Okaloosa County BOCC — March 15, 2016 — The Agency Group invoice — reading text

Cummins Station Phone: 615 564 2580 209 10th Avenue South Suite 511 The Fax: 615 564 2585 Nashville, Tennessee 37203 Booking Agent: Alec Vidmar United States Geoup Lid DEPOSIT INVOICE FOR CONTRACT # 115232 Artist: Chris Janson Promoter: Okaloosa County Show(s): Due Date Venue City May 12, 2016 Emerald Coast Convention Ft. Walton Beach, United States Center Payments: Deposits to The Agency Group Inc. by certified check or bank ACH quoting reference 115232 Due Date Comment Amount Due Mar 19, 2016 50%, 60 days prior 20,000.00 USD Total due 20,000.00 USD Payments by bank ACH to United Talent Agency, LLC quoting reference #115232 Bank: City National Bank 400 N Roxbury Dr, Beverly Hills, California 90210, United States Sort Code: Account #: 123947126 Swift: Currency: USD IBAN #: BIC #: ABA #: 122016066 Transit #: Promoter must advise their bank that funds are to be paid as per the requested currency and not converted by an intermediate or remitting bank Page 1 of 1 Company reg No: Registration No: W-9 Form (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. The Agency Group Inc. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank 2 Business name/disregarded entity name, if different from above D Individual/sole proprietor or C Corporation single-member LLC the tax classification of the single-member owner. D Other (see instructions) » Print or type 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: [:] S Corporation D Partnership D Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) » Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for 4 Exemptions (codes apply only to certain entities, not individuals: see instructions on page 3): Exempt payee code (if any) D Trust/estate Exemption from FATCA reporting code (if any) (Applies o accounts mantained cutside the U.S 5 Address (number, street, and apt. or suite no.) 209 10th Avenue South, Suite 511 Requester’'s name and address (optional) 6 City, state, and ZIP code Nashville, TN 37203 See Specific Instructions on page 2. 7 List account number(s) nere (optional) Taxpayer ldentification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part | instructions on page 3. For other - - entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. [ Social security number or Employer identification number ] 114 -/ 1|18|8(6|9|5]|2 Part i Certification Under penalties of perjury, | certify that: 1. The number shown on this form is my correct taxpayer identification number (or | am waiting for a number to be issued to me); and 2. am not subject to backup withholding because: (a) | am exempt from backup withholding, or (b) | have not been notified by the Internal Revenue Service (IRS) that | am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that | am no longer subject to backup withholding; and 3. lam a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that | am exempt from FATCA reporting is correct. 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 you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and divid}jwu are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. S'gn Signature of Here U.S. person » E74 Date» 3~/7~/% General Instructions Section references are to the Internal Revenue Code unless otherwise noted Future developments. Information about developments affecting Form W-g (such as legislation enacted after we release it) is at www.irs.gov/fw9. Purpose of Form An individual or entity (Form W-9 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 (ITIN}, adoption taxpayer identification number (ATIN), or 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 infermation returns include, but are not limited to, the following: * Form 1099-INT (interest earned 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) * Form 1098-B (stock or mutual fund sales and certain other transactions by brokers) * Form 1099-S (proceeds from real estate transactions) * Form 1089-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 alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withnolding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. Calt. No. 10231X Form W=-9 (Rev. 12-2014)