Cash Account Client
CLIENT1S COpy · KEEP FOR YOUR RECORDS
Cash Account
Client Agreement
Please read carefully, sign and return
To Shearson Lehman Brothers Inc.
Client Documentation Services
388 Greenwich Street. 24th Floor
New York. NY 10013-2396
In consideration of Shearson Lehman Brothers Inc ("Shearson") accepting my account and
agreeing to act as my broker, I agree to the following. This agreement shall not become effective
until accepted by you in your New York office Acceptance may be evidenced by internal records
maintained by you. Throughout this agreement, "I," "me," "my," "we," and "us" refer to the client
and all others who are legally obligated on my account "You" and "your" refer to Shearson, its
subsidiaries and parents and any and all divisions or other entities, their officers, directors,
agents and/or employees.
1. MY REPRESENTATIONS. I represent that I am of the age of majority according to the laws of
my place of residence. I further represent that I am not an employee of any exchange or of a
member firm of any exchange or of a member of the National Association of Securities Dealers,
Inc. ("NASD"), or of a bank, trust company, or insurance company unless I have notified you to
that effect. If I become so employed, I agree to notify you promptly. I also represent that no persons
other than those signing this agreement have an interest in my account.
2. DEFINITION OF "PROPERTY". The word "property" is used herein to mean securities of all
kinds, monies, contracts and all other property usually and customarily dealt in by brokerage
firms.
3. ORDERS, EXECUTIONS, DELIVERIES, SETTLEMENTS AND ORAL AUTHORIZATIONS. I
agree that, in giving orders to sell, I own the securities, and thatall sales orders will be designated
as "long". The designation on a sale order as "long" is a representation on my part that I own the
security, and if the security is not in your possession at the time of the contract for sale, I agree
to deliver the security to you by settlement date, In case of non-delivery of a security, you are
authorized to purchase the security to cover my position and charge any loss, commissions and
fees to my account. I agree that if you fail to receive payment for securities purchased you may,
without prior demand or notice, sell securities or other property held by you in any of my accounts
and any loss resulting therefrom will be charged to my account. By accepting my limit order for
transactions in securities in the NASDAQ Clr over-the-counter market, you undertake to monitor
the interdealer market and to seek to execute my order only if the inside bid (in the case of a limit
order to sell, the highest price at which a dealer is being quoted as willing to buy securities) or
the inside asked (in the case of a limit order to buy, the lowest price at which a dealer is being
quoted as willing to sell securities) reaches my limit price You reserve the right, while my limit
order remains unexecuted, to trade for your own market-maker account at prices equal to or better
than my limit order price and not to execute my order against incoming orders from other
customers. For example, if the inside market is 10 bid, 10 '/. asked and I place a limit order to
sell securities at 10 '/, , you will seek to execute my order only if the inside bid reaches my limit
price of 10 '/a (exclusive of any markdown or commission equivalent that you may charge in
connection with the transaction) and, while my order remains unexecuted, you may continue to
sell securities for your market-maker account at prices at or above 10 'Is Unless I have directed
that the order be executed on a specified exchange or market and you have agreed to such
execution, you will, at your sole discretion and without prior notification to me, execute any order
to purchase or sell securities on the over-the-counter market in any location or on any exchange,
including a foreign exchange where such security is traded, either on a principal or agency basis.
I agree that you shall incur no liability In acting upon oral instructions given to you concerning
my account
4. IMPARTIAL LOTTERY ALLOCATION SYSTEM. When you holG on my behalf bonds or pre-
ferred stocks in street or bearer form which are callable in part, I agree to participate in the
impartial lottery allocation system of the called securities in accordance with the provisions of
the New York Stock Exchange, Inc. ("NYSE") rules. Further, I understand when the call is
favorable, no allocation will be made to any account in which you, your officers, or employees,
have a financial interest until all other clients' positions in such securities are satisfied on an
impartial lottery basis.
5. RESTRICTIONS ON TRADING. I understand that you may in your sole discretion prohibit or
restrict trading of securities in my account.
6. TERMINATION. You have the right to terminate any of my accounts (including multiple owner
accounts) at any time by notice to me.
7. TRANSFER OF FUNDS BY WIRE. By giving you instructions to transfer funds bywire from my
accounts to any bank or other entity, I agree to provide you with an accurate account number
designating the account to receive such funds. I acknowledge that the bank or other receiving
entity may be under no obligation to verify the identity of the beneficiary of the funds transfer and
may rely exclusively upon the account number provided by me. I agree to indemnify and hold
you harmless from and against all liabilities arising from the provision by me of an inaccurate
account number.
8. EXCHANGE RATE FLUCTUATIONS. If any transactions are effected on an exchange in which
a foreign currency is used, any profit or loss as a result of a fluctuation in the exchange rate will
be charged or credited to my account.
g, TEMPORARY INVESTMENT OF FREE CREDIT BALANCES; BOND PRINCIPAL AND INTER-
EST PAYMENTS. I authorize, but do not require, you to automatically invest on a periodic basis
the free credit balances in my accounts, Including interest and dividends paid to me, in mutually
selected money market funds or, in the absence of such selection, in money market funds of your
designation You are not required to remit interest or dividends to me on a daily basis. With
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NOTICE: This agreement is for cash account
transactions only. Margin, options or commodities
transactions require execution of additional agreements.
SHFARSON
LEHMAN
BRarHERS
ri;i
respect to bond principal and interest payments, you may credit my account with principal and
interest due on the payment dates and are entitled to recover any such payments from me if the
same are not actually received by you from the trustee or paying agent. With respect to debits
arising from bond principal and interest payments or any other debits, you may redeem my
money market fund shares, without notice, to the extent necessary to satisfy any debits arising
in any of my accounts. I acknowledge that interest will not be paid to me on credit balances in
any of my accounts unless specifically agreed to by you in writing.
10. FEES AND CHARGES. I understand that you may impose various service charges and other
fees relating to my account as well as charge commiSSions and other fees for execution of
transactions and I agree to pay such charges, commissions and fees at your then prevailing rates.
I also understand that such charges, commissions and fees may be changed from time to time
without notice to me and I agree to be bound thereby. I may be subject to an administrative fee
on my accounts which produce insufficient commission revenue for any calendar year and you
will notify me prior to applying this fee. I agree to pay a late charge, to the extent permitted by law,
if I purchase securities or other property in my account and fail to pay for such securities or other
property by settlement date. Any late charge you may impose will be at the maximum rate of
interest set forth in your disclosure statement and may be charged from the settlement date to
the date of payment
11. ACCURACY OF REPORTS; COMMUNICATIONS. Confirmation of orders and statements of
my accounts shall be conclusive if not objected to in writing within ten days after mailing by you
to me. In the event I fail to receive a confirmation within ten days from the date of a transaction
in my account, I agree to notify you immediately in writing Communications mailed to me at
the address specified by me shall, until you have received notice in writing from me of a different
address, be deemed to have been personally delivered to me and I agree to waive all claims
resulting from failure to receive such communications,
12. INTRODUCED ACCOUNTS. If my account has been introduced to you and is carried by you
only as a clearing broker, I agree that you are not responsible for the conduct of the introducing
broker and your only responsibilities to me relate to the execution, clearing and bookkeeping of
transactions in my accounts.
13. SECURITY INTEREST. As security for the payment of all liabilities or indebtedness presently
outstanding or to be incurred under this or any other agreement between us, and for all liabilities
or indebtedness I may have to you now or in the future, I grant you a security interest in any and
all property belonging to me or in which I may have an interest, held by you or carried in any of
my accounts including individual or multiple owner accounts. All property shall be subject to
such security interest as collateral for the discharge of my obligations to you, wherever or
however arising. You are hereby authorized to sell and/or purchase any and all property in any
of my accounts without notice in order to satisfy such obligations In enforcin(}-Ybur security
interest, you shall have the discretion to determine which property is to be sold and the order in
which it is to be sold and shall haveall the rights and remedies availableto a secured party under
the New York Uniform Commercial Code. Without your prior written consent, I will not cause or
allow any of the property held in my account, whether now owned or hereafter acquired, to be or
become subject to any liens, security interests, mortgages or encumbrances of any nature other
than your security interest.
14. LIQUIDATION OF ACCOUNT. You may sell any or all property held in any of my accounts
and cancel any open orders for the purchase or sale of any property without notice in the event
of my death or whenever in your discretion you consider it necessary for your protection. In such
events you also may borrow or buy-in all property required to make delivery against any sale
effected for me. Such sale or purchase may be publiC or private and may be made without
advertising or notice to me and in such manner as you may in your discretion determine, No
demands, calls, tenders or notices which you may make or give in anyone or more instances
shall invalidate the foregoing waiver on my part. Atany such sale you may purchase the property
free of any right of redemption and I shall be liable for any deficiency in my accounts.
15. LOAN RESTRICTIONS. With respect to this account, I agree that I will not engage in any
transaction requiring the extension of a "margin loan" including the short sale of securities
(securities which I do not own) nor will I engage in option transactions, unless I execute and agree
to the terms of your standard Client Agreementapplicable to margin and option transactions. In
addition, I agree that I will not engage in any transaction involving the purChase or sale of
commOdities unless I execute and agree to the terms of your standard Commodity Client Agree-
ment. If I engage in any margin, option or commodity transactions prior to my actual execufion
of your standard Client Agreement or Commodity Client Agreement, as applicable, by sllch
action I represent that I have agreed to all of the terms and conditions contained in said standara
Client Agreement or Commodity Client Agreement, which by this reference are hereby specifi-
cally incorporated into this agreement.
16. CREDIT AND BUSINESS CONDUCT INFORMATION AND INVESTIGATION. I authorize you
at your discretion to obtain reports and to provide information to others concerning my credit
standing and my business conduct. You may ask credit reporting agencies for consumer reports
of my credit history, Upon my request you will inform me whefher you have obtained any such
consumer reports and if you have, you will inform me of the name and address of the consumer
reporting agency that furnished the reports to you,
'HE REVERSE SIDE OF THIS AGREEMUH MUST Bf SIGfllD Bi ALL ACCOllW OWNERS
CLIENT'S COpy. KEEP FOR YOUR RECORDS
17. JOINT ACCOUNTS
a. If this is a Joint Account, we agree that each of us shall have the authority on behalf of the
account to buy, sell and otherwise deal in, through you as brokers, securities or other property;
to receive for the account, confirmations, statements and communications of every kind; to
receive for the account and to dispose of money, securities and other property; to make, termi-
nate, or modify for the account, agreements relating to these matters or waive any of the provi-
sions of such agreements; and generally to deal with you as if each of us alone were the account
owner, all without notice to the other account owners. We agree that notice to any account owner
shall be deemed to be notice to all account owners. Each account owner shall be jointly and
severally liable for this account
b. You may follow the instructions of any of us concerning this account and make deliveries to
any of us, of any or all securities or other property in this account, and make payments to any
of us, of anyor all monies in thisaccountas any of us may order and direct, even ifsuch deliveries
and/or payments shall be made to one of us personally or to third parties. You shall be under no
obligation to i,lquire into the purpose of any such demand for delivery of securities, property, or
payment of monies, and you shall not be bound to seeto the application or disposition of the said
securities, property and/or monies so delivered or paid to any of us. Notwithstandingtheforegoing,
you are authorized, in your discretion, to require joint action by the joint tenants with respect to
any matter concerning the joint account, including the giving or cancellation of orders and the
withdrawal of monies, securities or other property.
c In the event of the death of any of us, the survivor(s) shall immediately give you written notice
thereof, and you may, before or after receiving such notice, take such proceedings, require such
documents, retain such portion of the account and/or restrict transactions in the account as you
may deem advisable to protect you against any tax, liability, penalty or loss under any present
or future laws or otherwise The estate of any of us who shall have died shall be liable and each
survivor will be liable, jointly and severally, to you for any debt or loss in this account resulting
from the completion of transactions initiated priorto your receipt of a written notice of such death
or incurred in the liquidation of the account or the adjustment of the interests of the respective
parties.
d. Any taxes or other expenses becoming a lien against or being payable out of the account as
the result of the death of any of us, or through the exercise by his or her estate or representatives
of any rights in the account shall be chargeable against the interest of the survivor(s) as well as
against the interest of the estate of the decedent This provision shall not release the decedent's
estate from any liability provided for in this agreement
e. DESIGNATION OF TENANCY (This paragraph "17(e)" is not applicable in the State of Texas,
where form no. 3882 "Texas Joint Account Supplement. . "must be executed and returned with
this agreement to you) You may presume that it is the express intention of us to create an estate
or account as joint tenants with rights of survivorship and not as tenants-in-common, unless
otherwise provided by striking this paragraph and executing a separate TenanCY-in-Common
form and returning it to you. In the event of the death of either or any of us, the entire interest in
the joint account shall be vested in the survivor(s) on the same terms and conditions as theretofore
held, without in any manner releasing the decedent's estate from the liability.
18. GOVERNING LAW AND APPLICABLE REGULATIONS This agreement, including the arbi-
tration provisions contained herein, shall be governed by the laws of the State of New York
without giving effect to the choice of law or conflict of laws provisions thereof All transactions
for my accounts shall be subject to the regulations of all applicable federal, state and self-
regulatory agencies including but not limited to the Securities and Exchange Commission, the
various securities and commodity exchanges, the Municipal Securities Rulemaking Board, the
NASD, the Board of Governors of the Federal Reserve System and the constitution, rules and
customs of the exchange or market (and its clearing house, If any) where executed Actual
deliveries are intended on all transactions.
19. BINDING EFFECT. This agreement and its terms shall be binding upon my heirs, executors,
successors, administrators, assigns, committee and/or conservators ("successors"). In theevent
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of my death, incompetency, or disabil ity, whether or not any successors of my estate and property
shall have qualified or been appointed, you may continue to operate as though I were alive and
competent and you may liquidate my account as described in Paragraph 14 above without prior
notice to or demand upon my successors. This agreement shall inure to the benefit of your
assigns and successors, by merger, consolidation or otherwise (and you may transfer my
accounts to any such successors and assigns at your discretion).
20. WAIVER NOT IMPLIED. Your failure to insist at any time upon strict compliance with this
agreement or with any of its terms or any continued course of such conduct on your part shall
not constitute or be considered a waiver by you of any of your rights.
21 SEVERABILITY. If any provision of this agreement is or becomes inconsistent with any
applicable present or future law, rule or regulation, that provision will be deemed rescinded or
modified in order to comply with the relevant law, rule or regulation. All other provisions of this
agreement will continue and remain in full force and effect
22. NO ORAL MODIFICATION; AFFECT ON PRIOR AGREEMENTS. No modification of this
agreement shall be effective unless in writing and executed by you and me except as stated in
paragraph 15 above. This agreement is not subject to any oral modification. To the extent this
agreement is inconsistent with any other agreement governing cash transactions in this account,
the provisions of this agreement shall govern.
23. ARBITRATION.
. ARBITRATION IS FINAL AND BINDING ON THE PARTIES.
. THE PARTIES ARE WAIVING THEIR RIGHT TO SEEK REMEDIES IN COURT,
INCLUDING THE RIGHT TO A JURY TRIAL.
. PRE-ARBITRATION DISCOVERY IS GENERALLY MORE LIMITED THAN AND
DIFFERENT FROM COURT PROCEEDINGS.
.THEARBITRATORS' AWARD IS NOTREQUIRED TO INCLUDE FACTUAL FINDINGS
OR LEGAL REASONING AND ANY PARTY'S RIGHT TO APPEAL OR TO SEEK
MODIFICATION OF RULINGS BY THE ARBITRATORS IS STRICTLY LIMITED.
. THE PANEL OF ARBITRATORS WILL TYPICALLY INCLUDE A MINORITY OF
ARBITRATORS WHO WERE OR ARE AFFILIATED WITH THE SECURITIES
INDUSTRY.
Any controversy: (1) arising out of or relating to any of my accounts maintained
individually or jointly with any other party, in any capacity, with you; or (2) relating
to my transactions or accounts with any of your predecessor firms by merger,
acquisition or other business combination from the inception of such accounts; or
(3) with respect to transactions of any kind executed by, through or with you, your
officers, directors, agents and/or employees; or(4) with respecttothis agreement
or any other agreements entered into with you relating to my accounts, or the
breach thereof, shall be resolved by arbitration conducted only at the NYSE,
NASD, or AMEX or any self-regulatory organization ("SRO") subject to the
jurisdiction of the Securities and Exchange Commission and 8ursuant to the
arbitration procedures then in effect of any such exchange or SR as I may elect.
If I do not make such election by registered mail addressed to you at your main
office within 5 days after demand by you that I make such election, then you will
have the right to elect the arbitration tribunal of your choice. Judgment upon any
award rendered by the arbitrators may be entered in any court having jurisdiction
thereof.
Tax Certification: Under penalties of perjury, I certify that the number shown below on this form is my correct taxpayer identification number or if not, then the number I
have entered below per instructions is my correct taxpayer identification number, and that I am not subject to backup withholding because: (a) 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 (b) the IRS has notified me that
I am no longer subject to backup withholding (see below), or (c) I am exempt from backup withholding (see below). Note: You must cross out (b) above if you are currently
subject to backup withholding because of underreporting interest or dividends on your tax return. For Those Exempt From BaCkup Withholding (see instructions), write
the word "Exempf' here:
NOTICE Any person, whether married, unmarried or separated, may apply for a separate account.
NOTICE By signing this agreement, I acknowledge receipt of a copy of this agreement
CAUTION TO CLIENT:
IT IS IMPORTANT THAT YOU THOROUGHLY READ THIS AGREEMENT BEFORE YOU SIGN IT.
NOTICE: This agreement contains a pre-dispute arbitration clause, which is located on this page at paragraph 23.
Client's
Signature X
Other Clients' X
Signatures
(ALL account
owners must X
sign this
agreement) X
Date
Date
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Date
Date
~ This Client's social security or tax lIlo.
,. Identification number on SLB's records IS. ,.
~ The sociaf security number of this account is the number of the client whose
,. name appears first. 00 not enter the number of any other account owner.
The social security or tax identification lIlo.
number shown above is incorrect. The ,..
CORRECT number is:
IMPORTANT TAX INFORMATION
Under the Interest and Dividend Tax Compliance Act of 1983 you (as a payee) are required to provide us with your correct Taxpayer Identification Number (TIN) If you are an individual. your TIN is your
Social Security Number.
If you do not provide us with your correct TIN you may be subject to a $50 penalty to the I.R.S. and backup withholding tax, at a rate of 20% on all dividends, interest and other payments made by us to
you after January 1, 1984
Even though our records indicate a TIN for your account, you must use the attached form to certify the number as it appears on our files or to furnish us with your correct TIN.
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Instructions
(Section references are to the Internal Revenue Code.)
Purpose of Form. - A person who is required to file an information return with IRS must obtain your correct
taxpayer identitication number (TIN) to report income paid to you, real estate transactions, mortgage interest
you paid, the acquisition or abandonment of secured property, or contributions you made to an individual
retirement arrangement (IRA). Use Form W-9 to turn ish your correct TIN to the requester (the person asking
you to furnish your TIN), and, when applicable, (1) to certify that the TIN you are furnishing is correct (or that
you are waiting for a number to be issued), (2) to certify that you are not subject to backup withholding, and
(3) to claim exemption from backup withholding if you are an exempt payee Furnishing your correct TIN and
making the appropriate certifications will prevent certain payments from being subject to the 20% backup
withholding
Note: II a requesler gives you alarm olher Ihan a W-g to request your TIN. you must use the requesters lorm
How To Obtain a TIN. -If you do not havea TfN, apply for one immediately. Toapply, get Form SS-5, Application
for a Social Security Number Card (for individuals) from your local office of the Social Security Administration.
or Form SS-4, Application for Employer Identification Number (for businesses and other entities), from your
local Internal Revenue Service office.
To complete Form W-9 if you do not have a TIN, write "Applied For" in the space for the TIN in Part I, sign and
date the form, and give it to the requester Generally, you will then have 60 days to obtain a TIN and furnish It
to the requester If the requester does not receive your TIN within 60 days, backup withholding, if applicable,
will begin and continue until you furnish yourTfN tothe requester. For reportable interest or dividend payments,
the payer must exercise one of the following options concerning backup withholding during this 60-day period
Under option (1), a payer must backup withhold on any withdrawals you make from your account after 7
business days after the requester receives this form back from you Under option (2), the payer must backup
withhold on any reportable interest or dividend payments made to your account, regard less of whether you make
any withdrawals. The backup withholding under option (2) must begin no later than 7 business days after the
requester receives this form back. Under option (2) the payer is required to refund the amounts withheld if your
certified TIN is received within the 60-day period and you were not subject to backup withholding during that
period.
Note: Writing ''Applied For" on the lorm means that you have atready apptied lor a TIN OR that you intend to
apply lor one in Ihe near luture
As soon as you receive your TIN, complete another Form W-9, include your TIN, sign and date the form, and
give it to the requester.
What Is BaCkup Withholding? - Persons making certain payments to you are required to withhold and to pay
to IRS 20% of such payments under certain conditions. This is called "backup withholding" Payments that
could be subject to backup withholding include interest, dividends, broker and barter transactions, rents,
royalties, nonemployee compensation, and certain payments from fishing boat operators, but do not include
real estate transactions
If you give the requester your correct TIN, make the appropriate certifications, and report all your taxable interest
and dividends on your tax return, your payments will not be subject to backup withholding Payments you
receive will be subject to backup withholding if
(1) You do not furnish your TIN to the requester, or
(2) IRS notifies the requester that you furnished an incorrect TIN, or
(3) You are notified by IRS thaf you are subject to backup withholding because you failed to report all your
interest and dividends on your tax return (for interest and diVidend accounts only), or
(4) You fail to certify to the requester that you are not sublect to backup withholding under (3) above (for
interest and dividend accounts opened after 1983 only), or
(5) You fail to certify your TIN. This applies only to interest, dividend, broker, or barter exchange accounts
opened after 1983, or broker accounts considered Inactive in 1983
For other payments, you are subject to backup withholding only if (1) or (2) above applies.
Certain payees and payments are exempt from backup withholding and information reporting. See Payees and
Payments Exempt From Backup Withholding, and Exempt Payees and Payments under Specific Instructions,
below, if you are an exempt payee
Payees and Payments Exempt From Backup Withholding. - Thefollowing isa list of payees exempt from backup
withholding and for which no information reporting IS required For interest and dividends, all listed payees
are exempt except item (9) For broker transactions, payees listed in (1) through (13), and a person registered
under the Investment Advisers Act of 1940 who regularly acts as a broker are exempt. Payments subject to
reporting under sections 6041 and 6041 Aare generally exempt from backup withholding only if made to payees
described in items (1) through (7), except that a corporation that provides medical and health care services or
bills and collects payments for such services is not exempt from backup withholding or information reporting.
Only payees desCflbed in items (2) through (6) are exempt from backup withholding for barter exchange
transactions, patronage dividends, and payments by certain fishing boat operators
(1) A corporation
(2) An organization exempt from tax under section 501 (a), or an individual retirement plan (IRA), or a
custodial account under 403(b)(7).
(3) The United States or any of its agencies or instrumentalities
(4) A state, the District of Columbia, a possession of the United States, or any of their political subdivisions
or instrumentalities
(5) A foreign government or any of its political subdivisions, agencies or instrumentalities.
(6) An international organization or any of its instrumentalities
(7) A foreign central bank of issue
(8) A dealer in securities or commodities required to register in the US or a possession of the US.
(9) A futures commission merchant registered with the CommOdity Futures Trading Commission
(10) A real estate investment trust.
(11) An entity registered at all times during the tax year under the Investment Company Act of 1940.
(12) A common trust fund operated by a bank under section 584(a)
(13) A financial institution.
(14) A middleman known in the investment community as a nominee or listed in the most recent publi-
cation of the American Society of Corporate Secretaries, Inc Nominee List.
(15) A trust exempt from tax under section 664 or described in section 4947
Payments of dividends and patronage dividends generally not subject to backup withholding also include the
follOWing
o Payments to nonresident aliens SUbject to withholding under section 1441.
o Payments to partnerships not engaged in a trade or business in the US. and that have at least one nonresident
partner
o Payments of patronage dividends not paid in money.
oPayments made by certain foreign organizations
Payments of interest generally not subject to backup withholding include fhe following:
oPayments of interest on obligations issued by individuals Note You may be subjectto backup wilhholding
if this interest is $6000rmoreand is paid in the course 01 Ihe payers trade or business and you have notprovided
your correct TIN to the payer.
opayments of tax-exempt interest (including exempt-interest dividends under section 852)
oPayments described in section 6049(b)(5) to nonresident aliens
opayments on tax-free covenant bonds under section 1451
opayments made by certain foreign organizations
o Mortgage interest paid by you
Payments that are not SUbject to information reporting are also not subject to backup withholding. For details,
see sections 6041, 6041A(a), 6042, 6044, 6045, 6049, 6050A, and 6050N, and the regulations under such
sections.
Penalties
Failure To Furnish TIN. -If you fail to furnish your correctTlN to a requester, 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
Failure To Include Certain Items on Your Tax Return -If you fail to properly include on your tax return certain
items reported to IRS, such failure will be treated as being due to negligence, and you will be subjecttoa penalty
of 5% on any part of an underpayment of tax attributable to that failure unless there is clear and convinCing
evidence to the contrary
Civil Penalty for False Information With Respect To Withholding. - If you make a false statement with no
reasonable basis that results in no imposition of backup withholding, you are SUbject to a penalty of $500
Criminal Penalty for Falsifying Information - Willfully falSifying certifications or affirmations may subject you
to criminal penalties including fines and/or imprisonment
Specific Instructions
Name - If you are an individual, generally prOVide the name shown on your social security card However. if
you have changed your last name, for instance, due to marriage, without Informing the Social Security Admin-
istration of the name change, please enter your first name and both the last name shown on your social security
card and your new last name.
Signing the Certification. .
(1) Interest, Dividend, and Barter Exchange Accounts Opened Before 1984 and Broker Accounts That Were
Considered Active During 1983. - You are not required to sign the certification; however, you may do so. You
are required to provide your correct TIN
(2) Interest, Dividend, Broker and Barter Exchange Accounts Opened After 1983, and Broker Accounts That
Were Considered Inactive During 19S3 - You must sign the certification or backup withholding will apply. If
you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must
cross out item (2) In the certification before signing the form
(3) Real Estate Transactions - You must sign the certification You may cross out item (2) of the certification
if you wish
(4) Other Payments - You are required to furnish your correct TIN, but you are not required to sign the
certification unless you have been notified of an incorrect TIN. Other payments Include payments made in the
course of the requester's trade or business for rents, royalties, goods (other than bills for merchandise), medical
and health care services, payments to a nonemployeefor services (including attorney and accounting fees), and
payments to certain fishing boat crew members
(5) Mortgage Interest Paid by You, AcquiSition or Abandonment of Secured Property, or IRA Contributions. -
You are required to furnish your correct TIN, but you are not required to sign the certificafion
(6) Exempt Payees and Payments. -If you are exempf from baCkup withholding, you should complete this form
to avoid possible erroneous backup withholding Enter your correctTlN in Part I, write "EXEMPT" in the block
in Part It, sign and date the form. If you are a nonresident alien or foreign entity not subject to backup
withholding, give the requester a completed Form W-S, Certificate of Foreign Status.
(7) TIN "Applied For" - Follow the instructions under How To Obtain a TIN, above, sign and date this form.
Signature. - For a joint account, only the person whose TIN is shown in Part I should sign the form
Privacy Act Notice. - Section 6109 requires you to furnish your correct taxpayer Identification number (TIN) to
persons who must file information returns with IRS to report interest, dividends, and certain other income paid
to you, mortgage interest you paid, the acquisition or abandonment of secured property, or contributions you
made to an individual retirement arrangement (IRA). IRS uses the numbers for identification purposes and to
help verify the accuracy of your tax return. You must provide your TIN whether or not you are required to file
a tax return Payers must generally withhold 20% if taxable interest, dividend, and certain other payments to
a payee who does not furnish a TIN to a payer. Certain penalties may also apply.
What Name and Number To Give the Requester
'List first and circle the names of the person whose number you furnish.
'Circle the minor's name and furnish the minor's social security number.
'Show the name of the owner.
'List first and circle the name of the legal 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