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EXHIBIT (a)(3)
SUBSTITUTE FORM W-9
SUBSTITUTE FORM W-9 REQUEST FOR
TAXPAYER IDENTIFICATION NUMBER AND CERTIFICATION
PAYER'S NAME: UMB BANK, N.A.
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Name as shown on account (if joint, list first and circle name of the person or entity whose number you enter below):
Name
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Address
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City, State and Zip Code
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SUBSTITUTE TAXPAYER IDENTIFICATION NO.
FORM W-9 FOR ALL ACCOUNTS Social Security Number
Department of the Treasury Enter your taxpayer identification ----------------------------------
Internal Revenue Service number in the appropriate box.
Payer's Request for For most individuals this is your Employer Identification No.
Taxpayer Identification Number (TIN) social security number. If you do
not have a number, see the enclosed ----------------------------------
Guidelines.
Note: If the account is more than
one name, see the chart in the
enclosed Guideline on which number
to give the payor.
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CERTIFICATION - 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 either because 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 the
IRS has notified me that I am no longer subject to backup withholding.
CERTIFICATION INFORMATION - You must cross out Item (2) above if you have been notified by the IRS that you are subject to
backup withholding because of under reporting interest on dividends on your tax returns. However, if after being notified by
the IRS that you were subject to backup withholding you received another notification from the IRS that you are no longer
subject to backup withholding, do not cross out Item (2). The certification requirement does not apply to real estate
transactions, mortgage interest paid, the acquisition or abandonment of secured property, contributions as to an individual
retirement account, and payments other than interest and dividend. Also see "Signing the Certification" under "Specific
Instructions" in the enclosed Guidelines.
SIGNATURE: DATE:
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NOTE: FAILURE TO COMPLETE AND RETURN THIS FORM MAY RESULT IN BACKUP WITHHOLDING, PLEASE REVIEW THE ENCLOSED GUIDELINES FOR
CERTIFICATION OF TAXPAYER IDENTIFICATION NUMBER ON SUBSTITUTE FORM W-9 FOR ADDITIONAL DETAILS YOU MUST COMPLETE THE FOLLOWING
CERTIFICATE IF YOU WROTE "APPLIED FOR" IN THE SPACE FOR THE TIN" ON SUBSTITUTE FORM W-9.
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CERTIFICATE OF AWAITING TAXPAYER IDENTIFICATION NUMBER
I certify under the penalty of perjury that a taxpayer identification number has not been issued to me and either (a) I have
mailed an application to receive a taxpayer identification number to the appropriate Internal Revenue Service Center or
Social Security Administration Office or (b) I intend to mail or deliver an application in the near future. I understand that
if I do not provide a taxpayer identification number within 60 days, 31% of all reportable payments made to me thereafter will
be withheld until I provide a number.
SIGNATURE: DATE:
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