W'9
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Name (as shown on your incorne tax return). Name is required on this line; do not leave this line blank.
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US SPECIAL DELIVERY INC
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Busin€ss name/disregarded entity name, ifdifterent from above
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single-memb€r LLC
[Limiteotianilitycompany.Enterthetaxclassification(c=ccorporation,S=Scorporation,P=parlnership)>*
Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate bpx in the line above for
the tax classification of the single-m6mber owner.
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5
Otner lsee insfuctions) >
Address (number, street, and apt. or suite no.)
4
Exemptions {codes apdy only to
certain entities, not individuals; s€e
instructions on page 3):
Exempl payee code frf
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Exemption from FATCA reporting
code (if any)
(Applbs
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tuinEin€d ourside dF U.9.,
Requester's name and address (optional)
PO BOX 207
6
City, state, and ZIP code
IRON MOUNTAIN, MI 49801
7
Ust account numb€r(s) hero (optiona0
Taxoaver ldentification Number {Tllr
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 (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, $ee the Part I instructions on page 3. For off€r
entities, it is your employer identification number (ElN). lf you do not have a number, see How to get a
IIN on page 3.
Social s€curity number
NTI
Note, lf the account is in more than one name, se€ the instructions for line 1 and the chart on page 4 for
guidelines on whose number to enter.
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2.
I am not subject to backup withholding because: (a) I am exempt lrom backup withholding, or (b) lhave not been notified by the lntemal Revenue
Service (lBS) that I am subiect to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am
no longer subiect to backup withholding; and
3.
I am a U.S. citizen of other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is conect.
Certification instructions. You must cross out item 2 above if you have been notified by the lR$ that you are currently subject to backup withholding
because you have failed to r€port all interest and dividends on your tax return. For real estate trslsactions, item 2 does not apply. For mongage
int€rest paid, acquisition or abandonment of secured property, cancellation of debt, contributionp to an individual retirement arrangement (h{, and
generally, payments other than interest and dividends, you are not requked to sign the certification, but you must provide your conea TlN. See the
instructions on paqe
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3.
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Here
General lnstructions
Section references are to the lnternal Revenue Code unless otherwise noted.
Fufure developments. lnformation about dev€lopments atfecting Form W-9 (such
as legislation enacted after we r€lease it) is at www.ts.govlffi.
Purpose of Form
An individual or entity (Form W-9 requester) who is required to file an information
return with the IRS must obtain )lour eorrect taxpayer identification numb€r fflN)
which may be your social security number (SSN), individual taxpayer identification
number (lTlN), adoption taxpayer identification number (ATIN), or emptoyer
identification number (ElN), to report on an information re{um the amounl paid to
you, or other amount reportable on an information return. Exampl€s of information
returns include, but are not limited to, the following:
. Form 1099-lNT (interest earned or paid)
.
Form 109$DlV (dividends, including those from stocks or mutual funds)
. Form I og!'-MISC {various types of income, priz€s, awards, or gross proceeds)
. Form 1099-8 {stock or mutual fund sales and cert&in other transac-tions by
brokers)
.
Form 1099-S (proceeds from real estate transactions)
(merchant card and thirct party network transactions)
r Form 1099-K
Date >
/-o t-zot
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.
Form 1098 (home mortgage int€re6t), 1098-E (student loan interest), 1098-T
ftuition)
. Form 1099-C {canceld debt)
.
Form 1099-4 (acquisition or abandonment of secured propertyi
Use Form W-g only il you are a U.S. person (including a resident allen), to
provide your conect TlN.
ff you do not return Form W-g to the requester with a nN, you might be subiect
to backup withholding. S€e lyhat is bacrrup withhotding? an page 2.
By signing the filled-out form, you:
1. Certify that the TIN you are giving is conect (or you are waitang for a numb€r
to be issued),
2. Certify that you Bre not subject to backup withholding, or
3. Claim exemptiofl from backup withholding if you are a U.S, exempt payee. lf
applicable, you are also certifying that as a U.S. person, your allocable share of
any partnership incoine from a U.S. trade or business is not subjec.t to the
withholding tax on foleign partners' share of eftectively connected income, and
4. Certity that FATQA code(s) entered on this form (if any) indicaung that you are
exernpt from the FAIgA reporting, is coffect. See What is FATCA ,epoding? on
page 2 fror further infermation.