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FORM W-9 Request for Taxpayer

(Rev. January 1993) Give this form to the


Identification Number and Certification requester. Do NOT
Department of the Treasury
Internal Revenue Service send to IRS.
Name (If joint names, list first and circle the name of the person or entity whose number you enter in Part 1 below. See instructions on page 2 if your name has
changed).
Please print or type

Business name (Sole proprietors see instructions on page 2.) (If you are exempt from backup withholding, complete this form and enter “EXEMPT” in Part II below.)

Address (number and Street) List account numbers(s) here (optional)

City, state, and ZIP Code

Part 1 Taxpayer Identification Number (TIN) Part II For Payees Exempt from Backup
Withholding (See Exempt Payees
Enter your TIN in the appropriate box. For and Payments on page 2)
individuals, this is your social security number Social security number
(SSN). For sole proprietors, see the instructions
on page 2. For other entities, it is your employer ►
identification number (EIN). If you do not have a OR Requester’s name and address (optional)
number, see How To Obtain a TIN below.
Employer identification number
Note: If the account is in more than one name,
see the chart on page 2 for guidelines on whose
number to enter.

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 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.

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 of under reporting interest or dividends on your tax return. For real estate transactions, item 2. does not apply. For mortgage
interest paid, the acquisition or abandonment of secured property, contributions to an individual retirement arrangement (IRA), and generally payment
other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (All see
Signing the Certification on page 2.)
Sign
► ►
Here Signature Date

BIDDER NUMBER

OWNERSHIP TYPE / CODE


01 INDIVIDUAL 07 AS JOINT TENANTS/WROS
02 MARRIED JT/WROS 08 MARRIED S/S AND UNMARRIED
JT/WROS
03 MARRIED PERSON AS SOLE & 09 UNDIVIDED ½ INTEREST
SEPARATE PROPERTY
04 AS TENANTS IN COMMON 10 CORPORATION

05 REVOCABLE TRUST 11 PARTNERSHIP

06 IRREVOCABLE TRUST 12 MARRIED, COMMUNITY PROP,


CPWROS

FAX Completed form to (928) 753-0788

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