ich provided us with this information. The Internal Revenue Service does not require your centerline any provision of this document other than the Signature of Joint Account Holder Date For Credit Union Use Only ChaxSystems Verification Opened by klernbersboOrtIcer SEG WV I. EFTA00124782

dal. date of birth, and other Information that will allow us to fatality may *so ask to sea tffr r rivers license or other identifying 4.0eurnen Signature of Joint Account Holder Certification of Taxpayer Identification Number (W-9) Under penalties of perjury. I certify that: (1) The number shown on this form is my c