NC0003395_Permit Modification_20101217

NPDES DOCUMENT SCANNINO COVER SHEET
NPDES Permit:
NC0003395
Document Type:
Permit Issuance
Wasteload Allocation
Authorization to Construct (AtC)
QermitModificatioii)
Complete File - Historical
Monitoring Report
Instream Assessment
(67B)
Environmental Assessment (EA)
Permit
History
Document Date:
December 17, 2010
Thiiec document ig printed on reuse paper - iggriore any
content on the reYe1'Be side

2-z2 / ATA atin
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Coleen H. Sullins Dee Freeman
Govemor Director Secretary
December 17, 2010
RONALD BAZINET
SITE LEADER
MOMENTIVE SPECIALTY CHEMICALS INC
333 NEILS EDDY ROAD
RIEGELWOOD NC 28456
Subject: NPDES Permit Modification- Name and/or
Ownership Change
Permit Number NC0003395
Acme Facility
Columbus County
Dear Mr. Bazinet:
Division personnel have reviewed and approved your request to transfer ownership of the subject permit, received
on December 2, 2010. This permit modification documents the change of ownership.
Please find enclosed the revised permit. All other terms and conditions contained in the original permit remain
unchanged and in full effect. This permit modification is issued under the requirements of North Carolina General
Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions concerning this permit modification, please contact the Point Source Branch at (919)
807-6304.
Sincerely,
Coleen H. Sullins
cc: Central Files
Wilmington Regional Office, Surface Water Protection
NPDES Unit File NC0003395
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] Customer Service: 1-877-623-6748
Internet: www.ncwaterquality.org
An Equal Opportunity 1 Affirmative Action Employer
No11ehCarolina
7Vaturaij

Permit NC0003395
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
PERMIT
TO DISCHARGE WASTEWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
Tn compliance with the provision of -North Carolina General Statute 113_915,1, other lawfW standards
and regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Federal Water Pollution Control Act, as amended, the
• Momentive Specialty Chemicals, Inc
is hereby authorized to discharge wastewater from a facility located at
Acme Facility
333 Neils Eddy Road
Riegelwood
Columbus County
to receiving waters designated as Livingston Creek in the Cape Fear River Basin
in accordance with effluent limitations, monitoring requirements, and other conditions set forth in Parts
I, II and III hereof.
This permit shall become effective December 17, 2010.
This permit and authorization to discharge shall expire at midnight on December 30, 2011.
Signed this day December 17, 2010.
crQ'oleen H. Sullins, Director
- Division of Water Quality
By Authority of the Environmental Management Commission

Permit NC0003395
SUPPLEMENT TO PERMIT COVER SHEET
All previous NPLES Permits issued to this facility, whether for operation or discharge are hereby
revoked. As of this permit issuance, any previously issued permit bearing this number is no longer
effective. Therefore, the exclusive authority to operate and discharge from this facility arises under the
permit conditions, requirements, terms, and provisions included herein.
Momentive Specialty Chemicals, Inc. is hereby authorized to:
1. Continue to discharge non -contact cooling water, reverse osmosis reject, water softener
backwash, water softener regenerant and firewater tank blowdown from outfall 002. This
wastewater system is located at the Acme facility, 333 Neils Eddy Road, Riegelwood in
Columbus County
2. Discharge from said outfall at the location specified on the attached map into Livingston Creek,
classified C-Swamp waters in the Cape Fear River Basin.

Permit NC0003395
A. (1.) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS (002)
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is
authorized to discharge non -contact cooling water, reverse osmosis reject, softener backwash, water softener
regenerant, firewater tank blowdown and similar wastewaters from outfall 002. Such discharges shall be limited and
monitored by the Permittee as specified below:
EFFLUENT
CHARACTERISTICS
LIMITS
MONITORING REQUIREMENTS
Weekly Average
Daily Maximum
MeasurFrequencyement
Sample Type
Sample Locationi
Flow, MGD
Weekly
Instantaneous
Effluent
BOD, 5 day 20°C, mg/L.
Monthly
Grab
Effluent
NH3 as N, mg/L
Monthly
Grab
Effluent
Total Residual Chlorine (TRC) 2
28.0 pg1L
Monthly
Grab
Effluent
Temperature, °C 3
Monthly
Grab
Effluent
Methanol, mg/L
Monthly
Grab
Effluent
Formaldehyde
7.48 mglL
Monthly
Grab
Effluent
pH
Not greater than 9.0 s.u. nor less than
6.0 s.u.
Monthly
Grab
Effluent
Dissolved Oxygen, mg/L (DO) 4
Monthly
Grab
Effluent, U, D
Total Arsenic, mgiL 4
Monthly
Grab
Effluent
Total Copper, mg/L 4
Monthly
Grab
Effluent
Total Chloride, mg/L 4
Monthly
Grab
Effluent
Total Iron, mg/L 4
Monthly
Grab
Effluent
Total Fluoride, mg/L 4
Monthly
Grab
Effluent
Total Zinc, mg/L 4
Monthly
Grab
Effluent
Total Nitrogen, mg/L (TN) 45
TN = TJN + (NO2-N + NO3-N)
Monthly
Grab
Effluent
Total Phosphorus, mg/L (TP) 4
Monthly
Grab
Effluent
Salinity, ppt 4
Monthly
Grab
Effluent, U, D
Conductivity, pmho/cm 4
Monthly
Grab
Effluent, U, D
Chronic WET 6
Quarterly
Grab .
Effluent
Footnotes:
1. Sample locations: U= at least 50 feet upstream of discharge location, D= at least 50 feet downstream of discharge location.
2. The total residual chlorine (TRC) limit will become effective on March 1, 2009. Monthly monitoring is required beginning on
the permit effective date. Total Residual Chlorine compliance is required for chlorine or chlorine derivative used for
disinfection. The Division shall consider all effluent TRC values reported below 50 ug/1 to be in compliance with the permit.
However, the Permittee shall continue to record and submit all values reported by a North Carolina certified laboratory
(including field certified), even if these values fall below 50 ug/L.
3. The temperature 'of the effluent shall not increase the temperature of the receiving stream more than 2.8 °C. In no case shall
the temperature of the effluent cause the receiving stream to exceed 32°C.
4. Monitoring can be deleted if the permittee can demonstrate that 12 consecutive months of effluent sampling results are
below detection level, and RO and IE sources are disconnected.
5. Total Nitrogen, TN = TJN + (NO2-N — NO3-N), where TJN is the Total Kjeldahl Nitrogen and (NO2-N + NO3-N) is
Nitrite and Nitrate Nitrogen.
6. Chronic Whole Effluent Toxicity (Ceriodaphnia) at 4.7%; quarterly during February, May, August, and November. See
Special Conditioxi A. (2.).
There shall be no discharge of floating solids or visible foam in other than trace amounts.

Permit NC0003395
A. (2.) CHRONIC TOXICITY PERMIT LIMIT (QUARTERLY)
The effluent discharge shall at no time exhibit observable inhibition of reproduction or significant
mortality to Ceriodaphnia dubia at an effluent concentration of 4.7 %.
The permit holder shall perform at a minimum, quarterly monitoring using test procedures outlined in
the "North Carolina Ceriodaphnia Chronic Effluent Bioassay Procedure," Revised February 1998, or
subsequent versions or "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -
February 1998) or subsequent versions. The tests will be performed during the months of February, May,
August and November. Effluent sampling for this testing shall be performed at the NPDES permitted final
effluent discharge below all treatment processes.
If the test procedure. performed as the first test of any single quarter. results in a failure or ChV below
the permit limit, then multiple -concentration testing shall be performed at a minimum, in each of the two
following months, as described in "North Carolina Phase II Chronic Whole Effluent Toxicity Test
Procedure" (Revised -February 1998) or subsequent versions.
The chronic value for multiple concentration tests will be determined using the geometric mean of the
highest concentration having no detectable impairment of reproduction or survival and the lowest
concentration that does have a detectable impairment of reproduction or survival. The definition of
"detectable impairment," collection methods, exposure regimes, and further statistical methods are specified
in the "North Carolina Phase II Chronic Whole Effluent Toxicity Test Procedure" (Revised -February 1998)
or subsequent versions.All toxicity testing results required as part of this permit condition will be entered on
the Effluent Discharge Monitoring Form (MR-1) for the months in which tests were performed, using the
parameter code TGP3B for the pass/fail results and THP3B for the Chronic Value. Additionally, DWQ Form
AT-3 (original) is to be sent to the following address:
Attention: NC DENR / DWQ / Environmental Sciences Section
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
Completed Aquatic Toxicity Test Forms shall be filed with the Environmental Sciences Section no
later than 30 days after the end of the reporting period for which the report is made.
Test data shall be complete, accurate, include all supporting chemical/physical measurements and all
concentration/response data, and be certified by laboratory supervisor and ORC or approved designate
signature. Total residual chlorine of the effluent toxicity sample must be measured and reported if chlorine is
employed for disinfection of the waste stream.
Should there be no discharge of flow from the facility during a month in which toxicity monitoring is
required, the permittee will complete the information located at the top of the aquatic toxicity (AT) test form
indicating the facility name, permit number, pipe number, county, and the month/year of the report with the
notation of "No Flow" in the comment area of the form. The report shall be submitted to the Environmental
Sciences Branch at the address cited above.
Should the permittee fail to monitor during a month in which toxicity monitoring is required,
monitoring will be required during the following month. Should any test data from this monitoring
requirement or tests performed by the North Carolina Division of Water Quality indicate potential impacts to
the receiving stream, this permit may be re -opened and modified to include alternate monitoring requirements
or limits.
NOTE: Failure to achieve test conditions as specified in the cited document, such as minimum control
organism survival, minimum control organism reproduction, and appropriate environmental controls,
shall constitute an invalid test and will require immediate follow-up testing to be completed no later than
the last day of the month following the month of the initial monitoring.

MOMENTIVE" Forest Products Division
-,dyH
kiegeiwood, NO 284f 6 9G/0
October 15, 2010
Division of Water Quality
ATTN: Ms Coleen Sullins, Director
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Notification of Hexion Specialty Chemicals, Inc. Corporate Name Change
Hexion has Become "Momentive Specialty Chemicals Inc."
To Whom It May Concern:
Please accept this letter as official notification that, effective October 1, 2010 Hexion Specialty
Chemicals, Inc. became Momentive Specialty Chemicals Inc. Other than the name change, there
has been no change to the entity owning and operating the facility. Please change our permits
accordingly.
Our records indicate that the following permit has been issued by your agency for the facility located
at 333 Neils Eddy Road, Riegelwood, NC.
Water Permit# NC0003395
While no "substantive" changes to these environmental permits are required as a result of this
corporate name change, we wanted to apprise the agency of this change, and to assure you of its
continued commitment to comply with its permits and all applicable laws and regulations.
If you have any questions or wish to discuss this matter further, please do not hesitate to contact me
at [phone].
Sincerely,
MOMENTIVE SPECIALTY CHEMICALS INC.
Ronald Bazinet
Site Leader
uoutug^ ele epuellBM
wno 2431bNr - aN30
G;GZ 6 i 1J0
@gallgal

Beverly Eaves Perdue, Governor
Dee Freeman, Secretary
North Carolina Department of Environment and Natural Resources
;.S VR1`
. Please enter the permit number for which the change is requested.
(or)
NPDES Permit
N
C
0
0
0
3
3
9
5
II. Permit status prior to requested change.
a. Permit issued to (company name):
b. Person legally responsible for permit:
c. Facility name (discharge):
d. Facility address:
Coleen H. Sullins, Director
Division of Water Quality
Certificate of Coverage
N
C
G
Hexion Specialty Chemicals, Inc.
Ronald
Bazinet
First
Ml
Site Leader
Last
Title
333 Neils Eddy Road
Permit Holder Mailing Address
Riegelwood
NC 28456
City
[phone]
State
Zip
[phone]
Phone Fax
Hexion Specialty Chemicals, Inc.
333 Neils Eddy Road
Address
Riegelwood NC 28456
City State
e. Facility contact person: April S. Hanson
First / MI / Last
III. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ❑ Change in ownership of the facility
® Name change of the facility or owner
0
N
If other please explain:
Zip
[phone]
Phone
b. Permit issued to (company name):
c. Person legally responsible for permit:
cility name (discharge):
acility address:
f. Facility contact person:
Momentive Specialty Chemicals Inc.
Ronald Bazinet
First MI Last
Site Leader
Title
333 Neils Eddy Road
Permit Holder Mailing Address
Riegelwood
NC 28456
City State Zip
[phone] [e-mail]
Phone E-mail Address
Momentive Specialty Chemicals Inc.
333 Neils Eddy Road
Riegelwood
Address
NC 28456
City
April
State Zip
S Hanson
First MI Last
[phone] [e-mail]
Revised 8/2008
Phone E-mail Address

PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact:
V.
VI.
First
MI Last
Title
Mailing Address
City State Zip
( )
Phone E-mail Address
Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
® This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Ronald Bazinet, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete.
lov‘a
Signs ur
12/1/2010
Date
APPLICANT CERTIFICATION
I, Ronald Bazinet, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be returned as incomplete. n
i
Signa re
12/1/2010
Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 7/2008

'4
H IONT"
Specialty Chemicals
Momentive Specialty Chemicals Inc.
(Formerly Known As Host/on Specialty Chonrlcnls. Inc.)
180 East Broad Street
Columbus, OH 43215
MOMENTIVE'
- Notification of Name Change to Suppliers -
Momentive Specialty Chemicals Inc.
- Formerly known as -
(Hexion Specialty Chemicals, Inc.)
Momentive Specialty Chemicals Canada Inc.
Produits Chimiques Specialises Momentive Canada Inc.
- Formerly known as -
(Hexion Specialty Chemicals Canada, Inc.)
(Produits Chimiques Specialises Hexion Canada, Inc.)
Dear Supplier,
As of October tst in the US and October 6th in Canada, Hexion Specialty Chemicals has changed its name.
Full legal entity names are listed above. Effective November 16t, purchase orders will begin reflecting these
new names. All outstanding purchase orders, and purchase orders to be issued prior to November 1st are,
by means of this letter, amended to the new legal names above.
Please ensure that all future communications (particularly invoicing) for our US and Canadian entities are
amended to reflect our new legal name effective immediately. After November 15th, invoices bearing the
Hexion legal name(s) in North America will no longer be accepted. The tax identification and corporation
numbers will remain unchanged. Attached please find Certificate of Amendments validating the Canadian
and US legal name changes. Also attached please find the updated W-9 form for US vendors. Please be
advised that the names of Hexion legal entities outside of North America have not yet been changed and you
will be notified when these changes occur.
Please do not confuse our name change with Momentive Performance Materials entities. The Mome
Performance Materials entities continue to exist, and are unchanged. This change will affect only He
entities.
Yours sincerely,
Nathan E. Fisher
Executive Vice President, Global Procurement
Momentive. Specialty Chemicals Inc.
Registered Addresses (Unchanged):
Momentive Specialty Chemicals Inc.
180 East Broad Street
Columbus, Ohio 43215 USA
Momentive Specialty Chemicals Canada Inc.
12621 156thiSt NW
Edmonton, Alberta Canada TSV 1 E1
Invoicing Address (Unchanged):
Momentive Specialty Chemicals Inc or Momentive
Specialty Chemicals Canada Inc
Attn: Invoice Processing
PO Box 1310
Columbus, OH 43216 USA
[e-mail] (Please note that if you
currently email invoices to Momentive (formerly known as
Hexion), we will advise you via email when the email
address will change)

C-102A Rev 12/93
D.--
[OCT 012010
New Jersey Division of Revenue
��
ST T t G A�,l �..� .
Certificate of Amendment to the Certificate of incorporation C i)c j Qd3
(For Use by Domestic Profit Corporations) o
Pursuant to the provisions of Section 14A:9-2 (4) and Section I4A:9.4 (3), Corporations, General, of the New Jersey
Statutes, the undersigned corporation executes the following Certificate of Amendment to its Certificate of Incorporation:
1. The name ofthe corporation is:
Hexion Specialty Chemicals, Inc.
2. The following amendment to the Certificate of Incorporation was approved by the directors and thereafter duly adopted by
the shareholders of the corporation on the 1st day of October , 20 10
Resolved, that Article 1
of the Certificate of Incorporation be amended to read as follows:
The name of the corporation is Momentive Specialty Chemicals Inc.
3. The number of shares outstanding at the time of the adoption ofthe amendment was: 82,558,847
The total number of shares entitled to vote thereon was: 82,558,847
4. The number of shares voting for and against such amendment is as follows: (If the shares of any class or series are entitled
to vote as a class, set forth the number of shares of each such class and series voting for and against the amendment,
respectively).
Number of Shares Voting fbr Amendment Number Qf Share* Voting. Against Amendment
82,558,847 0
BY:
Dated this / day of October , 2010
(Signature)
vtOintistismdt
cedent
May be executed by the Chairman' of the Board, or the President, or a Vice President of the Corporation.

STATE OF NEW JERSEY
DEPARTMENT OF THE TREASURY
SHORT FORM STANDING
MOMENTIVE SPECIALTY CHEMICALS INC.
2287701000
With the Previous or Alternate Name
BORDEN, INC. (Previous Name)
BURDEN CHEMICAL, INC. (Previous Name)
BORDEN'S CONDENSED MILK COMPANY (Previous Name)
THE BORDEN COMPANY (Previous Name)
HEXION SPECIALTY CHEMICALS, INC. (Previous Name)
1, the Treasurer of the State of New Jersey, do hereby certify that the
above( -named.New Jersey Domestic Profit Corporation was registered by
this office on April 24, 1899.
As of the date of this certificate, said business continues as an active
business in good standing in the State of New Jersey, and its Annual
Reports are current.
1 further certifii that the registered agent and registered office are:
National Registered Agents, Inc. Of Nj
100 Canal Pointe Blvd.
Suite 212
Princeton, NJ 08540
Certification# 118373621
Verify this certificate at
https://www1.state.nj.us/TYTR_StandingCert/JSPNerify_Certj sp
Page 1 of 1
IN TESTIMONY WHEREOF, I have
hereunto set my hand and affixed my
Official Seal at Trenton, this
4th day of October, 2010
Andrew P Sidamon-Eristoff
State Treasurer

® ® Industry Industrie
Canada Canada
Certificate of Amendment Certificat de modification
Canada Business Corporations Act Loi canadienne sur les societds par actions
Momentive Specialty Chemicals Canada Inc.
Produits Chimiques Specialises Momentive Canada Inc.
Corporate name / Denomination sociale
278296-1
Corporation number / Numdro de socidte
I HEREBY CERTIFY that the articles of the
above -named corporation are amended under
section 179 of the Canada Business
Corporations Act as set out in the attached
articles of amendment.
JE CERTIFIE que les statuts de la societe
susmentionnee sont modifies aux termes de
1'article 179 de la Loi canadienne sur les
societes par actions, tel qu'il est indique dans les
clauses modificatrices ci-jointes.
Aissa Aomari
Deputy Director / Directeur adjoint
2010-10-06
Date of Amendment (YYYY-MM-DD)
Date de modification (AAAA-MM-JJ)
Canada

'r
Industry Industrie
EN Canada Canada
Form 4
Articles of Amendment
Canada Business Corporations Act
(CBCA) (s. 27 or 177)
Formulaire 4
Clauses modificatrices
Loi canadienne sur ies soci6t1s par
actions (LCSA) (art. 27 ou 177)
j 1 Corporate name
Denomination sociale
Hexion Sp ciaity Chemicals Canada, Inc.
Produits Ctt imiques Specialises Hexion Canada, Inc.
Corporation number
Numero de la societe
278296-1
31 The articles re amended as follows
Les statuts s re
modifies de la fa9on suivante
The corporation changes its name to:
La denomination sociale est modifiee pour :
Momentive Specialty Chemicals Canada Inc.
Produits Chimiques Specialises Momentive Canada Inc.
j 4 ; Declaration: l certify that I am a director or an officer of the corporation.
Declaration : J 'atteste que je suis un administrateur ou un dirigeant de la societe.
Original signed by / Original signo par
Ellen German Berndt
Ellen German Berndt
614-225-4382
Note: Misrepresentation constitutes an offence and, on summary conviction, a person is liable to a fine not exceeding 55000 or to imprisonment
for a term not exceeding six months or both (subsection 250(1) of the CBCA).
Nota : Faire une fausse declaration constitue une infraction et son auteur, sur declaration de culpabilite par procedure sommaire, est passible
d'une amende ma' ima1e de 5 000 $ ou d'un emprisonnement maximal de six mois, ou de ces deux peines (paragraphe 250(1) de la LCSA).
Cary A IC 3069 (2008/04)

• f •
Form w-9
(Rev. October 2007)
Department a! Ira Treasury
rntertst Revenue s«Mee
Request for Taxpayer
identification Number and Certification
Name (as shown on your income tax return)
Momentive Specialty Chemicals, Inc.
suslneie name, E< different from above
Give form to tho
requester. Do not
sond to the IRS.
Check appropriate box: ❑ IndividuaU3olo proprietor ® Co poratlon 0 Pannertzhip
❑ United ttability company. Enter the tax ctasstftcattcn (D_dfsregardod entity. Cwcorporation, P..partnerahfp) ►
❑ cal'er tsce Whams) ►
Addrea9 inumber, street, and apt. or suite no.)
180 E Broad St,
City, state, and ZIP code
Columbus, OH 43215
Ust account number(s) here (options!
❑
Exempt
payee
Requester's name and address (optional)
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on Une 1 to avoid
• backup withholding. For individuals, this is your social security number (SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it Is
your employer identification number (EIN).11 you do not have a number, see How to get a TIN on page 3.•
. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter!
Part iI
Certification
Sodsr security number
l t
or
Employer Identification number
13 = a'3112C )
Under penalties Of perjury, i certify that:
1. The number shown on this form Is my correct taxpayer identification number (or l 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 aU 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).
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 fatted to report elf 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, cancellation of debt, contnbutlons 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. S instructions an • :go 4.
Sign signature of
. Here us. van on ►
• General Instructions
• Section references are to the internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to filo an information return with the
• IRS must obtain your correct taxpayer Identification number (1'IN)
• . to report, for example, income paid to you, real estate
• transactions, mortgage Interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
c ontnbutions you made to an IRA.
Use Form W-9 only if you are a U.S. person (including a
. • resident alien), to provide your correct TIN to the person
requesting it (the requester) and, when applicable, to:
1. Certify that the TIN you are giving Is correct (or you are
walling for a number to be Issued),
2. Certify that you am not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable. you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business Is not subject to the withholding tax an
foreign partners' share of effectively connected Income.
Note. if a requester gives you a form other than Form W9 to
request your TIN, you must use the requester's form If It is
• substantially similar to this Form W-9.
•
•
Cato► ChOter 1aa010
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
• An individual who is a U.S. citizen or U.S. resident alien..
• A partnership, corporation, company, or association created or
organized In the United States or under the laws of the United
States,
• An estate (other than a foreign estate), or
• A domestic trust (as defined in Regulations section
301.7701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership Is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that Is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
Income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net Income from the partnership
conducting a trade or business In the United States Is in the
following cases:
• The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 (Rev.10-20