Reference Id: A05193441VCX2NHQ0QTKF
Request for Taxpayer
W-9
SUBSTITUTE
Form Identification Number and Certification (March 2024)
1 Name of entity/individual. An entry is required. (For a sole proprietor or disregarded entity, enter the owner’s name on line 1, and
enter the business/disregarded entity’s name on line 2.)
7f0763ec-ff2c-4115-847f-954107cbbda5
2 Business name/disregarded entity name, if different from above
3 Check appropriate box for federal tax classification.
Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate
✔
S
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) a
Note: Check the "LLC" box above and, in the entry space, enter the appropriate code (C, S, or P) for the tax
classification of the LLC, unless it is a disregarded entity. A disregarded entity should instead check the appropriate box
for the tax classification of its owner.
Other a
4 Address (number, street, and apt. or suite no.)
1001 S. Main St. STE 600
5 City, state, and ZIP code
KALISPELL MT United States 59901
Part I Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Social security number
the "Name" line to avoid backup withholding.
or
Employer identification number
XXXXX1833
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); 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. You will need to print out your hard copy form at the end of the interview and cross out item 2 before signing and mailing to the
address provided.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required
to avoid backup withholding.
Sign Signature of Md Samir Al Masud
Date a 07-06-2025
Here U.S. person a
Form W-9
