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Home My Public Portal About085-2015 - Sanitary & Stormwater - Pitney Bowes - Leasing mailing equipmentPITNEY BOWES LEASE AGREEMENT STATE AND LOCAL TERM RENTAL Agreement Number Your Business Information CITY OF RICHMOND Full Legal Nance of Lessee DBA Name of Lessee Tax ID # (FEINITIN) 2380 LIBERTY AVE RICHMOND IN 47374.7282 BiWng Address: Street City Slate lip*4 20472647864 Billing Contact Name Billing Contact Phone # Billing CAN # 2360 LIBERTY AVE RICHMOND IN 47374-7282 Insla)1a11on Address (ltdifferent from billing address) : street City State Zipi4 Installation Contact Name Fiscal Period (from -10) Your Business Needs Oty 1 Business Solution Description Mall Creation - i DL200 Letter Opener 1 ConnectRlght Mailer Electronically Delivered Stand-alone Soft 1 ConnectRight Mailer- Basic Installation, Training, and Mail Run 1 Planet Press Envelo eNow 1 01500 6 Station 1 01600 OMR Level 1 Basic 1 Hei ht Adjustable Table, 72in, w/Shelf & Locking Doors 1 D16001D1600 OMR Install & Operator Training Your Payment Plan 20472647864 Installation Contact Phone # Installation CAN # Lessee PO # Delivery CAN # ChockaddIilonal items tOW Intkrded rI chant'. payment t v t sarvko La aIAgfdonwnl leer f-NOVdes reparaM maintenance se'ce W aqu:pneni Me Oda Id CIA) aalllV 4flainlanataet(ed,191"alterms apply)- PronHesraws;an Waras&teclsnNt- asyslalca Tier2 • Enharxed $015vare h1a-ntenanes ❑lV,efer lienlal () Value Noel Ss rvfoas(not lnclod'u,g USPS fees whkh wilt Ile thargod separaloty) Purchase Pn OO- A ana of credY provd*ng a cwrwnloN way to mtr hav algid pay rater. CortoFdale marerposlage, p&&9 poslege and ;Wp:sa wrdw ara a'.tolmf — too!arms & 0v.43M4 E1 eg0I"rtrtepltvvmntProgram -PAAadl rrncesadkssordamagaroleasedagL4penom l ( )Yes I watt to errol In IN VaWa4AXM egte pmenl lapaceMErA program (a) No EnrNlre,60 p WA pro4d4 proof of MsuranrA w41Jn the nerd 30 days as noted In $ ceon t,Q1 Initial Term : ¢g months () Required advance check of $( ) received () Tax Exempt Certificate Attached Number Of Months Monthly Amount Billed Quarterly At" () Tax Exempt Certificate Not Required First 60 31,112 $3,336 Woos riot R'/cl'Ude any app: -We salaa, use, a poperty lose$ yr i*h vr'.r he b:'red separates• payrrert Plans beo One, myopp& &N.4 wi, Usk Pedal. Your Signature Below )Esr_•9pprOpflslrOn L. You '&still ll th al too hivs '4ln4% sva:.a 0'a 52 Pat a4 psym eats vn1d lie 410 of foal Cdltenl 14:413erSod. s ad anal use four pest shorts v apIofl 1days 10 rtsOach ra oseq aaAl 9s:af pervd thro Ugh 1ha end Of YOjI passe TlIfM, #to•sr aaptoptagh tsgvest lo your �20''3,dvvt*Odr, Or fu:sd Ing lu:hoihj ?'b'•v _cling so If') br %Jn45 to Oa/ Aa Osymtn:f lid tnled,V4'J mat tei nlnale MIS L4as4 O:h trill 3atda/ 011h1 f'a;_al0efloe for lthlch sands have Seen aDot oar Yted, upon t) s'ao'nlaslol at 4o :unl el$n :bto ssons ail sa 5s13 CIorr t0 PS aVtY]t Yla felt 0ov efling a1at's dei'al of an sp Pro411aYOn SAtl Cfanl to Ca n1llua @its is see for In- nest %JCCO eO Ag fatal Der 00, 814 (to si:sfsclbn of sd tnargss and o0eastans Jndtt tha hest [M..'J(led :•Ir0'Jgn ?le end ollne t1Cs19itgtl for lrh ICn WrldS )t SV4 ott.l as fro pr'a:eel, is Nut zip Me ra1J1h DI the Equtonlell4tt0lr e%otlse. 91 a+anlag 0t€tat, 10J agree t002: aound Of alln4, ltrms or al 'a• Agratmelt, YIClUding those, COA3Deed a.'t alga: and 750at 10:a:ed Yi 01e sts:e of 1141aha 04h•.fsf1 A3A-f a• 3511PA! ISfs2, E;hb SO Pklet Bowese tnerdl Terms N uslon elf 4), Nh Yh are avi Ysort sl•,rw n. N351mistatts aa4 are k1tvaora:ed 0v edlertl:e.yea so Yh7N $a 301%s1 rag map hat on no if the le gig for any riasOn and that as papmsit obltgsilon5 are, an*O rs Ol ra as 1. The Gase '/t of 4 e 0 f141ng 011 us 3".f wa .lira coy a'e:-d 2Ur:re9S sl4 SO Cum enela, ;! tarOMS ah4 hsva a;la Id 4Olo'n Tle 'sass teO`l Yes 10J emir 10 Or OV Yfs Gt0010 f IASWIIACt or aaff�l:: In 1rie Yatle!AAXa !QWo "itll rea's-tMs11 Orogfam (s e• 2C1 i� ps 3} for in ad d 00131 tee. �.. Lessee Signature l a Pitney Bowes Signalure t!�`i~y e .v►� 4 V �� 1 \, e 1. �....��.. >,d n t Print Name CG Is�-�� rv.c� �Ac��`f►f fQL b 0-G'-0 r,---_(-r.4. , ._ :.. t.1R..w_ .- _►mot_ _ Title Tina - Ck 1 3 A 15 Email Address V Sales Information Michael Pennellatore Account Rep Name Pisiricl Office 9s:3-1 1 n11 Ja, Slat) of In4Usa Canlnd ASA I 1 2%; 4P•t Ili IL `.Aal:-t 0 Pa-1 B rats G^rv:nf ramps !or rJJ I.—.0 ttdrmt.A .sad.l." , r'IPX5 St"-I->11,14 +a LMP f�—,--3-1,l A.Jra,� ,ili'lfleic•n Oil lr- E-MaITH Contract- No. 85--2015 ';zQ 14 P lrei Bot, 4S ir,;. Alf, rTA rdairaet t"n5'13o,se5 P:Y,:Pa;^?[.+,grt'+.IVs'ds•difled a F9 i-'P:l<i7 i:4":Cs htr+:ra Y.fss' ern' 8D3$_GC Information Return for Small Tax -Exempt Govemmental Bona Issues, Leases, and Installment Sales OMB W. V45-0720 (I=}•Jawar,,2v+2) IF- Under Internal Revenue Codesecfionld9(e) €7 331MF4(iiJYpTeim) aF� east t"c��tJE S?NSy Caution: HfWia:ue prise of Bee issue is$100.000ormnrp, use Form 8038-G. ' Reporting Authority Check Box if Amended Return t. t_r:=fsRan£ 2. Lasuef=drQl4ff i7=Rh{taZSrrftp'$�lt ir} CITY OF RICHMOND '� �� ito 0c-.) i 1 & thislh�raDdstF=t{or1'O. xif mail isnxitf=fi'F:e3tostrEEta3;ra Romi(Sule 2380 LIBERTY AVE 4. City,,taxa,af ston€e•stataar371Pco e 6. Reportnufr&-r(For IRELb. Ci1Y) '=1 �. NarRa axZd�=OT Otfxf Ol�7��r£.`�i�+�?�es-'_Ot"fs_"-S'f Of fi�S[�`rri:�7lils?;�i t=r&iR .'{[y1�S�,2 i.�: �u7 Ca'�;'7r M4i2 i313ri43C��4 �. TflE�i'F.CIl2 nf3n'ti�f 4fD�CcrOffs]3�f2F1=5entahSP_ Descrtpfton ofobligations Chockone. a single issue M ora consolidated return ❑ Ba Issue price of ot>llgatian(s) (see imtructions)............................................... . b I s ua date (singlo issue) or calendar date (co nsol khto d) Enter date in m-71ddtyyyy format (forexariple, 0110112000) (see instructions) 9 Amount of the reported cbligatbri(s) to line na that is, a For leamsfor Vehicles. ... b For leases for office equipment ........................•................................ c For lewesfor real prop" ............................................................ d Forleases for other (see Instructions).................................................... o For bankloansforvehicles...............•............................. ................ f For bank loans for office equipmrt..................................................... . g For bank roams for real property . ............ • .............. • ................... . h For Bankloansforother(seeImtrllctions)................................................. I Used to refund prior issue(s).............. . ........... • .......... j Representings loan from the prooeeds afanothertay-exemptobligabon (%rexample, bond bank)..... kOther.................................••...............................•........... 10 If the issuer has designated any issLle unler action 265(bX3)(B;(i)(3II), (srm.11 isct_ier exceptions), check this box....... • ..... �- ❑ 11 If the ismer has elected to pay a penalty in lieu of arbitrage rebate, rtlock ibis bax (see instructions) ....................... jp- ❑ 12 Vendor's orbark's name: PITNFY BOINESINC __----- 13 Venlor'sorbark's employer identification nLtribec 0 Oi ; Q 4 9 5 0 5 0 Signature Lkiderpe ralftscfp=qu;;Id=_dar^that1tateaxan,va#thsrelar.arAaewm�qn}}rrec.sd sW`s_stmK and and bzbat theyafetr e, con_ct, aa�4mr�apbta I irtha dadare that Iroricmtb the tR�6 d�� bsua_ of tra i eais r turn infsrna6am, asr ce-�yio and prore=-sWh fa nil,tothewsor,(s)thatIha'&_Mthor¢e aba%s. S•�n! % !L�► Consent `�� Cf -ry CO,u r,126e-4-CY sraratrt> od iss:e se, �r ze,i �pre_ai tfr=_ Dot_ T1p•=_ or print Dania and G t!e €yinl.T}y=prepae s name Preparers signature Lit Cfrxx ❑ PTIN Paid if s&enploTei UseOnlys Frntsr,5,:a � FintsF3td Fr nts aide-ss � Rtwr=_ �• General Instructions S'ccticrt re, arirces ore to ff;e Mdenrol r Avenue C oc_- urfess oltkrMae riote& vvh ct's N eW The IRS has creswd apage m IRSgovfor hformation about the Gram €D38 series and is Irr-trucd'gns, at vsAttia`s.y0Vforra8W8. Information about amf future dzvEbpmeonts affecting the Form EM8 swiss f;uch as l=gbla.8co enacted after wtie ralFase it) wit he pcSted on that page. Purpme of Form Form 8D38-GC i; used by the issuers nf tax- exempt gorernrr,enbt obligations to pxo'vide the IRS Wth the hfarmadon regiITed by section 149(e) and to rroalcr the vNuirEments cfsactions 141 thicugh 150. Who Must Fite 15sucrs of tax-exempt garerrin,ental obligstians wHh 6sue pfrcEs cf less than $100,ODD must file Form 2038-GC. Issuets of a tax-exempt gavernmmntsl obligstbn Wth an 6sue price d S100,000 cc more must file Forn, 8028.6. Infornistion Ret,rn fcrr Tax-&Empt Gvvernn>cn— FiRrg a separate retum fora single issue. Issuers hove fha cptim to file a set crate Form 803E-GC fur any tax-exempt gtrternmr-Mal M.9uticn with an 6sue pfhs of less than $400,000, n issuer of a tax-exempt hand used to finance cons1ruC11Z(1 ExpenditurrS must file- a sepxatee Form Q38-GC for esch Issue to giw n t:troa to the IRS t hst an Erection',{as msda to pay a panai j in lieu of arbtiage rehaLe (see the linen instructions). F(Gng a consai dated return for muftipte tssU s. For el tax-exempt governmental cbNjsticns with issue priCEs of less than $100,rtrr0 that are rict raperted on a separate, Form 30?3-CC, an bsuer mst fii=_ a consdida1W lrrFvmutian rehrrn Including at such bsuo 6sued within lheDs]Ender year. Thus, an !saw may file a separate Form £03& GC for each cf a nun"r d small issues sndreport theremsf,drr r•fsmall t;sues issued durilg the, Calendar year nn Me consolidated Form &038-GC. Hoe Fvef, if 1ha hsue 6 a censtruction issue, a separate Firm &03&W must be filed to gore the IRS wtc* d fhb election to pay a penalty in feu of arbitrage, (ebate. Cat. No.641t1&& FormW3&GC fmv.1-2012) Form8738-Cu (R_v. f•2'7m2) When To File To Ilea separate return fora single Issue, file Farm 8028-GC on or bebre the ISth day of the second calendarmonth aflarthe dose of the calendar quarter In Mich the issue is tssu ed- To fle a consolidated return for mutipie issues, fib Form 8038-GC on or bafcre Februaryl5th ofthecalondaryearfoHoving the yonrin which the issue's issued. Late Filing. An issuer may be granted an extension of lime to file Foam 8038-GC under section 3 of Rev. Proc. M248, 2002-37 IKE.5131, Ifit Lsdebemminedthatthe fiifareto fie on tine is not due to willful neglect. Type OF print at the top of the bmm, 'Request for Relief under section 3 of Rev. Proc 2002-48." Attach b the Form e038-GC a letter briefly stating why the form vas not submitted to the IRS on time. Also indicate Mether the obligation in question Is under examinalian by the IRS. Do not submit copies of any bond documents, )eases, ar installment sale do cements. See H here To Fla nerd. Where To File He Form 8038-GC, and any attachments, ,Milli the Department oftheTreasury, Inlsmal Revenue Service Center, Ogden, UT84201. Private defivery services. You can use certain private dell,ery services designated by, the IRS to meet the 'timely mailing as thiela, fiinglpayings rule br tax returns and payments. These private delivery serJces Indud e onlylha btiov,ing: DHL Express LOHL): Dhl_Same Dry Servfm Federal Express (FedEx): FedEx Prlody Ovemlght, FedExStandard Ovcmn ht, FedEx Way. FedEX International prbdty, and FedEx International First. - United Parcel Seorlce ,ilrg5 UPS Ne)3 pay Air. UPS beet Day Air SavEr, UPS 2nd Day Ale, UPS 2rd Day Alt AM, UPS Woddwide Exrress Plus, and UFSliyorlowide E.xprss. The private dclh-ery service can tell you he veto get udttao praofofthemalling date. Other Forms That May Be Required For rebating art:itrage (or paying a penaty in lieu of arbitrage rrbate) to the Federal Gcvernment, use Form 8038T, Arbitrage Rebate, Yield Reduction and Ponnity in Lieu of 4bi!rage Rebate, For private activity bonds, use Form 8038, hibmiatbn Return for xempt PrivateAdivU}, Bond Issues For a twKFexempt governmental abfigaUtm tsfth an issue price of s100,0o0 ormore, use -Form 9038-G. Rounding to Whole Dollars You may showt he m en ey item s e n this return as vh lie-dalla r amounts. To do so, drop any -.--a m ou nt.l cgs t h an-C 0- cents -an d I ncroose-any— - - amount from $0 to W cents to the next higher dolor. Definitions Obligations This refers to a single tax. exempt governmental obligatico if Form 3038-GC is used forseparate reporting orto mutiipta tax-exempt governmental obligatons i€the form is used forconsofidatad reporting. Tax-eterrp t obligation. This Is any obligation inclmding a bond, Installment purchase agreement or financial lease, on %.filch the interest is 0zluded from income undersecticn 103, Tax-exemptgovernnmental obffgatiorm. A<ta:4 exempt obligation that is not a p0eate activity bend (see below) is a tat-e:ccmpt governmental obllgaUon. This includes a band issued bya qualified volunteer fie department under section 150(e). Private activlly band. This includes an Obligation Issued as part of an issue In vh tch: More than 10% of the proceeds are to be used foranyprivate activitybuslness use, and More than 1G% of the payment ofprindpal o r interest of the issue is ether (a) secured by an interest in popery to be used for a private business use (or payments Iorsuch property) or (b) ba be dedyad from payments br Property, (or boorov,ed money) used for a p rr.a to bu sin ess use, it also induces a bond, the proceeds of which (a) are to be used to make or' finance loans (other Ulan loans described In section 141(c)(2)) to persons other than governmental units and t'b) exceeds the lesser of%oflhe proceeds orS5nulibn. Issue. Generally, oblgatbns are treated as part oflhe same issue only ifthey are issued bythe samo issuer, on the same date, and as part of a single transaction, or a series of related transactions. Hovover, obligations Issued during the same calendar year (a) undera ban agreementuOder vhich amounts are to be advancedperfodirdily(a d av,Ldovn loan') or 0) v.ith a term not exceeding 270 days, niay be treated as part of the same issue lithe cbffgatloos are equaQ and ratably secured wider a single indonture or loan agreement and are Issued raider a common financing arrangement (brexample, undarthe same offdalstatemermt pariodleaRy updated to reflact changing factual ctcumsfances), Also, for obligations issued under a dravl doyen loan that meets the requirements of the preceding sentence, obligations Issued during dlferent calendar years may be treated as part of the same issue if all of the amounts to be aMnced under the drayMo;ar, loan are reasonably expected to be arhranced vthin 3 yours of the date of issue of the first obligation. Ukevise, obligations (ether than private activity bonds) Issued under a single agreement that is in the form of a lease cc instalment sale may be treated as part ofthe some issue If MI of the property covered by that agreement Is reasonably expected to be d0vered %,Ahfn 3 yearsofthe date of issue of the first obligation. , Arbitrage rebate, Generally, interest on a state or local bond'is'not tax-exempt unless the issuer of the bond rebates to the United States arE,f;rage prnNa earned from investing proceeds of the bond Iri higher }delt5no n onpuMo-se lnvestments. See section 148(t), Construction issue, This is an Is aftat- ex,empt bonds that meets bath of the fallov,ing conditions: Aaae 2 f. At least 75% ofth a avalable construction proceeds of the Issue are to be used for cnnstruclion expenditures Wth respect to Property to be ovned ty a govemmar¢al unit era 501(c,'(3) organization, and 2, Al of the bonds that are part of the issue are qualified 501((;X3) bonds, bonds that are not private activity bonds, or prvate activity bends'ssuedto financepropartyto be oyned by a governmental unit or a 501(01(3) organization. In l e u o f rebati ng any arbitrage that maybe ov,ed to the Unitad States, the Issuer of a construction Issuo may make an irrevocable election to pay a penalty. The penalty fs equal to 1.1.2% of the amount of construction proceeds that do not meet certain spending requirements. See section 14?�0(4XC) and the instructions Warm 8036 T. Specific Instructions In general, a Fenn 80-W-13C must be completed on the basis of available information and reasonable e4pedations as ai hadate of Issue. Hoverer, farms that are fled on a consclidated basis may be completed on Ile basis ofhbrmatfon reacify available to the Issuer at time dose of the calendar year to which the form relates, supplemented by estimates made In good fith. Part 1—Reporting Authority Amended retum, An Issuer may file an amended return to change or add to the information reported an a previously fled return for Hie same date of issue. If you are flhq to correct errors ofchange a previously fled felum, check the 14_merx4ed Pebm, box: h the heading of the bmi. The amended return must provide all the information reported on the originof return, In addition to the new corrected krformaton. Attach an eogalanatlon of Urea reason for the amended return and %cite across the top 'Arnended Return E:tpfanattan." Line f. The issuer's name is th a name of the en* Muing he obligations, not the name of the entity' receiving the benefit of the inancing. In the case of a base or Installment sale, Hie issuer is tho lessee o r purch ase r. --Line 2. An Issuer that does not have an employer identification number (1WI) should apply for one on Farm SS-4, Application for Employer Identlfca6an dumber. You can get thisferm onthe IRS v.ebsita at IRS.govorby calling 9-800-TAXFORt,t (1-800-829L-387E� You may receive an. Eitl ty telephone by blfoving the instructions for Form SS-4. Lines 3 and 4, Enter the issuer's address or th e a ddress of ih a de�fgnated contact person fisted on fine S. If the Issuorvishes ba use its own address and the issuer recetres its mail in care of a turd party authofi?ed representative (such as an accountant or altorney)Lenter on the street address line - 'G10'follovad by the third parly's name and street address or P.O. box Inctidi-, the suite, room, or other unt number after the street address.lfthe postoirce does notdeflver mail to the street address and the Is -suer has a P.D. bo:{ showthebox numberinsteadofthe Form alg-GC (Rev, 1-2017) street address. If a dhange in a ddress occu is after the return Is filed, use Form 3522, Change ofAddress, to notify the IRS of the nova dl&ess, note. The aairess entered on lines 3 and 4 is the address the IRS %%ll use. fcr all ;,ritten communications regarding the processing of this return, inducting any notices. By authori2ing a personotherthan an authorized officer or other employee of the issuer to communicate vAh the IRS andvhcm the IRS may contact about this return, the fssuler authorizes the IRS to communicate directly m0h the inciNdual fisted on Erie 8, v,tese address IB entered on Ines 3 and 4 and consents to disclose the Issuers return In€brmaticn to that individual, as necessary, to process this return, Line 6, This line Is br IRS use only, Do not male any ehtriesin this bax Pan iE---description of Obligations Check the appropriate box designating this as it rdum on a single Issue basis or a consolidated return basis, Line Sa, The issue price of obligations Is generally determined under Regulations section 1.148=1(b), Thus, vhen issued for cash, the issue price 's the price at Mich. a mbstantlal amount of the obligations are sold to the ter No. To determine the issue prim of an cbligation issued for property, see sections 1273 and 1274 and the related regulations. Line 8h. For a single issue, enter the dale of Issue (fear example, a21i6r2010 for a stngla issue issued on 1.1arch 15, 2010), generally the date on vhlch the issuer physically exchanges the bonds that are part of the issua, for the underyMees (or other purchaser's) funds; for a lease orinstaifinent sate, enter the date Interest starts to accrue, For sues repo ited on a consolidated basis, enter the first day ofthe calendar year during vhich the obligations vere issued (for example, for calendar year 2010, enter 011ai1L010). Lines 9a through 911 Complctethis section If property other than cash is a'Vhangad br the obligation, br axampla, acquiring a potfhe car, a fire lrucfi, or telephone equipment through a series of monthly payments. (This type of obligation is sometintos referred to as a `munidpal lease. Also complete this section if real property Is diraclly ao�uired In exchange far an abilgation to make periodic pa}aner>ts of interest and principal, Do not complete lines 9a through 94 If the proceeds of an cbligation are received In the form of cash even if the term 1aasa- Is used In the title of the Issue. For lines 9a through 9d, enter the amount on the appropriate fine that represents a lease or installment purchase. For line lid, enter the type of item --that is leased. For lines 8e through 9h, enter the amount on the appropriate Pro that represents a bank loan. For fine 9h, enterthe type of bank loan. Litres 9i and 9l, For line Si, enter the amount of the proceeds that %-ill be used to pay prindpal, interest, or call premium -on any other Issue of bends, Including proceeds that v;ill be used to fund an escrovr account for this purpose, Soveral lines may apply to a Particular obligation. For oxample, report on lines 9i and 9i Obligations used m refund prior issues vhh;h represent loans from the prccaeds of anoth artax-exempt obtigaticn. Line 9k, Enteron Iine 9k the amount on line 8a that does not represent an obfgation de-Wrlbod on tines 98 through %. Line 10. cheat this Lox if dhr: i;su-Er has designated any Issue as a "smelt Gsuer Exception' under sedcn 2Wb)(3;(2)0]Qllj. Line 11. Check, this box if the issue is a construction 'rive an d an irrevocable election to pay a penalty in fiun ofarblirage rebate has been made on or behre the date the bonds v,ere Issued. The penalty is payiblo vith a Form BG28-T br each 6-month period after the date the bonds are issued. Do not make any paymBnt of penalty in lieu of rebate vfh' Forth PA38-GC, See Rev. Prot 32-2Z 1592-1 C.B. 726, for rules regardng the 'election document.' Line 12, Fnterthe name 0fthelien dororbank v.ho Is a party to the instalment purchase agreement, loan, or financiat lease, If there are multiple vendors or banks, the Issuer should attach a schedule. Line 11 Enter the employer identification number of the vendor or bank oho 's a patty to the installment purchase agreement, loan, or financial lease. Ifthere are multiple vendors or banks, the Issuorshculd attach a schedulo, Sirgnatureand Consent An authorized representative of the Issuer must sign Farm 803a-GC and any applicable ceriiication. Also pant the name and title of the person signing Form 8038-GC. The authorized representative ofthe issuer signing this fomh must hale the authorityta consent to the dscbsure of the issuer's return information, as necessary to process this return, to tine person(s) that has been de_ggna ted In this firm. Note. I f the Issuer authorizes In Ire 8 the IRS to communicate mh a person otherthan Lin officer or other employee of the Issuer, (such authorization shall include Contact both fin vriting regafdless of tha address ea tared in fines 3 and 4, and bytelephone) bysign] ng this form, the Issuer's authorized representatke consents to the dsdesure of the Issuer's retum Infommation, as necessary to process this return, to such person. Paid Preparer if an authorized representatrre ofthe Issuer filled in its return, the paid preparer's space should remain blank. Anyone Who prepares the return but does not charge the organization should not sign Bee return. Certain others vhoprepare the return should nut sign, For example, it regular, 041me employee of the issuer, such as, a derk, secretary, etc, should notsign. Generaffy, anyone %she is paid 10 prepare a return must sign it and Elf in the other blanks in the Fa-1 FreparerUse Ony area ofthe return. A paid preparer cannot use a socsl security n umber in the Pad Freparer Use Cmy box. The paid prcparer must use a preparer tax Identification number (PTIII} if the paid preparerlssalf"enlployed, ihepreparershould enter his or h er address fin 1h a box Thep aid preparermList: Sign the. return In the space provided fcrthe preparer'ssignature, and Give a copy afthe return to the Issuer Paperwork Reduction Act Notice We ask for the information on tits form to carry out the internal Revenue lays of the United States. You are required to glue us the information. We need it to ensure that yuu are complying vdth these fays. You are not roqu�ed to provide the information requested on a form that Is suNact to the Papmn ork Reduction Act unless the form cltsplaysa valid OMB control number. Books or records relating to a form or fts lastrudfons must be reta fined as Icng as their Contents may become material in the administration of any Internal Revenue lave Generally, tax returns and return tnfnrmatm areconfidentiat asrequrlredbysection6103. The time needed to complete and file this farm vale vary depending on hdMdual circumstances. Tho astimated average time is: Lea m ing a bou t the law orlhe form . . . . 4 hr, 48 min. P repaiing th eform .... 2hr.,22min. Copying, assembling, and sending the form to the IRS . 2 hr., 34 min. If you hake cofr Er" mho :ring the accuracy cf thime time estimiss or suggestius for rmskfrV thh fern stmplar, tve,vodd be peppy to hest from You. You can write to iFe Internal Rarenue Sjvfce. Tax Pfcducts Cccrdinatfng ccnrnatteA SE:LV:CAR;NIR..T:hi:s, 1111 CcnsdtctionAve. thly',IR-S5oB, Washtngtco, CC 22044. Do not sand the form io thi5 ad&esi. Jr* lead, s is Hhhem To Rla.