cross out and complete an Ofirofghla Taw W4) Tho Internal Revenue Snare does not require your ceniam to any prowaroe of this document other than the CenthuitIon required to avoid backup withholding. Date ' Authorized Signatur.. X . )Sit ea knOtrlit 5500.00 Type: TRANSFER • Tønsaetlonx •octet 0 yes 0