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PAYER'S NAME: [PAYING AGENT]
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SUBSTITUTE PART I--PLEASE PROVIDE YOUR TIN IN THE BOX AT RIGHT
AND CERTIFY BY SIGNING AND DATING BELOW.
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FORM W-9 Social Security Number
DEPARTMENT OF THE TREASURY
INTERNAL REVENUE SERVICE OR
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Employer Identification
Number
(If awaiting TIN write
"Applied For")
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PAYER'S REQUEST FOR TAXPAYER PART II-- For Payees Exempt from Backup Withholding, see the enclosed
IDENTIFICATION NUMBER (TIN) Guidelines and complete as instructed therein.
AND CERTIFICATION FOR PAYEE
EXEMPT FROM BACKUP CERTIFICATION -- Under penalties of perjury, I certify that:
WITHHOLDING (1) The number shown on this form is my correct Taxpayer Identification
Number (or a Taxpayer Identification Number has not been issued to me and
either (a) I have mailed or delivered an application to receive a
Taxpayer Identification Number to the appropriate Internal Revenue Service
("IRS") or Social Security Administration office or (b) I intend to mail
or deliver an application in the near future. I understand that if I do
not provide a Taxpayer Identification Number within sixty (60) days, 31%
of all reportable payments made to me thereafter will be withheld until
I provide a number), and
(2) I am not subject to backup withholding because (a) I am exempt from backup
withholding, (b) I have not been notified by the IRS that I am subject to
backup withholding as a result of failure to report all interest or
dividends or (c) the IRS has notified me that I am no longer subject to
backup withholding.
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Certificate Instructions -- You must cross out item (2) above if you have been
notified by the IRS that you are subject to backup withholding because of
underreporting interest or dividends on your tax return. However, if after being
notified by the IRS that you were subject to backup withholding you received
another notification from the IRS that you are no longer subject to backup
withholding, do not cross out item (2). (Also see instructions in the enclosed
Guidelines.)
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Signature: Date:
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Name:
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Address:
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NOTE: FAILURE TO COMPLETE AND RETURN THIS FORM MAY RESULT IN BACKUP WITHHOLDING OF 31% OF ANY PAYMENTS MADE
TO YOU PURSUANT TO THE MERGER. PLEASE REVIEW THE ENCLOSED GUIDELINES FOR CERTIFICATION OF TAXPAYER
IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS.
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