SETTLEMENT AGREEMENT AND GENERAL RELEASE

This Settlement Agreement and General Release (“Agreement”), is made and entered 

into by and between EL CHURRASCO GRILL, LLC on behalf of itself, parent corporations, 

affiliates, subsidiaries, divisions, predecessors, successors, and assigns, joint employers and 

the current and former officers, managing members, directors, owners and agents thereof 

and EVER SANTIZO GONZALEZ, on behalf of himself, his heirs, executors, administrators, 

successors, and assigns and the other corporate entities that he owns and operates (El 

Ranchito Thrift Shop and Big Taco Food Truck (hereinafter collectively, jointly and severally 

referred to throughout this Agreement as “DEFENDANTS” and “Released Parties”), and

LETICIA MATEO, on behalf of herself, herheirs, executors, administrators, successors, and 

assigns (hereinafter “PLAINTIFF MATEO ”). 

WHEREAS, a dispute has arisen between PLAINTIFF MATEO, concerning allegations 

that PLAINTIFF MATEO has made in the Complaint styled as LETICIA MATEO v. EL 

CHURRASCO GRILL, LLC and Ever Santizo Gonzalez, Case No. 20-cv-14163-DMM currently 

pending in the United States District Court for the Southern District of Florida (referred to 

hereafter as the “Lawsuit”); 

WHEREAS, DEFENDANTS deny the validity of PLAINTIFF MATEO claims and deny 

that they are subject to any liability; 

WHEREAS, the parties wish to resolve and settle their differences without resort to 

further litigation; and 

NOW, THEREFORE, in consideration of the foregoing and the mutual covenants and 

agreements set forth herein, which covenants and agreements constitute good and valuable 

consideration, the receipt and sufficiency of which are hereby acknowledged, the parties 

hereto agree to be legally bound by the following terms and conditions, which constitute full 

settlement of any and all disputes between them: 

1. Recitals. The parties acknowledge that the “WHEREAS” clauses preceding 

Paragraph 1 are true and correct, and are incorporated herein as material parts to this 

Agreement. 

2. Consideration. In consideration for signing this Agreement and compliance 

with the promises made herein, DEFENDANT EL CHURRASCO GRILL, LLC (on behalf of all 

parties to the Lawsuit) shall pay to PLAINTIFF MATEO and her attorney the total sum of 

Twelve Thousand Dollars ($12,000.00) which shall be allocated as follows: 

a. Five Thousand Dollars ($5,000.00) of the total settlement amount has 

been apportioned to the Plaintiff for which two checks shall be issued to her. One check 

made payable to LETICIA MATEO shall be in the amount of Two-Thousand Five Hundred 

Dollars ($2,500.00) less applicable tax deductions for which a W-2 shall be issued and a 

second check made payable to LETICIA MATEO in the amount of Two-Thousand Five 

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 1 of 10
[ 2 ]

Hundred Dollars ($2,500.00) for which a 1099 shall be issued. The amount of the second 

check has been attributed to the liquidated damages arising from the FLSA claim, and for a 

general release of all claims against the Released Parties. 

b. Seven Thousand Dollars ($7,000.00) has been apportioned for 

attorney’s fees and costs and shall be paid to Law Offices of Zandro E. Palma, P.A. for which 

a 1099 shall be issued. 

c. The settlement proceeds set forth in paragraph 2(a) and 2(b) shall be 

payable within ten (10) days from the date of the Court’s Order approving the parties’ 

settlement. However, if the revocation period has not expired by the deadline (10 days from 

the Court’s Order of Approval), counsel for PLAINTIFF MATEO shall hold the settlement 

checks in escrow until the seven-day revocation period has expired. 

 

d. PLAINTIFF MATEO shall submit a signed Form W-4 and signed W-9 

form at the time he provides a signed copy of the Agreement to counsel for DEFENDANTS. 

At the same time, Law Offices of Zandro E. Palma, P.A., counsel for Plaintiff, shall also submit 

a signed Form W-9 to counsel for DEFENDANTS 

e. Any employee tax obligation arising from the payments made to 

PLAINTIFF MATEO under subparagraph 2(a) and 2(b) of this Agreement will be PLAINTIFF 

MATEO ’s sole responsibility. PLAINTIFF MATEO hereby agrees that in the event the United 

States Internal Revenue Service, or any federal, state or local government agency requires

DEFENDANTS to pay for or on behalf of PLAINTIFF MATEO any amount in the nature of 

federal, state or local taxes or surcharges, or any interest or penalties related to the abovereferenced payment, PLAINTIFF MATEO shall indemnify and hold DEFENDANTS harmless 

for such amounts. PLAINTIFF MATEO acknowledges that she has not relied on any 

statements or representations by DEFENDANTS with respect to the tax treatment of such 

payments. 

3. No Consideration Absent Execution of this Agreement. PLAINTIFF MATEO 

understands and agrees that she would not receive the monies and/or benefits specified in 

paragraph “2” and its subparts above, except for his execution of this Agreement and the 

fulfillment of the promises contained herein. The payments reflected in paragraph “2” and 

its subparts are made in full and final settlement and resolution of the Lawsuit. 

4. Neutral Reference. In the event that a prospective employer requests an 

employment reference for PLAINTIFF MATEO, the parties agree that the prospective 

employer shall contact the Managing Member of EL CHURRASCO GRILL, LLC, Ever Santizo 

Gonzalez, who will only provide dates of employment and position held. 

5. Release of Claims: PLAINTIFF MATEO knowingly and voluntarily releases 

and forever discharges, to the full extent permitted by law, EL CHURRASCO GRILL, LLC its 

parent corporations, affiliates, subsidiaries, divisions, predecessors, successors and 

assigns, joint employers, and the current and former employees, officers, managing 

members, directors, owners, and agents thereof, of and from any and all claims, known and 

unknown, asserted and unasserted, or that PLAINTIFF MATEO has or may have against 

the Released Parties, which arise out of or are in any way connected with any loss, damage 

or injury whatsoever to PLAINTIFF MATEO resulting from any act or omission by or on the 

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 2 of 10
[ 3 ]

part of DEFENDANTS as of the date of execution of this Agreement, including, but not 

limited to, any alleged violation of: 

 

• Title VII of the Civil Rights Act of 1964, as amended; 

• The Civil Rights Act of 1991; 

• The Age Discrimination in Employment Act (ADEA) 

• The Immigration Reform and Control Act, as amended; 

• The Fair Labor Standards Act, as amended; 

• The Equal Pay Act, as amended; 

• The Employee Retirement Income Security Act (ERISA) 

• 42 U.S.C. §1981, 1985 and 1986. 

• The Americans with Disabilities Act, as amended; 

• The Occupational Safety and Health Act, as amended;

• The Florida Civil Rights Act – Fla. Stat. §760.01 et seq.; 

• The Florida Whistle Blower Act – Fla. Stat. §448.101 et seq.; 

• Families First Coronavirus Response Act; 

• The Family Medical Leave Act; 

• Florida Wage Payment Laws; 

• Florida Workers’ Compensation Act; 

• Florida Stat. §440.205; 

• Any other federal, state or local civil or human rights law or any other 

local, state or federal law, regulation or ordinance; 

• Any public policy, contract, tort, or common law; and 

• Any claim for costs, fees, or other expenses including attorneys’ fees 

incurred in these matters. 

The parties acknowledge that the Agreement shall not apply to rights or claims that 

may arise after the Effective Date. Additionally, nothing in this paragraph or the Agreement 

is intended to limit or restrict any rights that cannot, by express and unequivocal terms of 

law, be limited, waived, or extinguished. PLAINTIFF MATEO understands and agrees that 

he is releasing all of the Released Parties, from any and all claims by which she is giving up 

the opportunity to recover any compensation, damages, or any other form of relief in any 

proceeding brought by her or on her behalf.

6. Older Workers Benefit Protection Act. In compliance with the Older 

Workers Benefit Protection Act and the Age Discrimination in Employment Act, PLAINTIFF 

MATEO hereby acknowledges that (a) PLAINTIFF MATEO fully understands this 

Agreement; (b) this Agreement specifically applies to a knowing and voluntary release of 

any rights or claims PLAINTIFF MATEO may have against DEFENDANT EL CHURRASCO 

GRILL, LLC under the Federal Age Discrimination in Employment Act of 1967, as amended 

arising on or before the date PLAINTIFF MATEO signs this Agreement; (c) this Agreement 

does not purport to waive any rights or claims that may arise from acts or events occurring 

after the date that this Agreement is executed; (d) the consideration provided for in this 

Agreement and the provisions of this paragraph are in addition to that to which PLAINTIFF 

MATEO is already entitled; (e) PLAINTIFF MATEO has been advised and encouraged to 

consult with an attorney prior to signing this Agreement; (f) PLAINTIFF MATEO has been 

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 3 of 10
[ 4 ]

given a period of twenty-one (21) days within which to consider this Agreement; (g) this 

Agreement shall be revocable for the seven (7)-day period following execution of this 

Agreement by PLAINTIFF MATEO , provided PLAINTIFF MATEO delivers written notice of 

such revocation to counsel for DEFENDANT, Ena T. Diaz, Esq., Law Offices of Ena T. Diaz, 

P.A., 999 Ponce De Leon Blvd., Suite 720, Coral Gables, Florida 33134 by hand delivery. 

Accordingly, this Agreement shall not become effective or enforceable until the expiration 

of this seven (7)-day revocation period. Should PLAINTIFF MATEO choose to sign this 

Agreement prior to the twenty-one (21) day period set forth in this paragraph, this is solely 

PLAINTIFF MATEO ’s choice, and PLAINTIFF MATEO acknowledges and agrees that 

PLAINTIFF MATEO knowingly and voluntarily waived the full amount of time she was 

provided with within which to consider this Agreement. PLAINTIFF MATEO and 

DEFENDANTS agree that changes to this Agreement, if any, and whether material or not 

material, will not restart the twenty-one (21)-day period. If the revocation period has not 

expired when the settlement funds become due, counsel for PLAINTIFF MATEO shall retain 

the settlement funds in “escrow” and release the settlement funds to PLAINTIFF MATEO 

after the expiration of the seven-day revocation period. 

7. Affirmations. 

 a. PLAINTIFF MATEO affirms that she has not filed, caused to be filed, or 

presently is a party to any claim, complaint, or action against the Released Parties in any 

forum or form. 

b. PLAINTIFF MATEO further affirms that she has been paid and/or has 

received all leave (paid or unpaid), compensation, wages, bonuses, commissions, and/or

benefits to which he may be entitled and that no other leave (paid or unpaid), 

compensation, wages, bonuses, commissions and/or benefits are due to her, except as 

provided for in this Agreement.

c. PLAINTIFF MATEO furthermore affirms that she has no occupational 

diseases and has been provided and/or has not been denied any leave to which he may be 

entitled under state or federal law. 

8. No Re-Application for Employment. PLAINTIFF MATEO permanently, 

unequivocally, and unconditionally waives any and all rights PLAINTIFF MATEO may now 

have, may have had in the past, or may have in the future to obtain or resume employment 

and/or work as an independent contractor or employee with EL CHURRASCO GRILL, LLC 

its parents, successors, affiliates, and subsidiaries. PLAINTIFF MATEO agrees never to 

apply for employment and/or to seek independent contractor work with EL CHURRASCO 

GRILL, LLC its parents, successors, affiliates, and subsidiaries. PLAINTIFF MATEO further 

agrees never to apply for employment and/or to seek independent contractor work with 

any corporate entity that EVER SANTIZO GONZALEZ is listed as an officer or director or 

have an ownership interest (including but not limited to, El Ranchito Thrift Shop, LLC and 

Big Taco Food Truck). 

9. Non-Disparagement. PLAINTIFF MATEO agrees that she will not in the 

future (a) talk about or otherwise communicate to any third party in a malicious, 

disparaging or defamatory manner regarding EVER SANTIZO GONZALEZ and EL 

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 4 of 10
[ 5 ]

CHURRASCO GRILL, LLC and/or the current and former officers, managers, managing 

members, directors, owners and agents of EL CHURRASCO GRILL, LLC or (b) make or 

authorize to be made by any written or oral statement that may disparage the reputation 

of EVER SANTIZO GONZALEZ and EL CHURRASCO GRILL, LLC and/or the current and 

former officers, managing members, directors, owners and agents. 

10. Confidentiality. PLAINTIFF MATEO agrees not to disclose any information 

regarding the existence or substance of this Agreement, except to her spouse, tax advisors, 

accountant and/or legal counsel with whom she chooses to consult regarding his 

consideration of this Agreement, and except as otherwise required by law or court order. 

The Parties to this Agreement intend this confidentiality provision to be enforced to the 

maximum extent permitted by law. PLAINTIFF MATEO agrees that any violation of the 

Confidentiality provision would cause DEFENDANTS to suffer immediate, substantial and 

irreparable injury. PLAINTIFF MATEO affirms that this confidentiality provision is a 

material provision of this Agreement and that any proven breach thereof by PLAINTIFF 

MATEO would constitute a material breach of this Agreement. 

11. Governing Law and Interpretation. This Agreement shall be governed in 

accordance with the laws of the State of Florida without regard to its conflict of laws 

provision. In the event that any party breaches any provision of this Agreement, the parties 

affirm that they may institute an action to specifically enforce any term or terms of this 

Agreement. The prevailing party shall be entitled to recover attorneys’ fees and costs from 

the non-prevailing party in any enforcement action. Should any provision of this 

Agreement be declared illegal or unenforceable by any court of competent jurisdiction and

cannot be modified to be enforceable, excluding the release language, such provision shall 

immediately become null and void, leaving the remainder of this Agreement in full force 

and effect. The parties agree that the U.S. District Court shall retain jurisdiction to enforce 

the terms of this Agreement. 

12. Non-admission of Wrongdoing. The parties agree that neither this 

Agreement nor the furnishing of the consideration for this Release shall be deemed or 

construed at any time for any purpose as an admission by DEFENDANTS of any liability or 

unlawful conduct of any kind. 

13. Amendment. This Agreement may not be modified, altered or changed except 

upon express written consent of both parties wherein specific reference is made to this 

Agreement. 

14. Successors and Assigns. This Agreement shall be binding upon the parties 

hereto and upon their heirs, administrators, representatives, executors, divisions, parents, 

subsidiaries, parents’ subsidiaries, affiliates, partners, limited partners, successors and 

assigns, and shall inure to the benefit of said parties and each of them and to their heirs, 

administrators, representatives, executors, divisions, parents, subsidiaries, parents’ 

subsidiaries, affiliates, partners, limited partners, successors and assigns. PLAINTIFF 

MATEO expressly warrants that she has not transferred to any person or entity any rights or 

causes of action, or claims released by this Agreement. 

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 5 of 10
[ 6 ]

15. Selective Enforcement. The Parties agree that the failure of any party to 

enforce or exercise any right, condition, term or provision of this Agreement shall not be 

construed as or deemed to be a waiver or relinquishment thereof, and the same shall 

continue in full force and effect. 

16. Copy of Agreement Valid. The parties agree that executed copies of this 

Agreement shall be valid and binding, in the event the original executed counterparts to the 

Agreement are missing. 

17. Entire Agreement. This Agreement sets forth the entire agreement between 

the parties hereto, and fully supersedes any prior agreements or understandings between 

the parties. PLAINTIFF MATEO acknowledges that she has not relied on any 

representations, promises, or agreements of any kind made to him in connection with his 

decision to accept this Agreement, except for those set forth in this Agreement. 

PLAINTIFF MATEO IS HEREBY ADVISED THAT SHE HAS TWENTY-ONE DAYS TO 

REVIEW THIS SETTLEMENT AGREEMENT AND GENERAL RELEASE AND THAT SHE 

SHOULD CONSULT WITH HIS ATTORNEY (ZANDRO E. PALMA, ESQ.) OR AN ATTORNEY 

PRIOR TO EXECUTION OF THIS SETTLEMENT AGREEMENT AND GENERAL RELEASE. 

HAVING ELECTED TO EXECUTE THIS SETTLEMENT AGREEMENT AND GENERAL 

RELEASE, TO FULFILL THE PROMISES AND TO RECEIVE THE SUMS AND BENEFITS IN 

PARAGRAPH 2 ABOVE, PLAINTIFF MATEO FREELY AND KNOWINGLY, AND AFTER 

DUE CONSIDERATION, ENTERS INTO THIS SETTLEMENT AGREEMENT AND GENERAL 

RELEASE INTENDING TO WAIVE, SETTLE AND RELEASE ALL CLAIMS SHE HAS OR 

MIGHT HAVE AGAINST THE RELEASED PARTIES.

THIS SECTION LEFT INTENTIONALLY BLANK – SIGNATURE PAGE FOLLOWS 

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 6 of 10
[ 7 ]

Ms. Mateo’s signature below represents that this Agreement has been translated from 

English into Spanish. La firma de la Sra. Mateo afirma que este acuerdo ha sido 

traducido de inglés a español. 

IN WITNESS WHEREOF, the parties hereto knowingly and voluntarily executed this 

Settlement Agreement and General Release as of the date(s) set forth below:

_______________________________________________

LETICIA MATEO 

 

Date: ____________________ 

EL CHURRASCO GRILL, LLC 

By: 

Name: EVER SANTIZO GONZALEZ 

Title: Managing Member 

Date: ____________________ 

__________________________________ 

EVER SANTIZO GONZALEZ 

Date: ______________________ 

09 / 16 / 2020

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 7 of 10
Form W-4

2020

Employee’s Withholding Certificate

Department of the Treasury 

Internal Revenue Service 

▶ Complete Form W-4 so that your employer can withhold the correct federal income tax from your pay.

▶ Give Form W-4 to your employer.

▶ Your withholding is subject to review by the IRS.

OMB No. 1545-0074

Step 1: 

Enter 

Personal 

Information

(a) First name and middle initial Last name

Address 

City or town, state, and ZIP code

(b) Social security number

▶ Does your name match the 

name on your social security 

card? If not, to ensure you get 

credit for your earnings, contact 

SSA at 800-772-1213 or go to

www.ssa.gov.

(c) Single or Married filing separately

Married filing jointly (or Qualifying widow(er))

Head of household (Check only if you’re unmarried and pay more than half the costs of keeping up a home for yourself and a qualifying individual.)

Complete Steps 2–4 ONLY if they apply to you; otherwise, skip to Step 5. See page 2 for more information on each step, who can 

claim exemption from withholding, when to use the online estimator, and privacy.

Step 2: 

Multiple Jobs 

or Spouse 

Works

Complete this step if you (1) hold more than one job at a time, or (2) are married filing jointly and your spouse

also works. The correct amount of withholding depends on income earned from all of these jobs.

Do only one of the following.

(a) Use the estimator at www.irs.gov/W4App for most accurate withholding for this step (and Steps 3–4); or

(b) Use the Multiple Jobs Worksheet on page 3 and enter the result in Step 4(c) below for roughly accurate withholding; or

(c) If there are only two jobs total, you may check this box. Do the same on Form W-4 for the other job. This option 

is accurate for jobs with similar pay; otherwise, more tax than necessary may be withheld . . . . . ▶

TIP: To be accurate, submit a 2020 Form W-4 for all other jobs. If you (or your spouse) have self-employment 

income, including as an independent contractor, use the estimator.

Complete Steps 3–4(b) on Form W-4 for only ONE of these jobs. Leave those steps blank for the other jobs. (Your withholding will 

be most accurate if you complete Steps 3–4(b) on the Form W-4 for the highest paying job.)

Step 3: 

Claim 

Dependents

If your income will be $200,000 or less ($400,000 or less if married filing jointly): 

Multiply the number of qualifying children under age 17 by $2,000 ▶ $

Multiply the number of other dependents by $500 . . . . ▶ $

Add the amounts above and enter the total here . . . . . . . . . . . . . 3 $

Step 4 

(optional): 

Other 

Adjustments

(a) Other income (not from jobs). If you want tax withheld for other income you expect 

this year that won’t have withholding, enter the amount of other income here. This may 

include interest, dividends, and retirement income . . . . . . . . . . . . 4(a) $

(b) Deductions. If you expect to claim deductions other than the standard deduction

and want to reduce your withholding, use the Deductions Worksheet on page 3 and 

enter the result here . . . . . . . . . . . . . . . . . . . . . 4(b) $

(c) Extra withholding. Enter any additional tax you want withheld each pay period . 4(c) $

Step 5: 

Sign 

Here

Under penalties of perjury, I declare that this certificate, to the best of my knowledge and belief, is true, correct, and complete.

▲

Employee’s signature (This form is not valid unless you sign it.)

▲

Date 

Employers 

Only

Employer’s name and address First date of 

employment

Employer identification 

number (EIN)

For Privacy Act and Paperwork Reduction Act Notice, see page 3. Cat. No. 10220Q Form W-4 (2020) 

Leticia Mateo

15807 SW 151 Ave

Indiantown, FL 34956

151-95-1829

✔

0

500

500.00

0

0

0

09 / 16 / 2020

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 8 of 10
Form W-9

(Rev. October 2018)

Department of the Treasury 

Internal Revenue Service 

Request for Taxpayer 

Identification Number and Certification

▶ Go to www.irs.gov/FormW9 for instructions and the latest information.

Give Form to the 

requester. Do not 

send to the IRS.

Print or type. 

See Specific Instructions on page 3.

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

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 

following seven boxes. 

Individual/sole proprietor or 

single-member LLC

 C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ▶

Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check 

LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is 

another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that 

is disregarded from the owner should check the appropriate box for the tax classification of its owner.

Other (see instructions) ▶

4 Exemptions (codes apply only to 

certain entities, not individuals; see 

instructions on page 3):

Exempt payee code (if any)

Exemption from FATCA reporting

 code (if any)

(Applies to accounts maintained outside the U.S.)

5 Address (number, street, and apt. or suite no.) See instructions.

6 City, state, and ZIP code

Requester’s name and address (optional)

7 List account number(s) here (optional)

Part I Taxpayer Identification 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 instructions for Part I, later. For other 

entities, it is your employer identification number (EIN). If you do not have a number, see How to get a 

TIN, later.

Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and 

Number To Give the Requester for guidelines on whose number to enter.

Social security number

– –

or

Employer identification number

–

Part II Certification

Under penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue 

Service (IRS) that I 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 I am 

no longer subject to backup withholding; and

3. I am 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 I 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 dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions for Part II, later.

Sign 

Here Signature of 

U.S. person ▶ Date ▶

General Instructions

Section references are to the Internal Revenue Code unless otherwise 

noted.

Future developments. For the latest information about developments 

related to Form W-9 and its instructions, such as legislation enacted 

after they were published, go to www.irs.gov/FormW9.

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 information 

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 1099-B (stock or mutual fund sales and certain other 

transactions by brokers)

• Form 1099-S (proceeds from real estate transactions)

• Form 1099-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, 

later.

Cat. No. 10231X Form W-9 (Rev. 10-2018)

Leticia Mateo

✔

15807 SW 151 Ave

Indiantown, FL 34956

1 5 1 9 5 1 8 2 9

09 / 16 / 2020

Doc ID: e02fcef9efd46b9320cf6bcd0d402e670029ef7c

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 9 of 10
Audit Trail

Title


File Name


Document ID


Audit Trail Date Format


Status

Settlement Documents

MATEO LETIC... 091620.pdf and 2 others

e02fcef9efd46b9320cf6bcd0d402e670029ef7c

MM / DD / YYYY

Completed

09 / 16 / 2020

16:54:28 UTC-5

Sent for signature to Leticia Mateo

(leticiamateo989@gmail.com) from jfp@thepalmalawgroup.com

IP: 73.0.216.26

09 / 16 / 2020

16:55:41 UTC-5

Viewed by Leticia Mateo (leticiamateo989@gmail.com)

IP: 107.77.249.39

09 / 16 / 2020

16:58:31 UTC-5

Signed by Leticia Mateo (leticiamateo989@gmail.com)

IP: 107.77.249.39

09 / 16 / 2020 The document has been completed.

16:58:31 UTC-5

Case 2:20-cv-14163-DMM Document 26-1 Entered on FLSD Docket 09/18/2020 Page 10 of 10