Exhibit 10.4

 

FIRPTA AFFIDAVIT

 

Section 1445 of the Internal Revenue Code of 1986, as amended (the “Code”)
provides that a transferee of a U.S. real property interest must withhold tax if
the transferor is a foreign person. To inform Reliability Incorporated, a Texas
corporation (the “Transferee”) that withholding of tax is not required upon the
disposition of interests in The Maslow Media Group, Inc., a Virginia corporation
(the “Company”) by the undersigned transferor (the “Transferor”), the
undersigned hereby certifies the following on behalf of Transferor:

1.Transferor is not a “foreign person” (as defined in the Code and Treasury
Regulations).

2.       Transferor’s U.S. taxpayer identification number is
________________________.

3.Transferor’s address is :________________________

  

 

4. Transferor 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, I declare that I have examined this certification
and to the best of my knowledge and belief it is true, correct and complete, and
I further declare that I have authority to sign this document on behalf of
Transferor.

 

Dated: _______, 2019

 

TRANSFEROR NAME: _____________________________________

 

 

By: ______________________________

 

Name: ______________________________

 

Title: ______________________________

(if applicable)