ding. and 3. I am a V.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 failed to report all interest and dividends on your tax return. For

atus Special Housing Unit Cell Number., ___________ n,ma e s :._________ --- ------- Is Inmate on Medication: NIA ,ca epa en : Med' 10 rtrn t Notified NIA 0111. of cell time Medical Date Shift Meals SH Exercise Comments Staff Sign OIC Signature B D s <Total minlhrsl Mom Day Eve 01