Fonn W•9

(Rev. March 2024)

Request for Taxpayer Give form to the
requester. Do not
Department of the Treasury Identification Number and Certification send to the IRS.
Internal Revenue Service Go to www.frs.gov/FormW9 for Instructions and the latest Information.
Before you begin. For guldan
ce re ated to the purpose of Form W-9, see Purpose of Form, below.
1 Name of entity/I dlvtd I th business/disregarded
entity' n ua • An entry Is required. (For a sole proprietor or disregarded entity enter the owner's name on line 1, and enter e
s name on line 2.) '

51.A.Qe<lOC- ReMode(e("s LLC.

2
Buslness name/dlsregarded entity name, If different from above.
C')
5 >"'{)en'o( R.eM-Od.el ev-s LLC.
(I) 3a Check the apP>rbiPr1 ate box for federal tax classlflcatlon of the entlty/lndlvldual whose name Is entered on line 1. Check 4 Exemptions (codes apply only to
Ol
(0 on1Y one of the fonowlng seven boxes. certain entitles, not Individuals;
a. see Instructions on page 3):
6 ~dividuol/sole proprietor O C corporation O s corporation O Partnership 0 TrusVestato
ai ~ LLC. Enter the tax classlflcatlon (C = C corporation, S = S corporation, p = Partnership) . . . . C Exempt payee code Of any)
j:8
~ u
Note: Check the "LLC" box above and, In the entry space, enter the appropriate code (C, S, or P) for the t a x - - -
ciboassification of the ';-LC, unless it Is a disregarded entity. A disregarded entity should instead check the appropriate Exemption from Foreign Account Tax
0 ~ x for the tax classification of Its owner. Compliance Act (FATCA) reporting
1: ~
·c .S □ Other (see Instructions) code (If any)

0.1 3b II on line 3a you checked "Partnership" or "Trusvestate," or checked "LLC" and entered •p• as its tax classification, (Appl/es to accounts malntalfl8d
:d you _are providing this form lo a partnership, trust, or estate in which you have an ownership Interest, check outside the United States.)
Cl) s box if you have any foreign partners, owners, or beneficiaries. See instructions . □
1 s Address (number, street, and apt. or suite no.). See Instructions. Requester's name and address (optlonaQ
~ 'St tY"lrY\ W'\ - ~i-\ e. "3 tJ
6 City, stale,)and ZIP code

7
f\. P- o. r{-ow tJ 1
list account numbef(s) here (optlona~
c-r obl{,o

•~-i
··• Taxpayer Identification Number (TIN)
I Social security number I
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the Instructions for Part I, later. For other
entities, it is your employer Identification number (EIN). If you do not have a number, see How to get a
TIN, later.
[IJJ-[D-1 I I I I
or
I Employer Identification number
Note: If the account is in more than one name. see the instructions for line 1. See also What Name and
Number To Give the Requester for guidelines on whose number to enter.

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 ORS) 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); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
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 an r!Kluired to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later.
Sign Signature of
Here U.S. person Date IO- :J L- o}&..f
New line 3b has been added to this form. A flow-through entity is
General Instructions required to complete this line to indicate that it has direct or indirect
section references are to the Internal Revenue Code unless otherwise foreign partners, owners, or beneficiaries when it provides the Form W-9
noted. to another flow-through entity in which it has an ownership interest. This
future developments. For the latest information about developments
change is intended to provide a flow-through entity with information
regarding the status of its indirect foreign partners, owners, or
related to Form W-9 and its instructions, such as legislation enacted
beneficiaries, so that it can satisfy any applicable reporting
after they were published, go to www.irs.gov/FormW9.
requirements. For example, a partnership that has any indirect foreign
partners may be required to complete Schedules K-2 and K-3. See the
What's New Partnership Instructions for Schedules K-2 and K-3 (Form 1065).
Line 3a has been modified to clarify how a disregarded entity completes
this line. An LLC that is a disregarded entity should check the Purpose of Form
appropriate box for the tax classification of its owner. Otherwise, it
should check the "LLC" box and enter its appropriate tax classification. An individual or entity (Fonn W-9 requester) who is required to file an
information return with the IRS is giving you this form because they

Cal No. 10231X Form W-9 (Rev. 3-2024)