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Form W-9
<br />(Rev. October 2018)
<br />DePartmerd of the Treasury
<br />Internal Revenue SeMra
<br />1 Name (as shown on
<br />Granite
<br />12 Busine
<br />Request for Taxpayer
<br />Identification Number -and Certification
<br />► Go to www.lrs gov1FormM for instructions and the latest information.
<br />e tax return). Name is required on this line; do not leave this One blank
<br />Inc.
<br />d entity name, If different from above
<br />Give Form to the
<br />requester. Do not
<br />send to the IRS.
<br />3 Check appropriate box for federal tax classification of the person whose name is.entered on line 1. Check only one of the 4 Exemptions (codes apply only to
<br />following seven boxes. certain entities, not Individuals; see
<br />Instructions on page 3):
<br />❑ Individual/sole proprietor or Z C Corporation ❑ S Corporation ❑ Partnership ❑ Trusi/estate
<br />single -member LLC
<br />❑ Umited liability company. Enter the tax classification (C=C corporation, S=S corporation, P--Partnership)►
<br />Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check
<br />LLC If the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is
<br />another LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-membeir LLC the
<br />Is disregarded from the owner should check the appropriate box for the tax classification of its owner.
<br />❑ Other (see Instructions) ►
<br />5 Address (number, street, and ap[ or suite no.) See instructions. Requester's name
<br />PO Box_1482
<br />6 City, state, am
<br />St. Cloud, MN 66302
<br />7 List account numbers) here (optioneQ
<br />r Taxpayer Identification Number (TIN)
<br />Enter your TIN In the appropriate box. The TIN provided must match the name
<br />backup withholding. For individuals, this is generally your social security nurn
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Pa
<br />entities, it is your employer Identification number (EIN). If you do not have a nu
<br />TIN, later.
<br />Note: If the account is in more than one name, see the instructions for line 1. AI
<br />Number To Glve the Requester for guidelines on whose number to enter.
<br />Exempt payee code (if arry)
<br />Exemption from FATCA reporting
<br />code (if any)
<br />(gopB•t ro•ccaunh mehm'nedaroWe tlN U 8J
<br />given on line 1 to avoid
<br />bar
<br />tuber,
<br />Social security number
<br />(SSN). However, for. a
<br />rt I, later. For other
<br />-
<br />m -
<br />see Now to get a
<br />or
<br />so see What Name and
<br />Employer Identification number
<br />M41
<br />-
<br />1
<br />1 2
<br />1 6
<br />6
<br />1 9
<br />4
<br />1 0
<br />--4[1 Certification _ --
<br />Under penalties of perjury, I certify that:
<br />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
<br />2.1 am not subject to backup withholding because: (a) I am exerhpt from backup withholding, or (b) I have not been notified by the Internal Revenue
<br />Service ORS) 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.
<br />no longer subject to backup withholding; and
<br />3.1 am a U.S. citizen or other U.S. person (defined below); and
<br />4. The FATCA code(s) entered on this form Of any) indicating that I am exempt from FATCA reporting is correct.
<br />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
<br />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,
<br />acquisition or abandonmentcf secured property, cancellation of debt, contributions to an individual retirement arrangement ORA), and generally, payments
<br />other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. Sea the instructions for Part 11, later.
<br />Sign signature of
<br />Here U.S. person ► Date► y o1 a 3
<br />General Instruc ions
<br />Section references are to the internal Revenue Code unless otherwise
<br />noted.
<br />Future developments. For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go to wwwJr:s.gov1FormW9.
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who is required to file an
<br />information return with the IRS must obtain your correct taxpayer
<br />Identification number (TIN) which may be your social security number
<br />(SSN), individual taxpayer Identification number OTIN), adoption
<br />taxpayer identification number (ATIN); or employer Identification number
<br />(EIN), to report on an information return the amount paid to you, or other
<br />amount reportable on an information return. Examples of Information
<br />returns include, but are not limited to, the following.
<br />• Form 1099-INT (interest earned or paid)
<br />Cat. No. 10231X
<br />• Form 1099-DN (dividends, including those from stocks or mutual
<br />funds)
<br />• Form 1099-MISC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1099-B (stock or mutual fund sales and certain other
<br />transactions by brokers) -
<br />• Form 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 (home mortgage interest),1098-E (student loan interest),
<br />1098-T (tultion)
<br />• Form 1099-C (canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only if you are a U.S. person (including a resident
<br />alien), to provide your correct TIN.
<br />If you do not return Form W-9 to the requester with a TiN, you might
<br />be subject to backup withholding. See What is backup withholding,
<br />later.
<br />- — — Form W-9 (Rev.10-2018)
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