EX-99.(A)(1)(B) 3 dex99a1b.htm FORM OF SUBSTITUTE FORM W-9 Form of Substitute Form W-9

Exhibit 99(a)(1)(B)

PAYER’S NAME:

 

SUBSTITUTE FORM W-9

Department of the Treasury Internal Revenue Service

   Part 1—TAXPAYER IDENTIFICATION NUMBER—PLEASE PROVIDE YOUR TIN IN THE BOX AT RIGHT AND CERTIFY BY SIGNING AND DATING BELOW. IF AWAITING TIN, WRITE “APPLIED FOR.”   

Social security number or

Employer identification number

Payer’s Request for Taxpayer Identification Number (“TIN”) and Certification    Part 2—For Payees Exempt from Backup Withholding—Check the box if you are NOT subject to backup withholding. ¨

 

                                                                                        

Name

   Part 3—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), (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. person (including a U.S. resident alien).

Business name if different from above Check appropriate box:

¨ individual/sole

¨ proprietor

¨ corporation

¨ partnership

¨ other                     

 

                                                                                        

Address

   Certificate Instructions—You must cross out item (2) in Part 3 above if you have been notified by IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. However, if, after being notified by the IRS that you were subject to backup withholding, you received another notification from the IRS that you are no longer subject to backup withholding, do not cross out item 2.

Signature of U.S. person                                                               Dated,                     , 2007

                                                                                                                                                                                                                                                                       

 

NOTE: FAILURE TO COMPLETE THIS SUBSTITUTE FORM W-9 MAY RESULT IN BACKUP WITHHOLDING OF 28% OF ANY PAYMENTS MADE TO YOU PURSUANT TO THE OPTION. IN ADDITION, FAILURE TO PROVIDE SUCH INFORMATION MAY RESULT IN A PENALTY IMPOSED BY THE INTERNAL REVENUE SERVICE. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS.

 

   YOU MUST COMPLETE THE FOLLOWING CERTIFICATE IF YOU WROTE “APPLIED FOR” INSTEAD OF A TIN IN THE SUBSTITUTE FORM W-9


CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER

I certify under penalties of perjury that a taxpayer identification number has not been issued to me, and either (a) I have mailed or delivered an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that if I do not provide a taxpayer identification number by the time of payment, 28% of all reportable payments made to me may be withheld until I provide a taxpayer identification number to the Paying Agent.

Signature of U.S. person                                                               Dated,                     , 2007


GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION

NUMBER ON SUBSTITUTE FORM W-9

Guidelines for Determining the Proper Identification Number to Give the Payer—Social Security numbers have nine digits separated by two hyphens: i.e., 000-00-0000. Employer Identification numbers have nine digits separated by only one hyphen: i.e., 00-0000000. The table below will help determine the number to give the payer.

 

For this type of account

  

Give the SOCIAL SECURITY
number of:

  

For this type of account:

  

Give the EMPLOYER
IDENTIFICATION number of:

1. Individual    The individual    6. Sole proprietorship or single-owner LLC    The owner(3)
2. Two or more individuals (joint account)    The actual owner of the account or, if combined funds, the first individual on the account(1)    7. A valid trust, estate, or pension trust    Legal entity (Do not furnish the identifying number of the personal representative or trustee unless the legal entity itself is not designated in the account title.)(4)
3. Custodian account of a minor (Uniform Gift to Minors Act)    The minor(2)    8. Corporate or LLC electing corporate status on Form 8832    The corporation
4.a. The usual revocable savings trust account (grantor is also trustee)    The grantor-trustee(1)    9. Association, club, religious, charitable, or educational organization or other tax exempt organization    The organization
b. So-called trust account that is not a legal or valid trust under State law    The actual owner(1)    10. Partnership or multi-member LLC    The partnership
5. Sole proprietor or single-owner LLC    The owner(3)    11. A broker or registered nominee    The broker or nominee
      12. Account with the Department of Agriculture in the name of a public entity (such as a State or local government, school district or prison) that receives agricultural program payments.    The public entity

(1) List first and circle the name of the person whose number you furnish. If only one person on a joint account has a social security number, that person’s social security number must be furnished.
(2) Circle the minor’s name and furnish the minor’s social security number.
(3) You must show your individual name, but you may also enter your business or “doing business as” name. You may use either your social security number or your employer identification number (if you have one).
(4) List first and circle the name of the legal trust, estate or pension trust.

 

NOTE: If no name is circled when there is more than one name listed, the number will be considered to be that of the first name listed.

 


GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION

NUMBER ON SUBSTITUTE FORM W-9

Obtaining a Number

If you don’t have a taxpayer identification number, obtain Form SS-5, Application for a Social Security Number Card, or Form SS-4, Application for Employer Identification Number, at the local office of the Social Security Administration or the Internal Revenue Service and apply for a number.

Payees Exempt from Backup Withholding

Payees specifically exempted from backup withholding on ALL payments include the following:

 

    An organization exempt from tax under section 501(a), an individual retirement plan or a custodial account under Section 403(b)(7) if the account satisfies the requirements of Section 401(f)(2).

 

    The United States or any agency or instrumentality thereof.

 

    A State, The District of Columbia, a possession of the United States, or any subdivision or instrumentality thereof.

 

    A foreign government, a political subdivision of a foreign government, or any agency or instrumentality thereof.

 

    An international organization or any agency or instrumentality thereof.

Other payees that may be exempt from back-up withholding include the following:

 

    A corporation

 

    A financial institution

 

    A registered dealer in securities or commodities registered in the U.S., the District of Columbia or a possession of the U.S.

 

    A real estate investment trust.

 

    A common trust fund operated by a bank under section 584(a).

 

    A trust exempt from tax under section 664 or described in section 4947.

 

    An entity registered at all times under the Investment Company Act of 1940.

 

    A foreign central bank of issue.

 

    A futures commission merchant registered with the Commodity Futures Trading Commission.

 

    A middleman known in the investment community as a nominee or custodian.

Payments of dividends and patronage dividends not generally subject to backup withholding include the following:

 

    Payments to nonresident aliens subject to withholding under section 1441.

 

    Payments to partnerships not engaged in a trade or business in the U.S. and which have at least one nonresident partner.

 

    Payments of patronage dividends where the amount renewed is not paid in money.

 

    Payments made by certain foreign organizations.


Payments of interest not generally subject to backup withholding include the following:

 

    Payments of interest on obligations issued by individuals. Note: You may be subject to backup withholding if this interest is $600 or more and is paid in the course of the payer’s trade or business and you have not provided your correct taxpayer identification number to the payer.

 

    Payments of tax-exempt interest (including exempt-interest dividends under section 852).

 

    Payments described in section 6049(b)(5) to non-resident aliens.

 

    Payments on tax-free covenant bonds under section 1451.

 

    Payments made by certain foreign organizations.

Exempt payees described above should file Form W-9 to avoid possible erroneous backup withholding. FILE THIS FORM WITH THE PAYER, FURNISH YOUR TAXPAYER IDENTIFICATION NUMBER, WRITE “EXEMPT” ON THE FACE OF THE FORM, SIGN AND DATE THE FORM AND RETURN IT TO THE PAYER.

Certain payments other than interest, dividends, and patronage dividends that are not subject to information reporting are also not subject to backup withholding. For details, see Code sections 6041, 6041A(a), 6042, 6044, 6045, 6049, 6050A and 6050N, and their regulations.

Privacy Act Notice—Section 6109 requires most recipients of dividend, interest, or other payments to give their correct taxpayer identification numbers to payers who must report the payments to IRS. The IRS uses the numbers for identification purposes and to help verify the accuracy of tax returns. The IRS may also provide this information to the Department of Justice for civil and criminal litigation and to cities, states and the District of Columbia to carry out their tax laws. We may also disclose this information to other countries under a tax treaty, or to Federal or state agencies to enforce Federal non-tax criminal laws and to combat terrorism. Payers must be given the numbers whether or not recipients are required to file tax returns. Payers must generally withhold 28% of taxable interest, dividend, and certain other payments to a payee who does not furnish a taxpayer identification number to a payer. Certain penalties may also apply.

Unless otherwise indicated, all section references are to the Internal Revenue Code of 1986, as amended.

Penalties

 

(1) Penalty for Failure to Furnish Taxpayer Identification Number.—If you fail to furnish your correct taxpayer identification number to a payer, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

 

(2) Civil Penalty for False Information With Respect to Withholding.—If you make a false statement with no reasonable basis which results in no imposition of backup withholding, you are subject to a penalty of $500.

 

(3) Criminal Penalty for Falsifying Information.—Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

 

(4) Misuse of Taxpayer Identification Numbers.—If the requester discloses or uses taxpayer identification numbers in violation of federal law, the requester may be subject to civil and criminal penalties.

FOR ADDITIONAL INFORMATION

CONTACT YOUR TAX CONSULTANT OR

THE INTERNAL REVENUE SERVICE.