ZB 22 08 Flores 156 Main Street Application Submission Package

Give Form to the raquester. Do not send to the IRS. Recpest for Taxpayer Identification Number and Certification ‘1 Name (a3 shown on your income tax return). Name is required on ins ite; do not leave this Ine Bl Jose Fiores 2 Business namesdieregarded entity name, if different from above 91 Mitchell Street 8 City, state, and ZIP code West Orange, NJ 07052 . 7 Uist account number(s) here (aptional) > P Part || Taxpayer Identification Number (TIN) ot i 3 Check appropriate box for federal tax claselfcatfon; check only one af te following saven boxes: 4 Sxomptions (odes apply en fo 5) ig ari proto or C1 ccomerstion [} Scoporation [1] Partnership (} trusticstato | Pursieniles, not indicus fe E (71 urited tality company, Enter the tax elassitication (C=C corporation, 8=8 corporation, P=parinershin) Exempt peyes code (fay) Note. For a singla-mamber LLC that fxd Exemption from FATCA reporting 8 Note. For anal mentor frogatded, donot check LLC; cheok the eppropata box ath Mis above fr ode ban) & = | Dlother cotanateye . (Aopisto neasune ieee eae eS) i 6 Address (number, street, and apt. or sulta no.) ‘Raquester's name and address (optional) Enter your TIN in the appropriate box. The TIN provided must matoh the name given on line 1 to avold Social security number : backup withholding, For individuats, this is generally your social security number (SSN). However, for a ry resident alln, sole propristr, or derepartied e entity, see the Part instructions on page 3. For other 117 i | A -} of 87 td entities, ftls your employer Identification number (EIN). if you do not have a number, see How to gota TIN on page 3. or Note. [f the eocount is in more than one name, see the instructions for line 1 and the chart on page 4for LE identification number guidelines on whase number to enter. Certification Under penatties of perjury, | certify that: 1. The number shown on this form is my correct taxpayer Identifloation nurnber (or | ami walting for a number to be Issued to me); and 2. Lam not subject to backup withholding because: (@} | am exempt from backup withholding, or (b)| have not been notified by the Internal Revenue Service (IRS) that | am subject to backup withholcing'es @ result of a fallure to raport all interest or dividends, or (c) the IRS has notified me that] am na longer subject to backup withholding; and 3. lamas. citizen oy other U.S. person

p withholcing'es @ result of a fallure to raport all interest or dividends, or (c) the IRS has notified me that] am na longer subject to backup withholding; and 3. lamas. citizen oy other U.S. person (defined betow); and 4. The FATCA code(e) anterad on thie form (if any) indigating that | am exempt from FATCA reporting is correct. Certitication Instructions. You must dross out item 2 above If you have been notified by the IRS thet you ara currently subject to backup withholding because you have failed to report all interest and dividende 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 (RA), and generally, pé aymante other {han interest and dividends, you are not required to sign the certifloation, but you must provide your correct TIN, See the Instractions on pags Sign Here tee JS oan General Instructions ‘= Form 1088 (home morigaye intorest), 1098-E (elusent (oan Intoreat), 1098-T ‘Section references are to the Internal Revenue Code unieas otherwise noted. «© Fostn 1089-0 (canceled deb!) Future developments, Information sbout development affect affecting Form W-8 (such as logiclation enaoted efter wa relaaaa 1 ie ak wwvwto,gov/Twd. # Form 1089-A {acquisition or abandonment of secured property) Use Form W-8 niger U8 psn fckng vat een to Purpose of Form provida your correct An individual or entity (Form We8 ws teguie ulred to fite an Information fou de nak feta Fem Wo to the requ with a TIN, you might Ge subject reurn with the BS uct cota sree pe cation number (TN) fo backyo withholding. Sea What is b20kup withholding? on page: TYR cearton espever Uorthonton nomser ATI, or omer sienna i Fi aniston furiar Nf apart onan ntermtion rer in tout pat ta to ba ety hat the TIN you are gag cosct for you ae walng fora number f, or other ariount rey On an ernples malion Falster sul we notin te a hea 2. City hat you ar not bjs fo hack witinoleng, or * Form 1099-INT (interest eamed or paid) . 3. Clalm exemption from haokup withholding i you eve a U.S. exempt payee, I + Form 1090-DIV (ltvidende, Inoluding those from stooke or mutual funda} Spateable, you are slo ootfyog theta a. prs Sa cate reat + For {00-MI8C (various type of Inoome, prizes, award, or gross proceeds) vt holting taxon tare

e, Inoluding those from stooke or mutual funda} Spateable, you are slo ootfyog theta a. prs Sa cate reat + For {00-MI8C (various type of Inoome, prizes, award, or gross proceeds) vt holting taxon tare pachar! enero fetal comactea + Form 1099-8 {stack ar mutual fund sates and cartain other transactions by 4. Certify that FATCA coda| entered on this orn ff ary) inoating hat you are brokers) exempt from the FATCA parting, Is eonrect. Sae What is FATCA reporting? on * Form 1098-8 (orocsede from real estate transactions) . : age 2 for further Information. ‘+ Form 1090-K (merchant oard and third party network transactions) ¢ at. Nix, 10258X Form W-9 (Rav, 12-2014)