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N the Certification, but you must provide your correct TIN Signature of Vendor Representative or Individual Payee Date Title of individual signing form for company Vendor/Payee (Same as Company Name from Page 1) IRS Instructions Regarding 1099 MISC Reporting IRS Instructions regarding 1099 MISC reporting are posted on the IRS website at: http://www.irs.gov//instructions/i1099msc/index.html. Reportable payments include (a) royalties or broker payments in lieu of dividends or tax-exempt intere.

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