EXHIBIT 99.12
PAYER'S NAME: CITIBANK, N.A.
NAME
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ADDRESS
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PART 1 - PLEASE PROVIDE YOUR TIN TIN
SUBSTITUTE IN THE BOX AT RIGHT AND CERTIFY BY -------------------------------
SIGNING AND DATING BELOW. (Social Security Number or
Employer Identification Number)
FORM W-9
PART 2 -- FOR PAYEES EXEMPT FROM BACKUP WITHHOLDING PLEASE WRITE
"EXEMPT" HERE
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DEPARTMENT OF PART 3 -- CERTIFICATION -- UNDER PENALTIES OF PERJURY, I CERTIFY THAT
THE TREASURY (1) The number shown on this form is my correct taxpayer identification
INTERNAL number (or I am waiting for a number to be issued to me), and (2) I am
REVENUE SERVICE not subject to backup withholding because: (a) I am exempt from backup
withholding, (b) I have not been notified by the Internal Revenue
Service (the "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.
XXXXX'S REQUEST FOR
TAXPAYER IDENTIFICATION THE INTERNAL REVENUE SERVICE DOES NOT REQUIRE YOUR CONSENT TO ANY
NUMBER ("TIN") PROVISION OF THIS DOCUMENT OTHER THAN THE CERTIFICATIONS REQUIRED TO
AVOID BACKUP WITHHOLDING.
SIGNATURE: DATE: , 2002
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You must cross out item (2) of Part 3 above if you have been notified by
the IRS that you are currently subject to backup withholding because of
underreporting interest or dividends on your tax return.
YOU MUST COMPLETE THE FOLLOWING CERTIFICATE
IF YOU WROTE "APPLIED FOR" IN PART 1 OF THE SUBSTITUTE FORM W-9.
CERTIFICATION OF AWAITING TAXPAYER IDENTIFICATION NUMBER
I CERTIFY UNDER PENALTIES OF PERJURY THAT A TAXPAYER IDENTIFICATION NUMBER HAS
NOT BEEN ISSUED TO ME, AND EITHER (1) I HAVE MAILED OR DELIVERED AN APPLICATION
TO RECEIVE A TAXPAYER IDENTIFICATION NUMBER TO THE APPROPRIATE INTERNAL REVENUE
SERVICE CENTER OR SOCIAL SECURITY ADMINISTRATION OFFICE, OR (2) 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 DAYS, THE PAYOR IS
REQUIRED TO WITHHOLD ON ALL CASH PAYMENTS MADE TO ME THEREAFTER UNTIL I PROVIDE
A NUMBER.
Signature: Date:
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NOTE: FAILURE TO COMPLETE AND RETURN THIS FORM W-9 MAY RESULT IN BACKUP
WITHHOLDING ON ANY CASH PAYMENTS.
