Crestmont ZBA Application Package 72224

| | | nts etamnendts| 2.2 US, sitizen of offer U.S. person { som W=Q (Rev. October 2a1e) Dépadment of the Treasury Informal Revenue Service Request for Taxpayer Identification Number and Certification > Go to www.irs.gov/FormW9 for Instructions and the latest information. Give Form to the requester. Do not gend to the IRS, Crestmont Country Club, Inc. ‘1 Name {as shown on your thcome tax retum), Name is required on this ine; do not leave this line Blank. 2 Business namo/disregarded enilty name, i diferent from above Crestmont Country Club following seven boxes. D1 Inctviduatisote proprietor or CComoration (1) Scorperation singie-member LLG (7 Other (sea instructions) > (CO) United tablity company, Enter the tax classticatlon (C=C corporation, S=$ corporation, P=Partnership) Note: Check the appropriate box n the tine above for he fax classification ofthe single-membor owner. Domnot check | Exemption from FATCA reporting LLG te LLC classed 25a single-ombor LLC hats laragared rom the owner nless the aura of tbe ULC | oer anyh another LLC that Is not disregarded from tha aumer for U.S, federal tax purposes, Otherwise, a single-member LLC tha "7 1s disregarded from the owner should check the appropriate box for the tax classification ofits owner. '& Check appropriate box for federal tax classification of the parson whose name is entered on fine 1. Check only ona of the | 4 Exemptions {codes apply only to certain entities, not incividuais: see Instructions an page 3): 1 Parinerstip =) Trusvestare Exempt payee code {if any) optes i accounss muna outsce me U8) & Address (number, street, and apt. or suite no.) Sce instructions. P.O. Box 358 / 780 Eagte Rock Avenue- Print or type. See Specific Instructions on page 3. Rieguester's nama and address (optional 6 City, state, and ZiP coda West Orange, NJ 07052 7 Uist acceum aumber(e) hara (optional Taxpayer Identification Number (TIN} Enter your TIN in the appropriate box, The TIN provided must match the name given online 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). Howaver, fora resident alien, sole proprietor, or disregarded entity, see the Instructions for Part |, later, For other -| 7 entities, il Is your employer identification number (Eth). If you do not have a number, see How fo geta TIN, later. Note: [f the accountis in more than

Instructions for Part |, later, For other -| 7 entities, il Is your employer identification number (Eth). If you do not have a number, see How fo geta TIN, later. Note: [f the accountis in more than ane name, see the instructions for line 1, Also see What Nartie and Number To Give the Requester for guidelines on whose number to enter, [Social secunty number or Employer identification nur 2/2) -1 1/5) 4/5 ol2ja (EG Certification Under penalties of perjury, t cerlify that: 1. The number showin on this form is my correct taxpayer identification number (or | am waiting for a number to be Issued to me); ancl 2.1.am not subject 10 backup withholding because: (a) ! am exempt from backup withholding, of (b)] have not been notified by the intema{ Revenue ‘Service (IRS) that | am subject te backup withholding as a result of a failure to report all interest or dividends, or (c) tite IRS has netified me that | am no longer subject to backup withholding; and below); and... 4, The FATCA code(s) enterad on this form (if ar licating that | am exempt from FATCA reporting is correct. Gertification Instructions. You must cross oul 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 retum. For real estate tranactions, item 2 does nol apply. For mortgage interest paid, acquisition or abandonment of secured property, cancelalign’ct ‘debi, contributions to an individual retirement arrangement (IRA), and generally, payments (0° other than interest and Cividends, you are not requites: in the ceriification, but you must provide your correct TIN. See the instructions for Part #, later. a Sf Sign |. signature of Here | us. person® Dote® SEY Zo 22 General Instructions Section references are ig the Internal Revenue Code unless otherwise noted, Le Future developments. For the latest information about developments related to Form W:3 and ils instructions, such as legislation enacted after they were published, ga to www.irs.gow/FormW9_ Purpose of Form An Individual or entity (Form W-8 requester} who is required to file an information return with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN, individual taxpayer Identification number (ITIN), adoption taxpayer identification

the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN, individual taxpayer Identification number (ITIN), adoption taxpayer identification number {ATIN), or employer identification number {EIN), to report on an information return the amount paid to you, or other amount reportable on an information return, Examples of information telus include, but are not fimited to, the folowing. » Form 1099-IN7 (interest earned or paid) + Form 1098-DiV (dividends, including those from stocks or mutual furids) ‘# Form 1039-MISG (various types of income, prizes, awards, or gross proceeds) » Form 1099-8 (stock or mutual fund sales and cartain other transactions by brokers) + Form 1099-8 {proceeds from real estate transactions} * Form 1089-K (merchant card anc third party network transactions) ‘* Form 1098 (rome mortgage interest), 1098-E (student Joan interest), 1098-T (tuition) « Form 1089-C (canceled debt) * Form 1099-A (acquisition or abandonment of eacured property) Use Form W-9 only if you are a U.S. person (Including a resident alien), to provide your correct TIN. Hf you do not return Form W-9 to the requesier with a TIN, you might be subject to backup withholding, See What is backup withholding, Jater, Gat. No, 10231% Form W-9 (Rav. 10-2078]