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Revised 7!09/20:3 <br />Page 2of2 <br />:riil:ii=�(r 71 sr• '�Ja (-0fl.ly, rr '..).' it , <br />Substitute Request for Taxpayer w <br />Fon W-9 identification Number and Certification <br />, Lego! Name (as shown on your income tax return) <br />KITTITAS COUNTY <br />2. Business Name, if different from Legal Name above —e.g. Doing Business As (DBA) Name <br />COUNTY GOVERNMENT <br />3 -Check ONLY ONE box below (see W-9 instructions for additional information) <br />❑ Individual or ❑ LLC filing as ❑Non Profit Organization ❑✓ Local Government <br />Sale Proprietor Corporation ❑ Tax-exempt <br />❑ Corporation Els-corporganization <br />❑ LLC filing as a sole ❑ LLC fil;ng as ❑ Volunteer ❑ State Government <br />proprietor Partnership ❑ T <br />rusJEstate <br />8oardlCommittee ❑Faders! Government <br />❑ Partnership ❑ LLC filing as S -Corp Member (including tribal) <br />4. For Corporation, S -Corp, Partnership or LLC, check one box below if applicable: <br />❑ Medical ❑ Attorney/Legal <br />5. If exempt from backup withholding, check here: ❑ <br />6. Address (number, street, and apt. or suite no.) <br />205 WEST 5TH, STE 105 For office use <br />7. City, state, and ZIP code The Legal Name, Address and TIN. must be <br />filled in completely and the document <br />ELLENSBU RG WA 98926 signed for the forms to be accepted, <br />8.Taxpayer Identification Number (TIN) <br />Enter your EIN OR SSN in the appropriate box to the right (do not enter both) Social security number <br />For individuals, this is your social security number (SSN). <br />For other entities, it is your employer identification number (EIN). OR <br />NOTE. The EIN or SSN must match the Legal Name as reported to the IRS. Fora resident alien, Sm la er identification number <br />sole proprleior or disregarded entity, or to find out how to get a Taxpayer Identification Number, see <br />the W9 Instructions. !f the account is in more than one name, see the W9 Instructions for guidelines 91-6001349 <br />on whose number to enter. <br />9. Certification <br />Under penalty of perjury, I certify that: <br />+ The number shown on this form is my correct taxpayer identification number (or 1 am waiting For a number to be issued to me), <br />and <br />• 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the <br />Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, <br />or (c) the IRS has notified me that I am no longer subject to backup withholding, and <br />• 1 am a U.S. person (including a U.S. resident alien). <br />SIGNATURE of .S. R ON Date <br />March 1, 2016 <br />