Federal Deposit Insurance Corporation

Division of Finance

Substitute Form W-9 REQUEST FOR TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION
PRI ACY ACT STATEMENT Section 6109 of the Internal Revenue Code requires you to give your correct Ta payer Identification !u"#er $TI!% to persons &ho "ust file infor"ation returns &ith the IRS to report interest' dividends' and certain other inco"e paid to you' "ortgage interest you paid' the acquisition or a#andon"ent of secured property' cancellation of de#t' or contri#utions you "ade to an IR() The IRS &ill use the nu"#ers for identification purposes and to help verify the accuracy of your ta return) The IRS "ay also provide this infor"ation to the Depart"ent of *ustice for civil and cri"inal litigation and to cities' states' and the District of Colu"#ia to carry out their ta la&s) +ou "ust provide your TI! &hether or not you are required to file a ta return) ,ayers "ust generally &ithhold -0. of ta a#le interest' dividend' and certain other pay"ents to a payee &ho does not give a TI! to a payer) Certain penalties "ay also apply)

!a"e /usiness !a"e (ddress (Number, Street, Apt. or Suite No.) City' State' and 3I, Code

0 e"pt Fro" /ac1up 2ithholding

4ist (ccount !u"#er$s% $5ptional%

SECTION I ! TAXPAYER ID NUMBER" PAYEE TYPE" AND BUSINESS OWNERS#IP TYPE TAXPAYER ID NUMBER E$ter %our T&'(&%er I)e$ti*i+&tio$ Number ,TIN- i$ t.e &((ro(ri&te bo'/ For i$)i0i)u&1s" t.is is %our So+i&1 Se+urit% Number ,SSN-/ For ot.er e$tities" it is %our Em(1o%er I)e$ti*i+&tio$ Number ,EIN-/ 0"ployer Identification !u"#er $0I!% Social Security !u"#er $SS!% PAYEE TYPE Individual Federal 7overn"ent (gency State' 4ocal 7overn"ent (gency 4a& Fir" or ,ractice 4egal Service ,rovider Foreign8!on6resident (Provide the appropriate Form W- ) 5ther (Please explain) 6 6 OR 6

(Please check one box in each column) BUSINESS OWNERS#IP TYPE Sole ,roprietorship ,artnership Corporation 7overn"ent (gency Trust Ta 0 e"pt8!on6,rofit 5ther (Please explain)

CERTIFICATION INSTRUCTIONS 6 +ou "ust cross out ite" 9' #elo& if you have #een notified #y the IRS that you are currently su#:ect to #ac1up &ithholding #ecause of underreporting of interest or dividends on your ta return) For real estate transactions' ite" 9 does not apply) For "ortgage interest paid' the acquisition or a#andon"ent of secured property' cancellation of de#t' contri#utions to an individual retire"ent account $IR(%' and generally' pay"ents other than interest and dividends' you are not required to sign the Certification' #ut you "ust provide your correct TI!) SECTION II - CERTIFICATION ;nder penalties of per:ury' I certify that< 1) The nu"#er sho&n on this for" is "y correct ta payer identification nu"#er $or I a" &aiting for a nu"#er to #e issued to "e%' &$) 9) I a" not su#:ect to #ac1up &ithholding #ecause< $a% I a" e e"pt fro" #ac1up &ithholding' or $#% I have not #een notified #y the IRS that I a" su#:ect to #ac1up &ithholding as a result of failure to report all interest and dividends' or $c% the IRS has notified "e that I a" no longer su#:ect to #ac1up &ithholding' &$) -) I a" a ;)S) person $including a ;)S) resident alien%) T.e I$ter$&1 Re0e$ue Ser0i+e )oes $ot re2uire %our +o$se$t to &$% (ro0isio$ o* t.is )o+ume$t ot.er t.&$ t.e +erti*i+&tio$s re2uire) to &0oi) b&+3u( 4it..o1)i$5) Signature of ;)S) ,erson Date !a"e(Please print) Title Telephone !u"#er Fa !u"#er $% 6 $% 6
FDIC =>-1810 $1060-%