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Commercial Facade Grant Application
phoenit, AZ
Onganization Name: Denier lumber * Hlardusare
a
phone: (923) ot - 5489 2ephone: 4p 54-4212 ———
Email: _Prew vaclambec at 6) lama!» Com)
Contact Name and Title: Sere Nunn Lead Santer —
Scope of Work:
Be-paint exterior of. building on_the west east ard South sicles,
Bat will be twe oie wit & dark brew and don _(ambination
Penching Lacing Ameunt, we would lock inte replacing the
wretel Caoking and olor matehihg it to tee \palding
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these _aesthehe iwprowe.mend will aid
Vue te bur location ,
is bputlding unikeconcty af ional appea behween, touon hal,
Librocy_g comontn hy lender and He Lwuuber yaro
Funding Amount Requested: ? Aunt pitojecd total ecdimate df do he.
Ag eee #9 00 Gren is requested
Authorized Agency Representative Title Dat
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BUSINESS LOCATION.
ORIGINATION DAT 9
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2025 LICENSE EXPIRATION DATE:
“SYP OF PERMIT:
Jorn named is hereby. penmaisd,
ISSUED LO: Premier b
Gonzalez }r., Jesus Hr.
188 V. Vasapat St
wwickenburg NZ: BAB90
OWNER:
MAM. TO:
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Docusign Lavelope IU, 101DAGAB-7L.C9-4621 -B/BB-C 19857841 LBY
om W-9
(Mev October 2018)
Department of the Treasury
lateral Revanua Service
Request for Taxpayer
Identification Number and Certification
> Go to www.irs.gov/FormW9 for instructions and the latest information,
Give Form to the
requester. Do not
sand to the [RS.
1 Name {as shown on your Income tax retum), Name is required on this line; do not leave this ne blank.
sesus MN. Gon2a fee oe
2 Business name/disragarded entity namo, d different from above
Preeuer bomber < Hercluare,
on on
followjrg seven boxes.
Individual/sote proctiator or im] C Gorporation Oo S Corporation
single-member LLC
mr stena
3 Check appropriate box for federal tax classification of the person whose names entered on ine 1. Check only one of the
4 Exemptions (codes apply only to
Certain entities, not individuals; soo
Instructions on page 3}:
OQ) Partnership 01 trusvestate
Exampt payee code {if any)
(1 Umied labitity company. Enter the tax classification (CxC corporation, S=S corporation, PaPartnership} >
Note: Check the appropriate box in the line above for tha tax classification of tie single-member aver. Oo not chack
LLC if the LUC Is Classified as a single-member LLC that Is disregarded from the owner unless the owner of the LLC is
anothor ULC that is not disregarded trom the awnar for U.S, federal lax purposes. Otherwise, a single-momber ULC that
is disregarded from the owner should check the appropriate box for the tax classification of its owner.
Exemption from FATCA reporting
code ¢f any)
Lares tn merce cate mnineapnart co sears th 14% |
fy Stier jac waatectons; >
S Address (number, street, and apt. or suite no.) See instructions,
($6 EF Navagar S+-
Print or type.
See Specific Instructions on page 3.
i
Requester’s name and address {optional
© City, stato, and ZIP coo
Ulickenbun , AX SS 370
Do Ter SEs
7 Ust account number{s}+sdre (optional)
|
Taxpayer Identification Number (TIN)
Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, fora
resident alien, sole proprietor, or disregarded entity, see the instructions for Part |, later. For other
entities, it Is your employer identification number (EIN). If you do not have number, see How fo geta
TIN, later.
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
Number To Give the Requester for guidelines on whose number to enter.
or
‘Employer Identification number
ASL TASE UU 4
EEG Certification
Under penaities of perjury, | certify that:
4. The number shown on this form is my correct taxpayer Identification number (or | am waiting for a number to de issued to me); and
2. lam not subject to backup withholding because: (a) | am exempt
Service (RS) that | am subject to backup withholding as a result of a failure to report all
no longer subject to backup withholding; and
3. lamaU.S. citizen or other U.S. person (defined below); and
from backup withholding, or (b} | have not been notified by ihe Intemal Revenue
interest or dividends, or (c) the IRS has notified me that | am
4, The FATCA code(s) entered on this form (if any) indicating that | am exempt from FATGA reporting !s correct.
Certification instructions. You must cross out
you have failed to report all interest and dividends on your tax retum. For re:
acquisition or abandonment of secured property, cancellation of debt, contri
item 2 above if you have been notified by the {RS that you are currently subject to backup withholding because
aj estate transactions, item 2 does not apply. For mortgage interest paid,
butions te an individual retirement arrangement (IRA), and generally, payments
but you must provide your correct TIN. See the instructions for Part il, later.
other than interest and dividends, you are not required to sign the certification,
Sign
6-14 -2s 7
Date
it
Here | us person Cc 2. KaL2-L 1
General Instructions DZ
Section references are to the Internal Revenue Code unless otherwise
noted.
Future developments. For the latest information about developments.
related to Form W-9 and its instructions, such as legislation enacted
after they were published, go to www. irs. gov/FormW9,
Purpose of Form
An individual or entity (Form W-S 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 (TIN), adoption
taxpayer identification number {ATIN), of 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 1099-INT (interest eamed or paid)
* Form 1099-DIV (dividends, including those from stocks or mutual
funds)
* Form 1099-MISC (various types of income, prizes, awards, or gross
proceeds)
« For 1099-B (stock or mutual fund sales and certain other
transactions by brokers)
»* Form 1099-S (proceeds trom real estate transactions)
© Form 1099-K (merchant card and third party network transactions)
* Form 1098 (home mortgage interest), 1098-E (student loan interest),
1098-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
allen), to provide your correct TIN.
if you do not retum Form W-9 to the requester with a TIN, you might
be subject to backup withholding. See What is backup withholding,
later.
Cat, No. 10231X
Form W-9 (Rev. 10-2018)