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HomeMy WebLinkAboutC11-182 Escrow Instructions Heritage Title DATE: 4-Kg , 2011 ESCROW NO.: H0308831 PROPERTYADDRESS: SEE ATTACHED EXHIBIT A ESCROW INSTRUCTIONS ADDENDUM (Interest Bearing Accounts) From the funds deposited in the above - numbered escrow for my account, you are hereby instructed to deposit $10,000.00' with Wells Fargo Bank whose address is: 550 California Street, 10 FI, San Francisco, CA 94104 , in an interest bearing account, at the prevailing rate of interest. My Taxpayer Identification Number is 88- 0309544. ( W -9 must be completed and provided to closing agent) The account is to be entitled "HERITAGE TITLE COMPANY, For the benefit of Eagle County, Colorado Q Any interest earned by such deposit shall be credited to the account of the undersigned depositor at close of escrow. In the event the escrow does not close, all interest earned shall be payable as stated on those instructions that allow the escrow to be cancelled. (or) ❑ Any interest earned by such deposit shall be credited to the account of: The undersigned hereby acknowledges the following: 1. The selection of the depository was made at the sole discretion of the undersigned. 2. The undersigned has made their independent inquiry of the depository and Heritage Title Company has no liability in the event of failure, insolvency or inability of the depository to pay said funds, or accrued interest upon demand for withdrawal. 3. The undersigned acknowledge their familiarity with limitations on payments made on accounts in excess of $250,000 and the cumulative effect of other accounts held or owned by undersigned in the above -named depository. 4. The total responsibility of the Escrow Holder is to make the deposit as above instructed 5. The escrow company is prohibited from withdrawing funds except to redeposit them into the escrow account. 6. Heritage Title Company is not responsible for levies by taxing authorities based upon the taxpayer identification number used to establish this interest bearing account. Eagle Co n. __ By. (Title) • Form W -9 Request for Taxpayer Give form to the requester. (Rev. January 2011) Do not Department of the Treasury Identification Number and Certification send to the IRS Internal Revenue Service Name (as shown on your income tax return) Eagle County, Colorado Business name /disregarded entity name, if different from above d Check appropriate ro riate box for federal tax ea a • classification (required): ❑ Individual /sole proprietor ❑ C Corporation ❑ S Corporation 0 Partnership ❑ Trust/estate 0 0 24 1 0 Limited liability company. Enter the tax classification (C =C corporation, S =5 corporation, P= partnership) • Exempt payee `02 0 Other (see Instructions) • a ° Address number, street, and apt or suite no. ( P � no.) Requester's name and address (optional) ?,Q , �� Heritage Title Company, Inc. P.O. Box 1980, 50 Chambers Ave. Suite I y City, state, and ZIP code Eagle, CO 81631 5%LLB 01 le3 List account number(s) here (optional) H0308831- 060 -MH1 Part 1: Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name° I Social security number line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part 1 instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose 1 Employer identification number number to enter. e 14- - D O U - T. (o Z. Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer idenfdication 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) 1 have not been notified by the Internal Revenue Service (IRS) that 1 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, and 3. I am a U.S. citizen or other U.S. person (defined below). 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 you have failed to report all interest and dividends 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 (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Signature Here U.S. person / Date / General Instructions Note: If a requester gives you a form other than Form W -9 to request Section references are to the Internal Revenue Code unless otherwise your TIN, you must use the requester's form if it is substantially similar to noted. this Form W -9. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.S. person if you are: • A person who is required to file an information retum with the IRS, • An individual who is a U.S. citizen or U.S. resident alien, must obtain your correct taxpayer identification number (TIN) to report, for • A partnership, corporation, company, or association created or example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. • Any estate (other than a foreign estate) or Use Form W -9 only if you are a U.S. person (including a resident • A domestic trust (as defined in Regulations section 301.7701 -7). alien), to provide your correct TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or requester) and, when applicable, to: business in the United States are generally required to pay a withholding 1. Certify that the TIN you are giving is correct (or you are waiting for tax on any foreign partners' share of income from such business. Further, a number to be issued), in certain cases where a Form W -9 has not been received, a partnership 2. Certify that you are not subject to backup withholding, or is required to presume that a partner is a foreign person, and pay the 3. Claim exemption from backup withholding if you are a U.S. exempt withholding tax. Therefore, if you are a U.S. person that is a partner in a payee. If applicable, you are also certifying that as a U.S. person, your Fo W- partnership the conducting a hip to establish business y u U.S. United a States, provide Form W -9 to the partnership to establish your U status and avoid allocable share of any partnership income from a U.S. trade or business withholding on your share of partnership income. is not subject to the withholding tax on foreign partners' share of effectively connected income. Cat. No. 10231X Form W - (Rev. 1 -2011) • A parcel of land in Lots E and F in Section Eight, and Lots D and G in Section Nine, of the State Subdivision of Tract 50, Township 2 South, Range 83 West of the Sixth Principal Meridian, in Eagle County, State of Colorado. The North boundary of said Parcel being that part of North boundary of said Tract 50 lying between the centerline of the Denver and Salt Lake Western Railroad Right of Way No. 602 -6 and the Colorado Department of Highways Right of Way No. being 1499 -14; The Easterly boundary of said parcel being the centerline of the Colorado Department of Highways Right of Way No. 1499 -14; the Westerly boundary of said Tract being the centerline of the Denver and Salt Lake Western Railroad Right of Way No. 602 -6; and the Southerly boundary of said parcel being the North line of a parcel of land common to both Rights of Way No. 1499 -14 and 602 -6 and extended Northeasterly to the centerline of the Colorado Department of Highway Right of Way No. 1499 -14 and also being extended Southwesterly to the centerline of the Denver and Salt Lake Western Railroad Right of Way No. 602 -6. The exterior boundary of said parcel being more particularly described as follows: Beginning at a point on the North boundary of said Tract 50, which point is the point of intersection of the centerline of said railroad right of way and the North boundary of said Tract 50, and bears East a distance of 99.3 feet from the Northwest comer of said Tract 50, thence East along the North boundary of said Tract 50 a distance of 923.69 feet, more or less, to the intersection of the centerline of said highway right of way and the North boundary of said Tract 50, thence South 01 degree 14 minutes East along the centerline of said highway right of way a distance of 580.8 feet to a point of spiral curve; thence along a spiral curve to the left, (being the centerline of said highway) having a Delta of 5 degrees, for a distance of 200 feet to a point of simple curve, thence along the are of a simple curve to the left (being the centerline of said highway right of way), having a delta of 13 degrees 49 minutes and a radius of 1,146 feet, for an arc distance of 276.3 feet to a point of spiral curve; thence along a spiral curve to the left (being the centerline of said highway right of way), having a delta of 5 degrees for a distance of 200 feet to a point of tangent; Thence South 25 degrees 03 minutes East along the centerline of said Highway right of way, a distance of 48.94 feet, more or less, to a point of intersection of the centerline of said highway right of way with the Northeasterly extended boundary of a parcel of land which is covered by both Railroad Right of Way No. 602.6 and Highway Right of Way No. 1499 -14, thence South 55 degrees 54 minutes West along the Northeast extension of said common right of way a distance of 46.43 feet, more or Less, to the Northeast corner of the parcel of said common rights of way, thence continuing South 55 degrees 54 minutes West along the Northerly boundary of the parcel of common right of way, a distance of 150 feet to the Northwest comer of the parcel of said common right of way, thence continuing South 55 degrees 54 minutes West along the Southwesterly extension of the Northerly boundary of the parcel of said common right of way a distance of 50 feet to a point on the centerline of said railroad right of way, thence Northwesterly, along the centerline of said railroad right of way, on a Searle's Spiral to the right having 4 chords 50 feet in length, for a total length of 200 feet to a point of tangent, thence North 32 degrees 25 minutes West along the centerline of said railroad right of way, for a distance of 1,486 feet, more or less, to the point of beginning. Being a point on the North boundary of said Tract 50, County of Eagle, State of Colorado Iegal rev. (010698) ON 0160 (02199) • COLORADO DEPARTMENT OF REVENUE DENVER C06026i•0013 CERTIFICATE OF EXEMPTION FOR COLORADO STATE SALES /USE TAX ONLY • • • USE �A a�d eferenc NUMBER • LIABILITY INFORMATION ISSUE DATE THIS LICENSE IS HOT TRANSFERABLE 98 .44 022 N 030983 SEP 22.2000 550 BROADWAY EAGLE CO' (1 11 1 11 11 11 . 1 1 111•1111411 1111n1u111111•111t1111,11 COUNTY OF EAGLE EAGLE COUNTY P 0 BOX 850 • EAGLE CO 81631 -0850 7-144 ,�7 • E ecutive Director • Depertmenr of Revenue • • • • • • • • • DATE: May , 2011 ESCROW NO.: H0307420 PROPERTYADDRESS: SEE ATTACHED EXHIBIT A ESCROW INSTRUCTIONS ADDENDUM (Interest Bearing Accounts) From the funds deposited in the above - numbered escrow for my account, you are hereby instructed to deposit $10,000.00 with Wells Fargo Bank whose address is: 550 California Street, 10 FI, San Francisco, CA 94104 , in an interest bearing account, at the prevailing rate of interest. My Taxpayer Identification Number is 88- 0309544. ( W -9 must be completed and provided to closing agent) The account is to be entitled "HERITAGE TITLE COMPANY, For the benefit of Eagle County, Colorado El Any interest earned by such deposit shall be credited to the account of the undersigned depositor at close of escrow. In the event the escrow does not close, all interest earned shall be payable as stated on those instructions that allow the escrow to be cancelled. (or) O Any interest earned by such deposit shall be credited to the account of: The undersigned hereby acknowledges the following: 1. The selection of the depository was made at the sole discretion of the undersigned. 2. The undersigned has made their independent inquiry of the depository and Heritage Title Company has no liability in the event of failure, insolvency or inability of the depository to pay said funds, or accrued interest upon demand for withdrawal. 3. The undersigned acknowledge their familiarity with limitations on payments made on accounts in excess of $250,000 and the cumulative effect of other accounts held or owned by undersigned in the above -named depository. 4. The total responsibility of the Escrow Holder is to make the deposit as above instructed 5. The escrow company is prohibited from withdrawing funds except to redeposit them into the escrow account. 6. Heritage Title Company is not responsible for levies by taxing authorities based upon the taxpayer identification number used to establish this interest bearing account. By Co By: s. - .i /x4000. (Title) Form YY -9 Request for Taxpayer Give form to the requester. (Rev. January 2011) Do not Department of the Treasury Identification Number and Certification send to the IRS Internal Revenue Service Name (as shown on your income tax retum) Eagle County, Colorado Business name /disregarded entity name, If different from above Check appropriate box for federal tax c classification (required): ❑ Individual /sole proprietor ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate 0 a o 0 Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= artnershi ► ❑Exempt payee : P P P) ,, u 0 c 0 ❑ Other (see Instructions) ■ s Address (number, street, and apt. or suite no.) Requester's name and address (optional) I - Ei),\CPcjD Heritage Title Company, Inc. P.O. Box 1980, 50 Chambers Ave. Suite I City, state, and ZIP code Eagle, CO 81631 O ( gtl t List account numbLr(s) here (optional) H0307420- 060 -MH1 Part I: Taxpayer Identification Number (TIN) Enter your TIN In the appropriate box. The TIN provided must match the name given on the "Name" J Social security number line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose I Employer identification number number to enter. Part II:' 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) 1 have not been notified by the Internal 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 notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). 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 you have failed to report all interest and dividends on your tax retum. 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 (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Signature Here U.S. person ► Date ► General Instructions Note: If a requester gives you a form other than Form W -9 to request Section references are to the Internal Revenue Code unless otherwise your TIN, you must use the requester's form If it is substantially similar to this Form W -9. noted. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.S. person if you are: • A person who is required to file an information retum with the IRS, • An individual who is a U.S. citizen or U.S. resident alien, must obtain your correct taxpayer identification number (TIN) to report, for • A partnership, corporation, company, or association created or example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. • Any estate (other than a foreign estate) or Use Form W -9 only if you are a U.S. person (including a resident • A domestic trust (as defined in Regulations section 301.7701 -7). alien), to provide your correct TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or requester) and, when applicable, to: business in the United States are generally required to pay a withholding 1. Certify that the TIN you are giving is correct (or you are waiting for tax on any foreign partners' share of income from such business. Further, a number to be issued), in certain cases where a Forrn W -9 has not been received, a partnership 2. Certify that you are not subject to backup withholding, or is required to presume that a partner is a foreign person, and pay the 3. Claim exemption from backup withholding if you are a U.S. exempt withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide payee. If applicable, you are also certifying that as a U.S. person, your Form W -9 to the partnership to establish your U.S. status and avoid allocable share of any partnership income from a U.S. trade or business withholding on your share of partnership income. Is not subject to the withholding tax on foreign partners' share of effectively connected income. Cat. No. 10231X Form W - (Rev. 1 - 2011) A parcel of land situate within Tracts 40 and 49 located in the NE 1/ of the NW 1 /4 of Section 5, Township 5 South, Range 86 West of the 6th Principal Meridian according to the. Independent Resurvey of said Township and Range approved by the U.S. Surveyor's General's Office June 20, 1922, more particularly described as follows: Beginning at a point in the center of the Colorado River whence a brass cap for the closing comer of the westerly line of said Tract 49 with the northerly line of said Section 5 bears N. 55 °40'47" W. 1144.64 feet; thence S. 56 °18'36" E. 88.66 feet to the southwest corner of the Doolittle Tract described in Book 530 at Page 613 of the Eagle County records; thence S. 74 °20'49" E. 177.65 feet along the southerly line of said Doolittle Tract; thence N. 23 °50'26" E. 25.28 feet along the easterly line of said Doolittle Tract to the southwesterly corner of the Neumayr -Brown Subdivision recorded in the Eagle County records in Book 378 at Page 979; thence S. 49 °56'47" E. 427.92 feet along said southwesterly line; thence S. 62 °49'38 E. 323.53 feet along said southwesterly line; thence S. 03 °57'00" W. 136.07 feet along said southwesterly line to the northerly right -of -way of Highway 6 and 24; thence N. 86 °03'00" W. 425.79 feet along said northerly line; thence S. 03 °57'00 "W. 15.00 feet along said northerly line; thence N. 86 °03'00 W. 65.50 feet along said northerly line; thence along said northerly line along a curve to the left having a radius of 1206.00 feet, a central angle of 21 °40'00 ", an arc distance of 456.06 feet and a Long Chord of 453.34 feet bearing S. 83 °07'00" W.; thence S. 72 °17'00" W. 107.40 feet along said northerly line; thence N. 86 °25'25" W. 120.00 feet to the centerline of the Colorado River; thence N. 04 °28'30" E. 139.35 feet along said centerline; thence N. 15 °25'43" E. 72.80 feet along said centerline; thence N. 26 °33'54" E. 346.59 feet along said centerline; thence N. 33 °41'24" E. 209.81 feet along said centerline to the point of beginning. COUNTY OF EAGLE, STATE OF COLORADO Formerly described as: Lot 5 of Section 32. in Township 4 South, Range 86 West of the 6th P.M.. according to the survey thereof under which Patent was issued July 26, 1899, and Lot numbered 20 of Section 5, Township 5 South, Range 86 West of the 6th P.M., according to the survey thereof under which Patent issued July 26, 1899, lying westerly of those certain parcels of land conveyed by Hervey J. VanHorn and George S. Yost, respectively to The Denver and Salt Lake Western Railroad Company, by Warranty Deeds recorded as Receptions Nos. 54527 and 54528, respectively, in Book 116 at Page 149 and 148. AND All that portion of Tract 40 in Township 5 South, Range 86 West of the 6th P.M., according to the Independent Resurvey of said Township and Range accepted by the General Land Office June 6, 1923, lying westerly of that certain parcel of land conveyed by Hervey J. VanHom to The Denver and Salt Lake Western Railroad Company in Book 116 at Page 149. EXCEPTING THEREFROM THE FOLLOWING PARCELS: Parcel described in Book 224 at Page 13 as Reception No. 119759 Parcel described in Book 281 at Page 997 as Reception No. 178405 Parcel described as the Plat recorded June 15, 1979 in Book 286 at Page 909 as Reception No. 183312 Parcel described in Plat recorded February 19, 1985 in Book 406 at Page 765 as Reception No. 303048 legal rev. (010698) Parcel described in Book 271 at Page 36 as Reception No. 167432 Parcel described in Book 271 at Page 37 as Reception No. 167433 Parcel described in Book 520 at Page 781 as Reception No. 416950 and Excepting any portion lying within the Land described in Book 584 at Page 476 as Reception No. 480581. COUNTY OF EAGLE, STATE OF COLORADO legal rev. (010698) DATE: Mai¢ , 2011 ESCROW NO.: H0307443 PROPERTYADDRESS: SEE ATTACHED EXHIBIT A ESCROW INSTRUCTIONS ADDENDUM (Interest Bearing Accounts) From the funds deposited in the above- numbered escrow for my account, you are hereby instructed to deposit $50,000.00 with Wells Fargo Bank whose address is: 550 California Street, 10 FI, San Francisco, CA 94104 , in an interest bearing account, at the prevailing rate of interest. My Taxpayer Identification Number is 88- 0309544. ( W -9 must be completed and provided to closing agent) The account is to be entitled "HERITAGE TITLE COMPANY, For the benefit of Eagle County, Colorado Q Any interest earned by such deposit shall be credited to the account of the undersigned depositor at close of escrow. In the event the escrow does not close, all interest earned shall be payable as stated on those instructions that allow the escrow to be cancelled. (or) ❑ Any interest earned by such deposit shall be credited to the account of: The undersigned hereby acknowledges the following: 1. The selection of the depository was made at the sole discretion of the undersigned. 2. The undersigned has made their independent inquiry of the depository and Heritage Title Company has no liability in the event of failure, insolvency or inability of the depository to pay said funds, or accrued interest upon demand for withdrawal. 3. The undersigned acknowledge their familiarity with limitations on payments made on accounts in excess of $250,000 and the cumulative effect of other accounts held or owned by undersigned in the above -named depository. 4. The total responsibility of the Escrow Holder is to make the deposit as above instructed 5. The escrow company is prohibited from withdrawing funds except to redeposit them into the escrow account. 6. Heritage Title Company is not responsible for levies by taxing authorities based upon the taxpayer identification number used to establish this interest bearing account. Eagle County Col. �� y . / l e) • Township 3 South, Range 86 West of the 6 P.M. All that part of the following described property lying North and West of the centerline of the Colorado River, to -wit: Section 13: NW1 /4NE1 /4, S1 /2NE1 /4, NE1 /4SE1 /4 and N1 /2SE1 /4SE1 /4 Township 3 South, Range 85 and Range 86 West of the 6 P.M. All that part of the following described property, lying North and West of the centerline of the Colorado River, to -wit: Tract No. 37 in Sections 7 and 18 of Township 3 South, Range 85 West of the 6 P.M.., and in Section 13, Township 3 South, Range 86 West of the 6 P.M., according to the Independent Resurvey. (Tract 37 being originally described as Lots 2, 3 and 4, Section 7, Township 3 South, Range 85 West of the 6 P.M. and SE1 /4SE1 /4, Section 12, Township 3 South, Range 86 West of the 6 P.M.) Excepting tracts of land conveyed to the Denver and Salt Lake Western Railroad Company as particularly described in documents recorded in Book 116 at Page 176, Book 116 at Page 198, Book 116 at Page 196, Book 82 at Page 554, Book 116 at Page 210, Book 116 at Page 165, Book 82 at Page 379 and Book 114 at Page 385 of the Eagle County Records. Also excepting a parcel of land described in a deed to the County of Eagle recorded in Book 135 at Page 167 of the Eagle County records, County of Eagle, State of Colorado legal rev. (010698) Form W-9 Request for Taxpayer Give form to the requester. (Rev. January 2011) Do not Department of the Treasury Identification Number and Certification send to the IRS Internal Revenue Service Name (as shown on your income tax return) Eagle County, Colorado Business name /disregarded entity name, if different from above m Check appropriate box for federal tax as Q. classification (required): ❑ Individual /sole proprietor ❑ C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate • c ❑ Exempt payee ❑ Limited liability company. Enter the tax classification (C =C corporation, S =S corporation, P= partnership) • `02 r •g ❑ Other (see Instructions) • w Addr, number, street. and apt. or suite no.) Requester's name and address (optional) 8 I g J Heritage Title Company, Inc. • City, state, and ZIP code P.O. Box 1980, 50 Chambers Ave. Suite I w // Eagle, CO 81631 GA-0 '_ C O 01( List account number(s) here (optional) H0307443- 060 -MH1 Part 1: Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the "Name" Social security number line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For - - other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is In more than one name, see the chart on page 4 for guidelines on whose I Employer identification number number to enter. 04-- W o V o 70 2 Part II: 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 (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 notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). 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 you have failed to report all interest and dividends 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 (IRA), and generally, payments other than interest and dividends, you are no quired to sign the certification, but you must provide your correct TIN. (See the instructions on page 4.) Sign Signature j t f Here U.S. person 'W�` l Gv/ Date . 1 General Instructions Note: If a requester gives you a form other than Form W -9 to request Section references are to the Internal Revenue Code unless otherwise your TIN, you must use the requester's form if it is substantially similar to this Form W -9. noted. Definition of a U.S. person. For federal tax purposes, you are Purpose of Form considered a U.S. person if you are: • A person who Is required to file an information return with the IRS, • An individual who is a U.S. citizen or U.S. resident alien, must obtain your correct taxpayer identification number (TIN) to report, for • A partnership, corporation, company, or association created or example, income paid to you, real estate transactions, mortgage interest organized in the United States or under the laws of the United States, you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. • Any estate (other than a foreign estate) or Use Form W -9 only if you are a U.S. person (including a resident • A domestic trust (as defined in Regulations section 301.7701 -7). alien), to provide your correct TIN to the person requesting it (the Special rules for partnerships. Partnerships that conduct a trade or requester) and, when applicable, to: business in the United States are generally required to pay a withholding 1. Certify that the TIN you are giving is correct (or you are waiting for tax on any foreign partners' share of income from such business. Further, a number to be issued), in certain cases where a Form W -9 has not been received, a partnership 2. Certify that you are not subject to backup withholding, or is required to presume that a partner is a foreign person, and pay the 3. Claim exemption from backup withholding if you are a U.S. exempt withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide payee. If applicable, you are also certifying that as a U.S. person, your Form W -9 to the partnership to establish your U.S. status and avoid allocable share of any partnership income from a U.S. trade or business withholding on your share of partnership income. is not subject to the withholding tax on foreign partners' share of effectively connected income. Cat. No. 10231X Form W -9 (Rev. 1 -2011)