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10-K
AMAZON COM INC filed this Form 10-K on 01/30/2013
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EXHIBIT G

TO PURCHASE AND SALE AGREEMENT

All Phases

Form of Certificate of Non-Foreign Status

CERTIFICATE OF NON-FOREIGN STATUS

Section 1445 of the Internal Revenue Code provides that a transferee of a U.S. real property interest must withhold tax if the transferor is a foreign person. To inform the transferee that withholding of tax is not required upon the disposition of a U.S. real property interest by the undersigned Seller, the undersigned hereby certifies the following:

 

  1. Seller is not a foreign person, foreign corporation, foreign partnership, foreign trust, or foreign estate (as those items are defined in the Internal Revenue Code and Income Tax Regulations);

 

  2. Seller is not a disregarded entity as defined in Treasury Regulation §1.1445-2(b)(2)(iii);

 

  3. Seller’s Taxpayer Identification Number is:                    

 

  4. Seller’s office address is:

c/o Vulcan Inc.

505 Fifth Avenue South, Suite 900

Seattle, WA 98104-3821

The undersigned understands that this certification may be disclosed to the Internal Revenue Service by transferee and that any false statement contained herein could be punished by fine, imprisonment, or both.

Under penalties of perjury, the undersigned declares that it has examined this certification and to the best of its knowledge and belief it is true, correct and complete.

DATED as of                    , 2012.

 

SELLER:

  [VARIES] LLC, a Washington limited liability company
  By:   City Investors LLC, a Washington limited liability company, its Manager
    By:  

 

    Name:  

 

    Title:  

 

     

 

EXHIBIT G

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