Case File
efta-01368407DOJ Data Set 10OtherEFTA01368407
Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01368407
Pages
1
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0
Integrity
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Fenn W
'''9
dkov. ocarfferene
basenstest el the Owen.
Numb R•70140 Unita
Request
for Taxpayer
Identification
Number
and
Certification
Give Form to the
reqUeSter. Co not
send to the In.
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no
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7st
Now
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in
a
I Name pa shown on your Income tat ratan} Name :4 toque", on This wteo not DM,
s Sy blank
Southern Trust Company, Inc.
ambi
t
ma namerearegardee enbly news, a callevern eon above
Southern Financial, LLC
3 Check approortaie
O
534545U445:010
seslomenter
O Lanka %salarycompany.
For a sontootcriba
am tax ounlecakon
box tor federal lax ctreelecaban: OW airy ere of the tonotAng seven box=
Minim or
❑O C Censeration
0
S Corporation
O
Penner-hip
O IneVestaro
U..0
Foto the tea clastaketkm PAC caporation. SeS corporation. Paparewesh10) lo
LLC that ts C..voientIce. do not creek tsc; chock tne futon/NOM box ln the aterarer°,
0 the Ace member C r AC Y.
•
4 Exemptions
icniir
n anttipaewlerta"
ExerPOI payee
bemPtic"
code et err)
Imam e sammemeeseeme
kenos Keit Otto
see
ma (4 9'1
keen FATCA159"5
lie Dow pee -euuceo
nut,
5 P4554333 (4,34004. *OMl and at. otaes red
6100 Red Hook Quarter, Et3
RagvetYle mete and a cene (opiO1a
e Cite. stilt anelte? COOS
St. Thomas, USVI 00802
7 Lot maount ntantspi here Matadi
Pa -t c
Taxpayer Identification Number (TIN)
Enter your TIN In the appropdate box. 11101114 provided must match the name given on Cr e 1 to twold
backup withholdIng. Foe Individuals. Una Is generally your social security number (SSN). However, tor e
resident alien. sole piraerletor, or dtcreparded entity, too the Part I Inatructiora on page 3. For other
snide,. It Is your employer Identikab011 number (EIN). It you do not have a number. see How CO gilt e
TrN on page 3.
Note. If the account Ls In more man ono nano. see the Insuucttons for line I and the than on page 4 lot
guldens* on whose number to snot.
Soda
tufty numbs,
or
rempieser ktentitiormon number
•
Certification
Under homilies of perjury. leen& that
1. The number shown on this form Is my correct taxpayer identiOCation number (or t am waiting for a number to be moved to mot and
2. lam not subfect to backup withhoierng because, (a) I an exempt from backup withholding, cr. (D) I have riot been nothied by the Internal Romeo
Service MS) that I ern subject to backup withholokne as o result of a failure to /opal ell Interest or dividends. or (c) the IRS has noticed mo that I em
no longer suttee% to osekup wIthholenth and
3. I em a U.S. citizen or other U.S. person (defined Wont end
4. The MICA code(a) entered on this tom el ant in:Scaling that I am exempt from MICA reporting le =Met.
Cardfleattlen Instructions. You must cross out kern 2 above If you have been notified try the IRS that you ere currently subject to backup setribaldna
because you have failed to report all Interest end dkridends on your tax return. For real estate hansackona, Item 2 dorm not apply. For snongegs
interest pair'. acquisition or abanconmont of secured property. cenceaadon of debt, C.OntributiOn3 loan Moviduel retheMent arrangement (MK end
gencreity. payments other than Interest and dividends, you me net required Wargo the cerliCositork but you muSt provide your corral TN. Seethe
instructions on pegs 3.
Sign
Hero
SIgnefore el
US. person
General
Instructions
BadlOCI Wet OICIS 010 le the Mint Anus CCOO Unitise otherwise noted.
Future develOprnentt. htonneton abate develooments Intorno Form W.9 Dash
of teebtarlon enacted saw we release it) i as wwvottspovihe9
Purpose of Form
An MK/up; Or way (Form W-9 I counIcr) ten Is /mtor! to Do an inforrnaition
rttsn with MOMS Mal obtain your ca-rect to Pryor lomalicaten mote (134
ores, get ,' be your
seamy
sods
number PSN),kihqual taxpayer ideninitatfon
number pus aotptitm taxpayer teranieloellon number (Mint or emoseret
alesinceeon Mar bra (ON). to report on en Inkanadon rotten the amontt paid to
you. or other amount model* an on atIcestakrt Man Examples of beOrMatIon
Want ar..isdel. but Ore net limited to, the lams**
• Form 1009.INI (intereet tented en peke
• Form 1099-DIV (Sulseneb, ineludno those bum nods a award West
• Fenn 1099411SC (webers types of income. prim nth.
of ontea prOcooth)
• rant, 1099-0 trio* or mutual fund sans Wasson ohs tramactiore by
broken)
• Form ‘039.S ;proceeds born red estate woodland
• Form t099-K One tent card arc third parry network kanracilens)
with 1/410/ziO1*
• Fenn low swims manatee Nees°. 1098M tovolennean Inane/ C0SVI
SteAM0
• Form 1099.0 (cancesea oeto
• Form i099.A(okartslice 44 se
t 34 waged PloPeral
the roan W4 only a you =au&
parson Criquans a hishinni Mat
inevkielert earedTIM
If swot no4 'alum Ftem 19-9 to me tequaste (wk., • fig ea.; rnient be seopel
to Now seentiokane. See Marl heap tePriekrrd? on page 2.
Starke the lined-Oa bark Put
1. Certify Pm the UN you are Imam Is owed pr you ere *Ong kr a mother
to be Sued).
2 Certify that you are not Sulackel to brekuls withhokline, or
2. Ctirn exemption ham backup swthheldue aypu ere a U.S. ammo payee If
sppecetle. you an extra Catayatty that meat porton your amble mare of
any eortnennip 'room* Worn a U.S. vale a Ike nen le not ineViect te to
wanhoktirg ea at heal cannon' etatt of elfrethebt Conlotaled Doom rot
4. C,erOfy that MICA co64(s1 ereensa al Mb lam Of tow ) bdpnky vut you aro
°henna; awn the FATCA lerenine, scored See whet a MM.* npauti?on
ono 21r kite: bkonerion.
Cat. No. 10231X
Form W-9 flee 12201q
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0060136
SDNY GM_00206320
EFTA01368407
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