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the IRS has named Ole Depositor that annals:neer subject to backup sainncldng or a is mow from imams eitmoiding. (3) the 0eMitzlor is a V.S. entity (Cross out subpart 2(a) if his not true. It Statement 3 Is not true. cross out and complete an appropriate Fern W-8) The internal Revenue Service does not
eon __,----Ceparatis Tee: Physical (Home) Address' Personal Mair9LAddress: Social Security Number Date Of Binh NallsTeØNumber. Ihshass Teptere Minter. Flip Of Cent Citizen OF. Bursa Fat tarter IlitOfta•Rutater. EmellAddress: Taish~ f Photo Manske:~ Type 8 masher. Iderelkation ~Ike Da El OF
he Interval of faltre to repel ail intennt or dm/owes. or (b) that the IRS has not/fled me tom backup wrIncldng. (3) the Deposnor is a U,S. enemy. (Cross out subpart complete an apponiate Fcan W-8) Service does not require your consent to any peoeislon of this document other AirthOresel Signatile X
ay. , (onaciln IT at "tread Ire a netaNinale. .d npodillo coralrucOnn ail dons. .vacs producod. or gents pronto tit Haim approve enliy tan on Minter ottani] lot and realve0 an OD 0 Vat gr.. II %lewd% 01•04)01e01 Mena has inn* Re PISMO/ Ad sic duelwn Attila Ft SS-0 lov. nen ASearf CIO:0CA
r* ce(b)tre toe IPS tea notified tie Depose< mat a is rata-ice( saes to backup wasaang or wee from been )10'03009. (3) me Depositor is a U.S. say. (Cross our subvert 2(a) if it is not But it Statement 3 le not true, cress out and cocas an appapithts Form se-e) The mark Revenue Senior. does not requir
ots I.- Quart.- R../2 1.4i ila inn. LLSY I O 6 tO 2 0sta Of t Place Of Birth ' I Caen LA Or. ILA e. ono , ai .l.reusinsss FaY VID -75 Minter Number Email Aness: s- - -el. I • - al X r Identlecattn Expiration Dye: 0 Ac . O4EXSYSTE SSN Response: Year iCtia State ID Response:
Entities connected to both Adriana Ross and Minter

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