The Lynde and Harry Bradley Foundation, Inc.

Foreign Grantee Tax Withholding Verification

I.	Organization Data:

Applicant Organization:	Hernando de Soto

Payee Organization:

(If different)

Employer ID #: (If applicable)

II.	Patriot Act:

I certify that this organization does NOT employ or deal with any entities or individuals on U.S. government Patriot Act lists, or with any entities or individuals known to support terrorism.

Yes □	No □

III.	Funding of Activities:

X	Grant funds will be used in connection with activities conducted entirely outside the United States. (No withholding required. Go to Section V.)

Grant funds will be used to purchase property. (No withholding required. Go to Section V.)

Grant funds will be used in part or in whole in connection with activities inside the United States.

Examples of U.S. activities: attending a conference, site visit, temporary work or research and similar activities, including travel costs to and from the U.S. and living expenses in the U.S.

(Withholding may be required. Go to Section IV.)

IV.	Exception Test:

The Foundation is required by law to withhold income tax of 30% of the grant funds allocated to activities within the United States. The taxes will be remitted to the U.S. Department of the Treasury. Income tax withholding will not be deducted from the grant if an exception applies. Check below if one of the exceptions apply:

An exception applies under a U.S. tax treaty.

□	Complete and return Form W-8BEN. (In the event a tax identification number must be obtained, please call for Form SS-4.)

□	Attach a statement naming the applicable treaty provision and its application to your organization.

The organization can demonstrate it could qualify as a U.S. tax exempt organization.

□	Complete and return the attached Form W-8EXP.

□	Attach a determination letter from the IRS or opinion of U.S. counsel concluding Section 501(c)(3) exempt status.

No exceptions apply.

Disclose the amount of the funds allocated to activities in the U.S.	% or $

(U.S. dollars)

V.	Purpose of the grant:

•	Will the proceeds of the requested grant be used exclusively for religious, charitable, scientific,

literary or educational purposes?	Yes □	No □

•	Will any of the requested grant funds be used to carry out propaganda or attempt to influence

legislation, to influence the outcome of any election, to carry on any voter registration drive

or invest in a commercial venture?	Yes □	No □

(Signature is Required)	(Title)

Hernando de Soto	6000482

(Printed Name)	(Date)	(Bradley ID#)