Extract W-9 tax form information from the following document.
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Form W-9 Request for Taxpayer Give Form to the<br>(Rev. October 2018) Identification Number and Certification requester. Do not<br>Internal Department Revenue of the Service Treasury • Goto www.irs.gov/FormW9 for instructions and the latest information. send to the IRS.<br>1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.<br>~ Yun Chin<br>2 Business name/disregarded entity name. if different from above<br>(')<br>Q) 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to<br>Ol (\J following seven boxes. certain entities, not individuals; see<br>0. 0 C ~ Individual/sole proprietor or D C Corporation D S Corporation D Partnership D Trust/estate instructions on page 3):<br>a, [. ] ["' ] C single-member LLC Exempt payee code (if any)<br>0. 0<br>~:;; ... :, 0 • Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) •<br>0 ... Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting<br>£~ tt ; ;,:: another LLC that is LLC is disregarded from the owner should check the appropriate box for the tax classification of its owner. if the LLC is classified as a single-member not disregarded from the owner for U.S. federal tax purposes. Otherwise. a single-member LLC thatLLC that is disregarded from the owner unless the owner of the LLC is code Of any)<br>·c:;<br>C. Cl) • Other (see instructions) • (Applies 10 accounts mainrained outside the U.S.)<br>rn 5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional)<br>Q)<br>(f) Q) 3550 Nicholson Dr , Apt 1A<br>6 City, state, and Zl P code<br>Baton Rouge, LA 70803<br>7 List acco unt number(s) here (optional)<br>ma Taxpayer Identif ication Number (TIN)<br>Enter backup your w i. thholding. TIN in . the For appropriate ... 1nd1v1duals, box this . The 1s TIN generally provided your must social match security t he number name given (SSN). on However, line 1 to avoid for a I Social security number<br>resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other<br>entities, it is your employer identification number (EIN). If you do not have a number, see How to get a<br>TIN, later.<br>**----- End of picture text -----**<br>
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I Employer identification number<br>**----- End of picture text -----**<br>
**Note:** If the account is in more than one name, see the instructions for line 1. Al so see _What Name and Number To Give the Requester_ for guidelines on whose number to enter.
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Certification<br>**----- End of picture text -----**<br>
## Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I 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 all interest or dividends, or (c) the IRS has notified me t hat I am no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
**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 real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions 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. See the instructions for Part II, later.
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Sign Signature of<br>Here U.S. person •<br>---~--- ----r1~-----<br>General lnstru<br>**----- End of picture text -----**<br>
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## **Date** •
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- Form 1099-DIV (dividends, including those from stocks or mutual
- funds)
Section references are to the Internal Revenue Code unless otherwise noted.
• Form 1099- MISC (various types of income, prizes, awards, or gross proceeds)
**Future developments.** For the latest information about developments relat ed to Form W-9 and its instructions, such as legislation enacted after they were published, go to _www.irs.gov/FormW9._
- Form 1099-B (stock or mutual fund sales and certain other transactions by brokers)
- Form 1 og9-S (proceeds from real estate transactions)
## **Purpose of Form**
- Form 1 og9-K (merchant card and third party network transactions)
An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following.
- Form 1098 (home mortgage interest), 1098-E (student loan interest),
- 1 098-T (tuition)
- Form 1099-C (canceled debt)
- Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S . person (including a resident
- alien), to provide your correct TIN.
_If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See_ What is backup withholding, _later._
• Form 1099-INT (interest earned or paid)
Form **W-9** (Rev. 10-2018)
Cat. No. 10231X
Pre-extracted NER entities:
- ADDRESS: U.S., Baton Rouge, LA, U.S
- BUSINESS_TYPE: Individual/sole proprietor, C Corporation, C corporation, S Corporation, S corporation, Partnership, Limited liability company
Return ONLY a valid JSON object with these exact keys: taxpayer_name, business_name, tax_classification, ssn, ein, address (object with street, city, state, zip), signature_date. No other text or markdown.