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Form W-9
(flev. November 2017)
Department a theTreastsy
:memo! Revenue Service
Request for Taxpayer
Identification Number and Certification
Iv Go to www.irs.goy/FormW9 for instructions and the latest Information.
Give Form to the
requester. Do not
send to the IRS.
Print or type.
See Specific Instructions on page 3.
1 Name (as shown on your Income tax return). Name is required on St ine; do not leave this line Wank
Butterfly Trust
2 Business namerdisregarded entity name. if dliferem from anent
3 Cheek swop*,
following seven bares.
box for federal tax dassincation of the person vmose name Is entered on awl. Check
proprietary
O C Corporation
Og Corporation
O Partner:110
LLC
company. Enter the lax deseScaticn (CC corporation, 5.5 corporation. P=Partnershio)
appropriate box in the as above for the tax classification of the tingle-monlOn, (mom
S ohs:lead as a ertaiihmornber LLC that is disregarded horn the owner unless the owner
Is not disregarded horn disown./ for U.B. federal tax purposes. Otherwise. a single
from the Owner sh0010 theft the ePlweltftete box tee the tee eleeeteeehen of 0 owns.
iv
Only One of the
0
Trust/estate
lb
4 Exemptions
certain entities,
instructions
Exempt payee
Exemption
code la any)
I4s.' me amextts
(codes apt* only to
not individuals; see
on page 3l:
code y any)
•
Indeekkitiliede
single-member
0
Limited Lability
Note: Check the
U.0 a the LLC
another LLC that
Is deregarded
O Other (see instructions)
from FATCA repefeng
Do not check
of the LLC is
.member LLC that
nwam ameene US)
5 Addresses's/tier. street, aid ba a at "al it twat&
6100 Red Hook Quarter, B3
requester's name and Andrea (Attune
5 City, etre, end DP code
St. Thomas, U.S.V.I. 00802
7 List account menter(s) here (00nOnalt
Part I
Taxpayer Identification Number (TIN)
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 (SSW). 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 ger a
77N, later.
or
Note: If the account is in more than one name, see the Instructions for line 1. Also see What Name and
Employer Identification number
Number To Ghre the Requester for guidelines on whose number to enter.
Social security number
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 wafting for a number to be issued to me); and
2.1am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internet 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; end
3. I am a U.S. citizen or other U.S. person (defined below): and
4. The FATCA code(s) entered on this form Of 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 said.
acquisition or abandonment of secured prepay, cancellation of debt, contributions to an individual retirement arrangement PRA). and generally, payments
other than Interest and dividends,
are not required to sign the certification, but you must provide your correct TN. See the instructions fa Part II, later.
Sign
Here
Sienese' of
U.B. person la
I
General Instruction
Section references ere to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www.es.gov/FomtW9.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer
ftleMificatIon number (TIN) which may be your social security number
(SSN), individual taxpayer identification number (ITIN), adoption
taxpayer identification number (ATIN), or employer identification number
(EIN), to report on an information return the amount paid to you, or other
amount reportable on an information return. Examples of information
returns include, but are not landed to, the foliowIng.
• Form 1099-INT (interest earned or paid)
Dow, iobizo
• Form 1099-DIV (dividends, including those from stocks or mutual
funds)
• Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
• Form 1099-8 (stock or mutual fund sales and certain other
transactions by brokers)
• Form 1099-S (proceeds from real estate transactions)
• Form 1009-K (merchant card and third party network transactions)
• Form 1098 fttome mortgage interest), 1098-E (student loan interest),
10984 (tuition)
• Form 1099-C (canceled debt)
• Form 1099-A (acquisition or abandonment of secured property)
Use Form W-9 only it you are a U.S. person (including a resident
alien), to provide your correct TIN.
If you do not return Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
Jai r.
Cal. No. 10231%
Form W-9 (Rev. 114017)
CONFIDENTIAL - PURSUANT TO FED. R. CRIM. P. 6(e)
CONFIDENTIAL
DB-SDNY-0076210
SDNY GM_00222394
EFTA01378929