp.p(etaDhcyeoiearl.
you are a C corporation that elects to be an S corporation, or if you no Broker transactions Exempt payees 1 through 4 and 6
through 11 and all C corporations.
saving clause and its exceptions.longer are tax exempt. In addition, you must furnish a new Form W-9 if
the name or TIN changes for the account; for example, if the grantor of a

4. The type and amount of income that qualifies for the exemptiongrantor trust dies.
S corporations must not enter an
exempt payee code because they
are exempt only for sales of
Pfernoamltietsax. noncovered securities acquired
prior to 2012.
Exempt payees 1 through 4
Failure to furnish TIN. If you fail to furnish your correct TIN to a IERnAte, rCyoovuerrcdietyll, EstSaAte,,AarncdheZrIPMcSoAdeo.r HSA contributions or

5. Sufficient facts to justify the exemption from tax under the terms ofrequester, you are subject to a penalty of $50 for each such failure Cmiavkilepaenfaalsltey sfotartefamlseentinwfiothrmnaotrioeanswonitahbrleesbpaescist tthoawt riethsuhlotsldininngo. If youTdPIiNsat,rrbibtuutItyi.oonTusda,oaxnnpdotapheyanevseriotonIdsdiegisntnrtihtbieuftciicoernatisfti.ciYaootinuonm.Nusut mgivbe yeorur(cToIrrNec)t
the treaty article.unless your failure is due to reasonable cause and not to willful neglect. Barter exchange transactions and *Note: The grantor also must provide a Form W-9 to trustee of trust.
patronage dividends Note: If no name is circled when more than one name is listed, the
Civil penalty for false information with respect to withholding. If you number will be considered to be that of the first name listed.
make a false statement with no reasonable basis that results in no Payments over $600 required to be Generally, exempt payees backup withholding, you are subjectWyEonuhtedarotynoNoutrahTmaINveeinanatdhneadraepNnporuot epmlrigiabibteelerbtooTxg.oeIftGyaoniuvSaSerNet,ahyroeeusriRdTeIeNntqiasuliyeeonusartnIeRdSr tSoeacu$re5Y0o0urpTeanxaRletyco. rds From Identity Theft
bFoarcmkuWp-9w(iRthehv.o1ld0-in2g01, 8y)ou are subject to a $500 penalty. reported and direct sales over
1 through 52 Page 3
$5,0001 indiviFdouratl htaisxptyapyeroidf eanctcifoicuantito:n number (IGTiIvNe).nEanmteer iat nindtSheSNsoocfia: l
s1e.cIundriitvyidnuuaml ber box. If you do not havTeheainndIiTvIidNu,asl ee How to get a TIN Identity theft occurs when someone uses your personal information
Criminal penalty for falsifying information. Willfully falsifying PaIyFmthenetsenmtiatyd/epienrseotntleomnelinnteo1f is ETxHemENptcphaeycekesth1ethbrooxugfohr4. . . b2e.loTwwo. or more individuals (joint such as your name, SSN, or other identifying information, without your
certifications or affirmations may subject you to criminal penalties paay(mn)en. t. .card or third party network The actual owner of the account or, if permission, to commit fraud or other crimes. An identity thief may use
including fines and/or imprisonment. Ifaycocuouanrte) oathseor ltehapnroapnraiectcoorunatnd you choamvbeinaendEfuINnd, sy,othuemfirasyt iendnitveidr ueaitl hoenr your SSN to get a job or may file a tax return using your SSN to receive
Misuse of TINs. If the requester discloses or uses TINs in violation of transactions youmr SaiSntNainoerdEbINy a. n FFI a refund.
federal law, the requester may be subject to civil and criminal penalties. • Corporation Corporation the account1
1 S• eIendFiovridmua1l099-MISC, MiscellaneousInIndcivoidmuea,l/asnodleitpsrionpsrtireutcotrioonrss.ingle- os3en.Ipef(Tja)oyw.rioDanouttooeaarcnfrmcroeoootmaureensntiUtitmnse.Sgaro.lietnwpht-eanemriensderoe,imdnsesrbbenyegteraarnLrdtLFheCFedI)toehwnanttEietaisycr’’hdssihEsSorISleNdNge.arI(froodtfrhetEhedeINLaaLs,cCicafontiushneectnloatiwstysnifeier dhaass
Specific Instructions 2 H• oSwoeleveprr,othperiefotollroswhiipng, oprayments mamdeemtobaercoLLrpCoration and To reduce your risk:
• Protect your SSN,
Line 1
You must enter one of the following on this line; do not leave this line r•epSoirntagblele-moenmFboermr li1m0it9e9d-MliaISbiClityare not exempt from backup a4c. oCrupsotordaitaiol ancocor upnatrotnf earmshiniopr, enter theTheentmitiyn’osr2EIN. • Ensure your employer is protecting your SSN, and
wcoithmhpoaldniyng(L:LmCe) doiwcanleadnbdyhaenalth care payments, attorneys’ fees, gross
pinrodciveidedusalpaanid tdoisarengaatrtdoerndefyoreUp.oSr.table under section 6045(f), and Not(Ue:niSfoerme WGihftattoNMainmoersaAncdt) Number To Give the Requester, later, for • Be careful when choosing a tax preparer.
pfeadymereanl tasxfoprusreprovsiceess. paid by a federal executive agency. fu5r.tah.eTrhcelaursiufiaclarteivooncaobflenasmaveingasndtruTsItN cTohmebgirnaantoior-ntsru.stee1 If your tax records are affected by identity theft and you receive a
How(grtaontogreits aalsToINtr.usIfteyeo)u do not have a TIN, apply for1 one immediately.
notice from the IRS, respond right away to the name and phone number

CREDIT APPLICATION FORM Please complete if credit is being requested.


YES, I hereby authorize my Bank to release any information Company Name:
needed from the Account Number noted below.

Bank Name: Account Number:

Account Number: Street Address:

Bank Contact: City: State: Zip Code:

Street Address: Email:

City: State: Zip Code: Phone:

Company Name:

TAX INFORMATION Account Number: State: Zip Code:
Street Address:
Standard Modern Company, Inc. is required by state law to have on file City:
a current Resale Exemption Certificate to exempt your purchases from Email:
state and local sales tax. Please send a copy of your certificate back
with your credit application. If we do not receive a Resale Exemption
Certificate, Standard Modern Company, Inc. must assume that sales
tax should be applied to all purchases made by your company.

S I G N AT U R E Phone:

Permission is here with granted to obtain credit information from all REFERENCE #3
listed references, including the bank. All financial information submit-
ted in support of this new account and credit application is true and Company Name:
complete in all respects. Furthermore I understand that my orders will
not be shipped if my account is past due. My company is fully respon- Account Number:
sible for the repayment of all amounts owed on its account and any
collection fees, including attorney's fee and related costs. The account Street Address:
will be subject to the laws of the State of Massachusetts, and the com-
pany consents to service of process, personal jurisdiction and venue City: State: Zip Code:
in the state and federal courts located in New Bedford, Massachusetts.

Print Name:

Title: Date: Phone:

STANDARD MODERN | 800.742.4123 | [email protected]





Company Name:

Name On Card:

Credit Card Number:

Expiration Date: CVC Code: (3 Digit Code/4 Digit Code (Amex))

Card Holder Email Address:


Street Address: State: Zip Code:

YES, I would like to keep this credit card on file.
I would like to charge the following invoice(s) to this credit card:


I, , hereby authorize

Card Holder Name

Standard Modern Company, Inc. to process charges against a credit card held in my name for any invoice

issued to .

Company Name


Signature: Date:

STANDARD MODERN | 800.742.4123 | [email protected]




PHONE: 508.586.4300 • FAX: 508.584.4566 • TOLL FREE: 800.742.4123



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