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Form W-9 Request for Taxpayer Give Form to the
<br />(Rev. December2014) I dentification Number and Certification requester. Do not
<br />Depeament ot l~e Treasury send to the IRS.
<br />lnlamDI Rewnoo Service
<br />1 Name (as shown on your income tax rerum). Name ls required on tills lln!': do ·nor leave this Jll'\o blank.
<br />Cou n ty of Kittitas
<br />C\i 2 B1;1Sfncss name/disregarded entity name, lt different from above
<br />GI Kittitas C o unty g>
<br />C. 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: 4 Exemptions (codes apply only to
<br />C:
<br />0 0 Individual/sole proprietor or 0 C Corporation 0 S Corporation 0 Partnership 0 Trust/estate certain entitles . not individuals; see
<br />GI II slngle-mcmber L.1.C instructions on page 3):
<br />c. a Exempt payee code flf any) 3 ~:g 0 Um.11.ed HablTity company. Enter the tax classification (C--C corporation, S=S corporation, P=partnership) •
<br />~ i:! Nate. For .tsln9le-m ember LLC that is dlsregar.de d, do not check L.1.C; check the appropriate box in the line above for Exemption from FATCA reporting .... ·lhu tax cl8S!)~kl(I of the single-mem ber OW/1<!1", code flf any) C: ID ·c ..5 0 Other (eee IN!rudticns) • (Appl/Nlo1--..-elhoU.S) a. .2
<br />13 5 Address (number, street, and apt. or suite no.) Reql.l!IStel"s name !11\d address (optlon:nJ)
<br />CII 205 W 5th Ave, Ste 105 C.
<br />UJ 6 City, state, and ZIP code GI
<br />GI Ellensburg, WA 98926 (I)
<br />7 List account number(s) here (optional)
<br />11111• Taxpayer Identification Number (TIN)
<br />I ~.cl.ii security numlat I Enter you~ TIN in_ the app_ropri_:=Ite box. :'1~ TIN provided must. match t~e name given on line 1 to avoid
<br />backup withholding. For 1ndivIduals, thJS IS generally your sacral security number (SSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other
<br />entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
<br />T1N on page 3.
<br />0JJ -[I] ~1 I I I I
<br />or
<br />Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for
<br />guidelines on whose number to enter.
<br />l ~pt0y11rldenttft<:a1!on number
<br />91 -6001349
<br />I
<br />Certification
<br />Under penalties of perjury, I certify that:
<br />1. Toe number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
<br />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
<br />Service ORS) 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
<br />no longer subject to backup withholding; and
<br />3. I am a U.S. citizen or other U.S. person (defined below); and
<br />4. Toe FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
<br />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
<br />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
<br />interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
<br />generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
<br />instructions on page 3.
<br />Sign Sisnatul'e o1
<br />Here U.S. person •
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise noted.
<br />Future developments. Information about developments affecting Form W-9 (such
<br />as legislation enacted after we release it) is at www.irs.gov/fw9.
<br />Purpose of Form
<br />An individual or entity (Form W-9 requestef) who is required to file an information
<br />return with the IRS must obtain your correct taxpayer identification rnmber (TIN)
<br />which may be yotX social security number (SSN), individual taxpayer identification
<br />number (TTIN), adoption taxpayer identification number (AllN), or employer
<br />identification number (EINJ, to report on an information return the amount paid to
<br />you, or other amount reportable on an information return. Examples of information
<br />nmans include, but ara not llmited to, the following:
<br />• Form 1099-INT (interest earned or paid)
<br />• Form 1099-DIV (llvfdends, including those from stocks or mutual uids)
<br />• Form 1099-MISC (various types of income, prizes, awards, or gross proceeds)
<br />• Form 1099-B (stock or mutual fund sales and certain other transactions by
<br />brokers)
<br />• Form 1099-S (proceeds from rear estate transactions)
<br />• Form 1 099-K (merchant card and third party network transactions)
<br />Date •
<br />• Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T
<br />(luition)
<br />• Form 1099-C (canceled debt)
<br />• Ferm 1oil9-A (at:qulsllk!n o, abal'ldcn/1'1ent of secured property)
<br />Use Form W-9 only if you are a U.S. person (1T1Cluding a resident alien), to
<br />provide your correct TIN.
<br />ff you do not return Form W-9 lo the requester wtth a 11N, you might be subject
<br />to backup withholding. See What is backup withholding? on page 2.
<br />By sq,ing the filed-out form, you:
<br />1. Certify that the TIN you are giving is correct (or you are waiting for a number
<br />to be issued),
<br />2. Certify that you are not subject to backup wtthholdlng, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt payee. If
<br />applicable, you are also certifying that as a U.S. person, your allocable share of
<br />any partnership income from a U.S. trade or business is not subject to the
<br />withholding tax on foreign partners' share of effectively connected income, and
<br />4. Certify that FATCA code(s) entered on this form (If anyj indicating that you are
<br />exempt from the FATCA reporting, Is correct. See What is FATCA reporting? on
<br />page 2 forti.ther infonnatlon.
<br />Cat. No. 10231X Form W-9 (Rev. 12-2014)
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