EX-99.5 11 a2162367zex-99_5.htm EXHIBIT 99.5
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Exhibit 99.5


GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION
NUMBER ON SUBSTITUTE FORM W-9

        Guidelines for Determining the Proper Taxpayer Identification Number to Give the Payor—Social Security Numbers have nine digits separated by two hyphens (i.e., 000-00-0000). Employer Identification Numbers have nine digits separated by only one hyphen (i.e., 00-0000000). The table below will help determine the type of number to give the payor.


For this type of account:

 
Give the
SOCIAL SECURITY
NUMBER of—


1.   An individual's account   The individual

2.

 

Two or more individuals (joint account)

 

The actual owner of the account or, if combined funds, the first individual on the account(1)

3.

 

Husband and wife (joint account)

 

The actual owner of the account or, if joint funds, the first individual on the account(l)

4.

 

Custodian account of a minor (Uniform Gift to Minors Act)

 

The minor(2)

5.

 

Adult and minor (joint account)

 

The adult or, if the minor is the only contributor, the minor(l)

6.

 

Account in the name of guardian or committee for a designated ward, minor, or incompetent person

 

The ward, minor or incompetent person(3)

7.

 

a.  The usual revocable savings trust account (grantor is also trustee)

 

The grantor-trustee(1)

 

 

b.  So-called trust account that is not a legal or valid trust under State law

 

The actual owner(1)

8.

 

Sole proprietorship account

 

The owner(4)

For this type of account:

  Give the EMPLOYER
IDENTIFICATION
NUMBER of—


9.   A valid trust, estate or pension trust   The legal entity (Do not furnish the identifying number of the personal representative or trustee unless the legal entity itself is not designated in the account title)(5)

10.

 

Corporate account

 

The corporation

11.

 

Religious, charitable, or educational organization account

 

The organization

12.

 

Partnership account held in the name of the business

 

The partnership

13.

 

Association, club, or other tax-exempt organization

 

The organization

14.

 

A broker or registered nominee

 

The broker or nominee

15.

 

Account with the Department of Agriculture in the name of a public entity (such as a State or local government, school district, or prison) that receives agricultural program payments

 

The public entity


(1)
List first and circle the name of the person whose social security number you furnish.
(2)
Circle the minor's name and furnish the minor's social security number.
(3)
Circle the ward's, minor's or incompetent person's name and furnish such person's social security number.
(4)
You must show owner's individual name, but you may also enter owner's business or "doing business" name. You may use either owner's Social Security Number or Employer Identification Number.
(5)
List first and circle the name of the valid trust, estate, or pension trust.

Note: If no name is circled when there is more than one name, the number will be considered to be that of the first name listed.



GUIDELINES FOR CERTIFICATION OF TAXPAYER IDENTIFICATION
NUMBER ON SUBSTITUTE FORM W-9

Page 2

Obtaining a Number

If you don't have a taxpayer identification number or you don't know your number, obtain Form SS-5, Application for a Social Security Number Card, or Form SS-4, Application for Employer Identification Number, at the local office of the Social Security Administration or the Internal Revenue Service and apply for a number.

Payees Exempt from Backup Withholding

Payees specifically exempted from backup withholding on ALL payments include the following:

A corporation.

A financial institution.

An organization exempt from tax under section 501(a) of the Internal Revenue Code, or an individual retirement plan.

The United States or any agency or instrumentality thereof.

A State, the District of Columbia, a possession of the United States, or any subdivision or instrumentality thereof.

A foreign government, a political subdivision of a foreign government, or any agency or instrumentality thereof.

An international organization or any agency, or instrumentality thereof.

A registered dealer in securities or commodities registered in the United States or a possession of the United States.

A real estate investment trust.

A common trust fund operated by a bank under section 584(a) of the Internal Revenue Code.

An exempt charitable remainder trust, or a non-exempt trust described in section 4947(a)(1) of the Internal Revenue Code.

An entity registered at all times under the Investment Company Act of 1940.

A foreign central bank of issue.

Payments of dividends and patronage dividends not generally subject to backup withholding include the following:

Payments to nonresident aliens subject to withholding under section 1441 of the Internal Revenue Code.

Payments to partnerships not engaged in a trade or business in the United States and which have at least one nonresident partner.

Payments of patronage dividends where the amount received is not paid in money.

Payments made by certain foreign organizations.

Payments made to a nominee.

Payments of interest not generally subject to backup withholding include the following:

Payments of interest on obligations issued by individuals.

Note: You may be subject to backup withholding if this interest is $600 or more and is paid in the course of the payer's trade or business and you have not provided your correct taxpayer identification number to the payor.

Payments of tax-exempt interest (including exempt-interest dividends under section 852 of the Internal Revenue Code).

Payments described in section 6049(b)(5) of the Internal Revenue Code to non-resident aliens.

Payments on tax-free covenant bonds under section 1451 of the Internal Revenue Code.

Payments made by certain foreign organizations.

Payments made to a nominee.

Exempt payees described above should file Form W-9 to avoid possible erroneous backup withholding. FILE THIS FORM WITH THE PAYOR, FURNISH YOUR TAXPAYER IDENTIFICATION NUMBER, WRITE "EXEMPT" ON THE FACE OF THE FORM, AND RETURN IT TO THE PAYOR. IF THE PAYMENTS ARE INTEREST, DIVIDENDS, OR PATRONAGE DIVIDENDS, ALSO SIGN AND DATE THE FORM.

Certain payments other than interest, dividends, and patronage dividends, that are not subject to information reporting are also not subject to backup withholding. For details, see the regulations under sections 6041, 6041A(a), 6045, and 6050A of the Internal Revenue Code.

Privacy Act Notice

Section 6109 of the Internal Revenue Code requires most recipients of dividends, interest, or other payments to give taxpayer identification numbers to payors who must report the payments to The Internal Revenue Service (the "IRS"). The IRS uses the numbers for identification purposes. Payors must be given the numbers whether or not recipients are required to file tax returns. Payors must generally withhold 28% of taxable interest, dividends, and certain other payments to a payee who does not furnish a taxpayer identification number to a payor. Certain penalties may also apply.

Penalties

(1) Penalty for Failure to Furnish Taxpayer Identification Number.—If you fail to furnish your taxpayer identification number to a payor, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.

(2) Civil Penalty for False Information With Respect to Withholding.—If you make a false statement with no reasonable basis which results in no imposition of backup withholding, you will be subject to a penalty of $500.

(3) Criminal Penalty for Falsifying Information.—Falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.

FOR ADDITIONAL INFORMATION CONTACT YOUR TAX
CONSULTANT OR THE INTERNAL REVENUE SERVICE.




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