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Form W-9

(Rev. November 2017)

Department of the Treasury InternalRevenue Service

Request for Taxpayer Identification Number and Certification

.,. Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the requester. Do not send to the IRS.


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1 Name (as shown on your income tax return). Name is required on this line; do not leavethis line blank.

Northwestern Indiana Reaional Plannina Commisson

2 Business name/disregarded entity name, 11 d i fferent frorp above

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes .

D Individual/sole proprietor or D C Corporation D S Corporation D Partnership D Trust/estate single-member LLC

D Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

0 Other (see instructions) Gov't Aaencv

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):


Exempt payee code (if any)


Exemption from FATCA reporting code (if any)


(Applies lo accounls mainlained outside the U.S.)

5 Address (number, street, and apt. or suite no.)S'ee in structions.

6100 Southport Rd

Requester's name and address (optional)

6 City, state, and ZIP code

PortaQe, IN 46368

7 List account number(s) 1ere (optional)

•• Taxpayer Jdentification Number (TIN)

Form W-9

(Rev. November 2017)

Department of the Treasury InternalRevenue Service

Request for Taxpayer Identification Number and Certification

.,. Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the requester. Do not send to the IRS.


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1 Name (as shown on your income tax return). Name is required on this line; do not leavethis line blank.

Northwestern Indiana Reaional Plannina Commisson

2 Business name/disregarded entity name, 11 d i fferent frorp above

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven boxes .

D Individual/sole proprietor or D C Corporation D S Corporation D Partnership D Trust/estate single-member LLC

D Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that is disregarded from the owner should check the appropriate box for the tax classification of its owner.

0 Other (see instructions) Gov't Aaencv

4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3):


Exempt payee code (if any)


Exemption from FATCA reporting code (if any)


(Applies lo accounls mainlained outside the U.S.)

5 Address (number, street, and apt. or suite no.)S'ee in structions.

6100 Southport Rd

Requester's name and address (optional)

6 City, state, and ZIP code

PortaQe, IN 46368

7 List account number(s) 1ere (optional)

•• Taxpayer Jdentification Number (TIN)

Enter your TIN in_ the appropri . ate box. :.he TIN provided must.match t e name given on Jlne 1 to avoid I Social security number I


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backup withholding. For Individuals, this 1s generally your social security number (SSN). How ever, 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 get a TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Give the Requester for guidelines on whose number to enter.

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Employer identification number

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35-1182844

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Certification

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 from backup withholding, or (b) I have not been notified by the Internal 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; and

  3. I am a U.S. citizen or 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 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 paid, acquisition or abandonment of secured property, cancellatlon of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

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Sign

Here ...

General Instructions

Section references are to the Internal Revenue Code unless otheiwise 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.irs.gov/FormW9.

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 identification 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 limited to, the following.

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TlN.

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, later.


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Cat. No. 10231X Form W-9 (Rev. 11-2017)