2 ZBA Application

om W-Q Request for Taxpayer Give Form to the Errata oy Identification Number and Certification Poco ‘1 Nama (as shown an your income tax roturn). Name Is required on Wis fina; da nat leave tia Tne BIONIC B Business name/disregarded antily name, if differant tram above of 3 2) 5 Check appropriate bax for federal tax. classification; check anly ane of the following sevon boxes: 4 Sxpmina| feodes apply only to §1g In culo prota 01 ccomporation [] Scarporation C] partnarchin Cl thustestato instructions en page so 8° singla-momber . uu C7] Lmited tabitty company, Entar tho tax ciassfcaton (CC corporation, S28 corporation, P=partnershilp) > Exommpt payee cada itany) Note. For a single-member LLG that ls disregarded, do nat check LLG; check the ate box in tha tite above for } Exempllon from FATCA coporting z i tha lax clasatcaton of hn ainglormaminar eee eo ose) eine mower | ode (any) j — © & | Cotter (sae tnstructions) > . (Appts lo acount ated outdo fo UB) = & Address (number, street, and apt. or suite no} Flequosier's name and addrass (aptlonaly é @ Cily, siato, and ZIP cade & i 7 Ust account number(s) here (optional) 7 [EQGI__Toxpayer (dentification Number (TiNj Enter your TIN in the appropriate box. The TIN provided must ‘match the name:given on line 1 to avold | Social security numbar =| backup withholding. For individuals, this is generally your sacial security number (S8N}, However, for & fesident allen, sole propristor, or disregarded entity, aee the Part | Instructiong'on page 3. For other ~ - nities, Is your employer Identifcation number (EIN), If you do nat have a nymbar, sea How fo got @ TIN on page 8, - 1 or Note. If tha account Is in mora than one name, sae the instructions for line 1 and the chart on page 4 for | Employer identification number guidelines on whose number to enter. | Certification ' Under penalties of perjury, { certify thal: 1. Tho number shown on this form fs my correct: taxpayer [dentification number (or { am walting for a number to be Issued to me); and 2. Lam not subject ta backup withholding because: a) { am exempt from backup withholding, or () {have not baea notified by tho internal Revenue Service (RS) that | ary subject to backup withnolcing’as a result ofa fallure to report ll interest or dvidends, or} the IAS has eatin ee that tam ‘no longer subject to backup withholding; and 3. LamaUS. altlzen or other U.S,

bject to backup withnolcing’as a result ofa fallure to report ll interest or dvidends, or} the IAS has eatin ee that tam ‘no longer subject to backup withholding; and 3. LamaUS. altlzen or other U.S, person (detined batow); and 4. The FATCA code(s) enterad on this form (any) indicating that | am exempt from FATCA reporting Is correct, Sign | signature ot Here | us. parson> Data> General Instructions Ae 1098 {home mortgage interest), 1098-E (studant foan Interest), 1086-7 ution) Seotlon ceferances ars to the internal Revenua Code unless otherwise noted, + Form 1099-6 (canceled debt) Future devolapmants information about developments affecting Form W-0 (auch : aan 48 legislation anactad atterws reloasa i leat wwwiies.gov/tva. Form 1989-4 {acquiillon ar abandonment of racured proper Use Form W-6 only It you ara. a US. person fnoluding a resldent alan), to : Purpose of Form provide your correct TIN, ‘An individual or antity (Form W-9 requester) wha Is requlted to file an information 1 you da not ratun Form W-9 to the requester with a TIN, you might be subject ‘Felurn with the IRS must obtain your correct taxpayer Identification numbar (TIN} 10 backup withhokding. Sea What Is backup withholding? an page 2. wale may bo Your sek sacurty ruber (SN, eau payin Identtcation By elgning tho titod-out form, yous ‘umber (TIN), adoption taxpayer Identification aumber (ATIN), or employer {dentifcatlon number (EWN), to report on an information raturn the amount pald to in ently that the TIN you are giving fs camect (or you ara walting for a numbor You, or other amount reportable on an Information retum. Examples of information poh Fetus Include, but ara not limited to, the fatlowing: 2, Certily that you are not subject to backup withholding, or + Form 1090-INT (Intovast eared or pale) 3, Clam exemeton tom backup witipling you sr aS. cxomet ayes, . 1 idends, inctucl 7 appltcabie, you ara also certifying that ac a U.S, person, your allocable share a Form 1088-DI (dude, tnctucing those from stocks oF mutusl funds} any partnership income from a U.S, trada or business ly not sublect to tha + Form 1089-MISG (varlovs types of lacome, prizes, awards, or gross pracaada) ‘withtalding tax on foreign partners’ share of effectively connacted incame, and * Form 1089-8 (stock or mutual {und sales and cartain other transactions by 4. Certity that FATGA cade(s) entered om this form

lding tax on foreign partners’ share of effectively connacted incame, and * Form 1089-8 (stock or mutual {und sales and cartain other transactions by 4. Certity that FATGA cade(s) entered om this form Of any} indicating that you ara brokers) ‘exempt fom tho FATCA raperting, Is comect. Saa What és FATCA reporting? on + Form 1098-9 (proceeds from real estate transactions) age 2 for further Infareration, + Form 1099-K (marchant card and thi party network transactions) . Gat. No. 10231 Form W-9 Rev. 12-2014)