Certification and Signature
Under penalties of perjury, I declare that the payee providing this certification is not a United States citizen or resident of the United States as determined for U.S. federal tax purposes, that the income to which this certification relates is not effectively connected with the conduct of a trade or business in the United States, and that the undersigned has examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. Furthermore, I authorize this form to be provided to any person that has control, receipt, or custody of the payment to which I am entitled or any person that can disburse or make the payments to which I am entitled.
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