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Form W_9 Request for Taxpayer Give Form to the <br /> (Rev. December2014) Identification Number and Certification requester. Do not <br /> Department of the Treasury send to the IRS. <br /> Internal revenue Service <br /> 1 Name(as shown on your income tax return).Name is required on this line;do not leave blank. <br /> N <br /> w <br /> g, 2 Business name/disregarded entity name,if different from above <br /> R <br /> Q <br /> 4 Exemptions(codes applyonlyto <br /> 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: p <br /> ❑Individual/Sole proprietor or ❑C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate certain entities,not individuals;see <br /> O. <br /> p instructions on page 3): <br /> Exempt Payee code(if any) <br /> v ❑single-member LLC Limited liability company.Enter the tax classification(C=C Corporation,S=S Corporation,P=partnership) <br /> p <br /> i Exemption from FATCA reporting i Note.For a single-member LLC tha is disregarded,do not check LLC;check the appropriate box in the line above for code(if any) <br /> C <br /> N the tax classification of the single-member owner. (Applies to accounts maintained outside the U.S.) <br /> E Other(see instructions) <br /> 0- cj <br /> L.= 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) <br /> V <br /> w <br /> 0- <br /> u) <br /> U) 6 City,state,and ZIP code <br /> w <br /> w <br /> U) <br /> 7 List account number(s)here(optional) <br /> Part I Taxpayer Identification Number(TIN) <br /> Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number <br /> backup withholding. For individuals,this is generally your social security number(SSN). However,for a _ _ <br /> resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3. For other <br /> entities, it is your employer identification number(EIN). If you do not have a number,see How To Get a <br /> TIN on page 3. <br /> Note: If the account is in more than one name,see the instructions for line 1 and the chart on Employer identification number <br /> page 4 for guidelines on whose number to enter. - <br /> Part II Certification <br /> Under penalties of perjury, I certify that: <br /> 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 <br /> 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 <br /> 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 <br /> notified me that I am no longer subject to backup withholding,and <br /> 3. I am a U.S.citizen or other U.S. person(defined below),and <br /> 4. The FATCA code(s)entered on this form(if any)indicating that i am exempt from FATCA reporting is correct. <br /> Certification Instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup <br /> 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 <br /> mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement <br /> (IRA),and generally, payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct <br /> TIN. See the instructions on page 3. <br /> Sign Signature of <br /> Here U.S.person Date <br /> • Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T <br /> General Instructions (tuition) <br /> Section references are to the Internal Revenue Code unless otherwise noted. <br /> •Form 1099--C(canceled debt) <br /> Future developments. Information about developments affecting Form W-9 (such <br /> as legislation enacted after we release it)is at wwwirs.gov/fw9. •Form 1099-A(acquisition or abandonment of secured property) <br /> Purpose of Form Use Form W-9 only if you are a U.S.person(including a resident alien),to provide <br /> your correct TIN. <br /> An individual or entity (Form W-9 requester)who is required to file an information <br /> return with the IRS must obtain your correct taxpayer identification number(TIN) If you do not return Form W-9 to the requester with a TIN,you might be subject to <br /> which may be your social security number(SSN), individual taxpayer identification backup withholding.See What is backup withholding?on page 2. <br /> (ITIN), adoption taxpayer identification number (ATIN), or employer identification <br /> number(EIN),to report on an information return the amount paid to you, or other By signing the filled-out form,you: <br /> amount reportable on an information return.Examples of information returns include, <br /> but are not limited to,the following, 1. Certify that the TIN you are giving is correct (or you are waiting for a number <br /> to be issued), <br /> •Form 1099-INT(interest earned or paid) <br /> 2.Certify that you are not subject to backup withholding,or <br /> •Form 1099-DIV(dividends,including those from stocks or mutual funds) <br /> 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If <br /> •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) applicable,you are also certifying that as a U.S.person,your allocable share of any <br /> partnership income from a U.S.trade or business is not subject to the withholding <br /> •Form 1099-B(stock or mutual fund sales and certain other transactions by brokers) tax on foreign partners'share of effectively connected income,and <br /> •Form 1099-S(proceeds from real estate transactions) 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are <br /> exempt from the FATCA reporting, is correct. See What is FATCA reporting?on <br /> •Form 1099-K(merchant card and third party network transactions) page 2 for further information. <br /> HAPPY Software, Inc. 1...11..11..11..11 11..1.1....11.1.1...1.1..1.1..1.111...1 DM 1/31/2017 11:07:53 AM <br />