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efta-01450290DOJ Data Set 10Other

EFTA01450290

Date
Unknown
Source
DOJ Data Set 10
Reference
efta-01450290
Pages
1
Persons
0
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EFTA Disclosure
Text extracted via OCR from the original document. May contain errors from the scanning process.
IV. TAX ELECTION/DECLARATION OF TAX STATUS This Account Agreement is designed for use by both U.S. Persons and Non'U.S. Persons. Please check the box next to the applicable item below. Client certifies that Client will notify DBSI in writing Immediately if the representation certified to below ceases to be true and correct. 4;0 U.S. Citizen or U.S. Resident Allen Fenn W9 Request for Taxpayer Identification Number and Certification Substitute a F i n Name (as shown on your income lax return)/ 'le (64•0:;yintiv eni Cie rra t‘ent Itusiness ne tole above raPPOPtiets borbrletlerel fax daasifaatWn (reeltdred); I Exempt payee ❑Individual/sole proprietor Ill C Corporation K S Corporation 0 PannereNp 0 Trust/estate Llmked liability company. Enter the tax classification (C.0 corporation, S.S corporation, P.partnership) Other 1 Addrela *Mbar, CMOS antdralfteilltrIte n0.) loc, pen *4 gelyKrier -33 aty P .'Sbliptilltd23 COM. -) r 7- korms ti5 V -I , Li Taxpayer den (cation Number (TIN) riterietiatiN 'nibs apPropitate Mi.*. The TIN provided must match the name given on the "Name line to avoid backup withholding. For individuals, this Is your social security number ISSN). For other entities. It Is your employer Identification number (EINI. t 11 Em identification Number Ix -MO I DO 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 lb/they° 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 lc/Wined in the instructions). - Certification Instructions. You pest cross out Item above if you have been 11K1 by the IRS that you ere currently subject to backup withholding erincit because you have failed to wort as all Interest and dry ands on your tax r p . Sign Here Signature of. IJA PIMA; 20 Non•U.S. Person I am not s U.S. person (including a U.S. resident alien). I am submitting the applicable Form WS with this form to eerily my foreign status and, if applicable, claim tax treaty benefits. For example: Client is note U.S. person (including a U.S. resident alien). Client agrees to provide DBSI with this application the applicable Internal Revenue Service ORS) Fare WA to certify the client's foreign status. WE forms and instructions are available on the IRS website at wvny.irspov. L>atsft..'t 9/05 (THIS SPACE INTENTIONALLY LEFT BLANK) 12.PWW.-0573 6 012145 011113 CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e) DEkSDNIY-0105842 CONFIDENTIAL SONY GM_00252026 EFTA01450290

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SWIFT/BICDECLARATION
SWIFT/BICELECTION

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