Thereby consent to include in my gross income as now hereafter provided in the federal income tax laws, the stated dollar amount of each written notice of allocation which receive from Belgrade Co-op. With respect to my patronage occurring during the current and all subsequent taxable years of this cooperative. This consent shall be revocable by me at any time in writing.
Certification Under penalties of perjury. certify that (1) The number shown on this form is my correct taxpayer ID number (or am waiting for a number to be issued to me and(2)I amnot subject to backup withholding because: (a) am exempt from backup withholding or (b) have not been notified by the IRS that am subject to backup withholding Certification Instructions You must cross out item (2) above if you have been notified by the IRS that you are currently subject to backup withholding because of underreporting interest or dividends on your tax return. However, if after being notified by the IRS that you were subject to backup withholding. you receive another notification from the IRS that you are no longer subject to backup withholding, do not cross out item (2 The IRS does not require your consent to any provision of this document other than the certification requiredto avoid backup withholding.