Tax Compliance Addendum

TAX COMPLIANCE ADDENDUM

This Tax Compliance Addendum (the Addendum) is entered into between the undersigned Taxpayer and the Recipient to supplement and govern tax reporting, withholding and related compliance obligations. Client Name:

Taxpayer Identification

Entity Type (check all that apply)

Individual / Sole Proprietor C Corp S Corp Partnership

Trust / Estate LLC Other

Taxpayer Identification Number (TIN)

Provide either Social Security Number (SSN) or Employer Identification Number (EIN). Social Security Number:

Employer Identification Number:

Applicable Tax Periods and Effective Date

Effective Date of this Addendum:

Representations, Certifications and Covenants

The Taxpayer hereby represents, warrants and certifies the following under penalty of perjury:

1. The TIN provided above is correct and belongs to the Taxpayer identified in this Addendum; the Taxpayer will notify the Recipient promptly of any change to the TIN or taxpayer name.

2. The Taxpayer is not currently subject to backup withholding as a result of a failure to report interest or dividends, except as disclosed below. If the Taxpayer is subject to backup withholding, check here: and provide explanation:

3. The Taxpayer will timely provide any new or corrected TIN, certifications, forms or documentation requested by the Recipient necessary to meet federal, state or local tax reporting and withholding obligations.

4. The Taxpayer will cooperate with audits, examinations and inquiries by supplying documentation and reasonable assistance related to amounts reported, withheld, remitted, or otherwise affecting tax compliance.

5. The Taxpayer acknowledges that failure to provide accurate information or to comply with tax reporting and withholding requirements may result in mandatory withholding, tax withholding at source, or other remedies authorized by law, and the Taxpayer shall indemnify and hold the Recipient harmless for any taxes, penalties or interest resulting directly from Taxpayer-supplied incorrect information, except to the extent caused by Recipient's gross negligence or willful misconduct.

Disclosure and Consent

The Taxpayer authorizes the Recipient to disclose the Taxpayer's TIN, name, tax classification, and any information supplied in this Addendum to governmental authorities and other parties to the extent required or permitted by law for tax reporting, withholding, compliance, or audit purposes. The Taxpayer consents to such disclosures and acknowledges that copies of documentation may be retained by the Recipient.

Recordkeeping and Audit Assistance

The Taxpayer agrees to retain and provide upon request records sufficient to substantiate the information contained in this Addendum for a period of not less than four (4) years from the Effective Date or such longer period as required by applicable law, and to provide reasonable assistance during any tax examination that implicates amounts reported to or withheld by the Recipient.

Certifications and Perjury Statement

By signing below, the Taxpayer certifies under penalty of perjury that the information provided in this Addendum is true, correct and complete to the best of the Taxpayer's knowledge and that the Taxpayer is authorized to provide the information and make the certifications contained herein.

The numbered representations above constitute material certifications. The Taxpayer understands that providing false information or failing to furnish required information may subject the Taxpayer to civil or criminal penalties under applicable tax laws.

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