Case File
efta-01368410DOJ Data Set 10OtherEFTA01368410
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DOJ Data Set 10
Reference
efta-01368410
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Form We
Feev, Debstrerf 2014
Desrinent
anof
s
itie Many
interns
ereSenke
Request for Taxpayer
Identification Number and Certification
Give Form to the
requester. Oa not
send to the IRS.
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7 Nae Its Shown on tae Income lex We nn Mere 4 rogWN onvn ow do not leave
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Southern Trust Company, Inc.
2 Webs nansektbreearded erttny twin, a decant Iron above
Southern Financial, LLC
a Chick appeconale bat for federal Lot clasedicatbn: shock on' one of the follareba swan busk
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rase
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Nycarnpatry. Enter the tee tlieeetatiOn froo° GOIParal tea 5.5 FerPerof we. P•PasentO)
Now, Fora s.natelember LLC ;halls c-srogercke, do not cheek LLC; Nock me appropriate Cox b
itx tax clessleeoice of the thee member anew.
ie
r. pow pan IratructkorteN
ri
L_i flank"
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4 Exemptions
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bibiNCUOMS
Exempt pare
bar:oder
bode (4 end
Vadesseetwensvineaseta
(cabs sepir orh 40
not Ircnisekr see
on px:64
code (If cw))
kern FATCArtecetb;
Pe Me above tor
31
5 Addetre (end.. skeet. led apt oral na)
6100 Red Hook Quarter, 63
Recomtlef a fume and edemas foplkeree
4 City. sole, arc) EP coda
St. Thomas, USVI 00802
7 LIst =own menbete)hens Optional)
Taxpayer Identification Number(T'IN)
Enter your TIN In the appropriate box. The 11N provided must match the name given on Snell° avoid
I soda
backup witinotrAng. For Individuals. this Is generally your social security number (EISN). However, for a
resident alien. sole proprietor, or rEwegarded ondly, See the Part I instructions on page 3. For other
entities, It Is yaw employee' Ideintlficatron number (EIN). If you do not have a number, se* Now lo pate
TIN on page 3.
Or
Nolo. If the account Is In more than ono nwno. sea the Instructions for (Inc I end the chart on page 4 for rEmploVerwentireeeen number
guldelines on whose number to enter.
city nimbi's'
-1
Certification
Undo, penalties of perjury. I certify that
1. The number shown on this form Is my correct taxpayer identilleadon number (slam walling for a number to be (Med to met and
2. I am not suofect to backup withhoteeng because: (a) I om exempt from backup withholding, cr (b) I have not been notified by the Internal Revenue
Service (IRS) that I ern subject to backup wilhhokkng as a mutt ol o railse to repel ell interest or dividends, or (c) the IRS has notified me that I am
no longer subject to traekup withholdings and
3. I am a U.S. citizen or caw U.S. person (defined belowt and
4, The FATCA MOEN entered on tNs Ism El any) indicating that I MI exempt from FATCA reporting Is correct.
rarefication tnatructlons. You must cross out Item 2 above If you have been notified by the IRS that you No currontly subject to backup eithhoising
because you have failed to moon all Interest and dividends on your tax return. For real estate hansactior.s, Item 2 does not appty. For rriOn9a9*
Interact paid, acquisition or abanoonmont of secured property. canceletion of debt, contributions tom InckvOnat roparmon arrangement g)uq, end
genaraity. payments other than Interest and dividends, you are not requIrea to sign the certification, let you must provide your coact TIN. See the
instructions on page 3.
Sign
Hero
u.s.
949neene
pormont
otThT -•••
General Instructions
Section islorences em to We Minn Revenue Oxle urge*: Othenvhe noise.
FUtute devolopmenta. Infortnatten about developments Meeting Form W-9 (sash
as unbutton enacted arts we release it) b la www./ratoWF.S.
Purpose of Form
Ni neonatal Cr ray (Porn W-9 sane/Mx) wed btogned lo No an Insermetica
semi nth its IRS man °Otter, yore Wren taxpayer leent(“ben mambo( (11N)
with may to ycur metal seolty mantes ESN), inchnun taxpayer klentbcalbet
mrnbor pm, adoption lamer bendlIcetion amber (411.5. or employer
canDlIcaeon novbcv(LTM, to egad an en Inkartanan beim theamount pakt to
you. or ens amount mortal* on en bloananon Man Emonples d trionnalkm
enfant inekdo, bat cm not Writs. to, the follow*
• Font 1009-Itir trams swoop or paid)
• Fenn 10994W essidrinds. rataing those Iran, stab or mead Von
• awn 109%MISC envious types of income. Neon ands. el geese proceed.)
• Form 10994 (stock ce infAue fund sake cod conah Wit leamactione by
broers)
• For, 1079.3 hatoMeat ham real estate trantactIonr4
• Form 1099.K sent= Card had fled party network bansactiOnN
oaten ahilfilzio iT
• Font 1008 9weno ~ogle trammel 1090-beaten loan Merest/. Eft.
(wkion)
• Form 1099-C bancelea esker
• Form 1095,4(acquieironcesbuwkement of sawed property)
Use roan W41 off if you am a U.S. preen Ohtenalel a reakin° dm). le
fortroldeyow comxit
Prude not Arum Tom W-9 to Om marooneWOa TIN. sou malpht be object
as owns aithrooldirp. See Muir bra* nitheato? on pest 2.
By spring Me lilled-oul ben Yon
1. Cerny met the Ni you are Ohre la cowed for you era wake tie a orate
to be Su*
2. Cattythet you ere not nubby. to beans witbotinte
3. Clem themptIon from baba. p wahholdvo a you teea US. exempt pose. If
appacenie, yoa fl ew centri.) that os a U.S. pent.. your Seeable ewe of
any brand* beam from a U S, bade or bus rAtil b not sub;ect to Me
wlihhotlarg tax on footan partnere' Mare of elfeethefy corrected Isom NC
4. Corley Ink PM CA cockfll entered on Mb Win of any) Indicettre ter you We
exempt front the FATCA female, b correct See What is FATC4 neve& an
Rao 2 for tether Irecemr&st
Cal. S. 10231X
Soon W-9 (Rev. l2-20l.)
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0060143
SDNY GM_00206327
EFTA01368410
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