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Form W•9 Request for Taxpayer Give Form to tho
<br />r,ov, Oeoombor 2014) Identification Number and Certification requester, Do not
<br />OP!ll~an l of Iha T~Oll,Y &Gnd to the IRS.
<br />1lll!Tlll Aovonue So eo
<br />1 Nnm~ (QO thown 01\ your ltlCO!r!O llll!.'rolUm), Nlllll ll lil r«1u1rod on l llfu llt\lll (l o no l loali'alhfil lh,10 b~11k.
<br />COUl"lly or Kittitas
<br />"1 2 eu ulllou nomn/<11a r9Q!lrddd on tlly 11001 0, II dllfelartt'frrlni o\J o'{o
<br />I Kittitas Counl}'
<br />.3 ptjool< npproprl!tld ~OX for lu dol'QI lllx ~oul/lc4llb o1 ohsck onl y ona ol lha lolowlng no 'l nn boxue\ 4 Ex~mpt/0110 {o odaa Oll ~~nly lo
<br />8 Q 1ndMduoV6o1tl 11roP1lulor or 0 O Cotpoio llO/\ 0 8 Co1po ru llon O P~r ~,orahl 11 0 TruaVaalulo uo,tn1111: 1t1go, nol Jridl\lt d l m lnij ll'II P na n po.o a•S): tj attlgfo-mom bor LLo
<br />[J Umltotl lhtb lNly c~m pDn y, Enlor tlt o llll! cf119D!01r.11l on (C•O corpora\lun, &8 onrprirnUnn, P.'pllrl nar9hlpl • l:xnmpt payoo code .~f any) __ 3_
<br />Noto, 11~ a i 11lo-mo~bp1 ~LC lh ~I llJ dlsr/lll n(dod, do not ohook LLO: oheok the ap~roprlate box In tho lln~or Examptlon from FATOA reporting
<br />:a U,e lnx 0S1 un tloo o lho • lnolo•mom bor ow ner. ood 0 \If any)
<br />0 Ol lio r t900 111ntiuolfenel • (App/fo r to mount, nM lnt,ln«/ oultlde /ho /J .. SJ ~t 8 AddrGH Vt\:«llbo r, otrool, and op l, or 1ul!M II Q,) flq11,1111Dlar'o name an d oaaros u (opll,moQ
<br />20G West Gth Ava Suite 10!i
<br />"' 8 Cl(y,·u,t~lo, and ZlP oodo ~ Ellensburg, WA 90926
<br />V Ll lrt acoounl.numb or{o) hGrO {o pllMllQ
<br />lil!H nl • Taxpayer Identification Number ITINI
<br />Elller ybur TIN In.the app~~~te box. The TIN pf'.OV l.dod muat match the name gfvon on ltn e 1 to avoid Soofql -suour flY numbar
<br />b11o k!1p•vfllh{io lcllno , For ., I~ <1u11la , t,hlB Is 9eno·l'lllly Y.our 00 01111 seoU JllY numbor.(S SNJ , k owowor, for u I I I ~DJ-I I I I roaldon l ollo n, oolo pru prl ol gr, .or_pla(eoar<J i,d ant ny, a~o l hi> P!lrt fl na tru oUo ns·on page 3, For other
<br />·e11 Ut{o a, It I~ your omployor ldentlllr.,n!IQ n number (EfN), If you do not have 11 number, sea How to get ,i
<br />T/N onAa~G.
<br />Note, If the account Is In mor e than ;on a name, soe the Jnstruotlona for Una 1 and the ohart on page 4 for
<br />guldellnoa on whose num bor fci 'en tei:
<br />-6001340
<br />CertUlontlon
<br />Under penaltlea ol perjury, I cartlry thal:
<br />1, The number show11 on thl:i form I.~ my correct taxpayer !dontlil_oa~!on number (?r I am waiting for a number to ba Issued to me); ond
<br />2, I am ri ot subleo t to b11o f1JJ(> wft hholdlno b110!ll)a &:Ja) .I am exem pt from 'beokup 1Yllh l10ldln g, or (b), I have not bean ,fl.Qll'/l ed by the 111\umw Ravonu a
<br />SwYlo e ((flS) thn t I am e1,1~)oct to ba okup w(thh ol Ing as a reau lt of a fall i,ro to re port all tn to rest or dlvldonda, or (o). tho IRS has noll tted mo Hint l am
<br />no lon ge r subfect to bn.okup wlthhoi dlno: Md •
<br />3, I am a U,S, citizen or other u.e, person (denned below); and
<br />4, The FATCA oode(e) entered on Ihle form (II any) lndlontlng that I am exempt from FATOA reporting le correct,
<br />Certffloatlon fnstruotlons, You must cross out Item 2 above If you h11ve baen notifi ed by lha IR S that yo1.1 qro ourt enll y aubJ oot to backup wlt11Holdln g
<br />beoause you have failed lo report all Interest and dividends on your IA)< return, For .real ea tH\e.!rM secllonu, lt11A1 2 does 11ot'apptv, For mortgage
<br />lht ore:et pai d, acquisition or abandonment of secured property, oanoellatlon or dobt oonl r!bullons·to on lnd!vlduoJ rotl1e n1an l orrn11 gem ent (I AAl , Md
<br />oonaroll y, pamonf:1 other lhon Interest and dividends, you ere not required to alan the cerll nQ;itlo n, but you must pro vl do your 11orro ol TI N, Sa a U10
<br />lrisl ru ollo na 011 pogo _3,
<br />Sign s1u nn1wra 11 ,
<br />Here u.11. polllOO • :J H,l["r,t,~ Dato •
<br />General Instructions
<br />Section rolerenooa are to tho lntarnol RovonLlo Codo unloss otheiwlaB noted,
<br />ruture d9valopmenlll, lnfom1111l011 about dev ol.ol)ments n!hrollng Form W-9 (such
<br />as legle)a tldn eneoted un,;r wq rgflla n II) la al WI.V\V,{(J,gov/M ,
<br />Purpose of Form
<br />All lndlvlduol or onl ijy (i-orm W·O r,,q1,oata~who la l'(.-q \ltnrd ta rn.o a,, ln lllf10 nUQf1
<br />rotum with tho IRS mutt ob W.Jn \loltt'oDITOO tlll(pt1yor ld onljllo nllon n\lmb lir (TlN)
<br />which may bo yoO r.eool «I aoou d'iy nLJ111 be1 SS f'II, lndMdu11 lilxpaylll' ldol'\IIOottUon
<br />n4ml;l or (ITIM,,nfkipllQrtto~p~yut ldon ll/lon too number (Al'INJ;or employer
<br />ldo11t Ul0Ji t1 0n numbor(EIN), (o ro po rt on 1m lrt fo!Tll nll on rot lltn tho omo 1111I paid to
<br />you, or ~lhor omou nt rop o!lablo 0/1 an !nfomi\\\lorr return, EKampliJ11 ol ln f01ma tloo
<br />retume lnb!U d!!, bUt aro not lmlt od to, tho lollowln n:
<br />• f'orm 1080-INT (lnloreet earned or p~ld)
<br />• Fom, 1099•DIV (dlvldanda, lncfudlng thouo Iron, atooka or mutunl funds)
<br />• l'orm 10BO•MISO (various types ol lnoome, p(lteo, aw~rde, or gro~a prooesda)
<br />• Fom, 1099•B (stook or mutu~l lund aQles Qnd certain ot11or transactions by
<br />btokore)
<br />• Form 1098-S (proooada rrom ran I estate tronaaollontil '
<br />• Form 1099-K (merohant oord and lhlrd party n~twork tranaaotl(ins)
<br />• ronn 1oae (home mortgaao lntereatl, 1098•!! (student loan lntaraat), 1090·T
<br />(tuition)
<br />• Form 1088•0 (canceled deb~
<br />• Form 1 O!lll-A (aoquIaI11on or abandonmont or aoourod property)
<br />Use r-ll(,n W-9 only l(you aro a u,s, pereon (lnoludlng a roaldont allan), to
<br />provide your corroot TIN,
<br />/f yoil do r!b f ~r11;n Form W-9 lo lh n 111q uo4fo r Wll h a TIN, you m/o/JI l,11 a11b/eol
<br />to baakup wt tl lho ld/11t1. 800 Whal Is bno/rtJp W/lhho /dlt10 ? on pooe 2,
<br />By signing Iha llllad-oul form, you:
<br />1, Co rtlry th at lho TIN you aro giving Is oorreot (or you era waiting for a number
<br />lo bo lasuod),
<br />2. Cert~y U1nt you Hrn ~at subJool to bJ1 okup Wlll)holdl/\11 or
<br />3, Olclm OXtJm pUon from bil\l~Up y1mi1at df~O' II you nro I\ U,8 , OX.Dlll pt P,OYOO, It
<br />ap f>Qoobfo, you aro nla o o~fl lfylng lljn t au ll.9, pDra on, your olloauhl ~ 4)11#U ol
<br />~ny PM11cn1(11p rncomo 11cm ~ U.$, lrndo or bU11ftio sa Is no1 -eu1Jioo"t 10 lli9
<br />l'illhhokijng I/IJ\ an fo,ol gn pnrjn or•' •llarll of o[foo UVoly oonnaotod Inc ome, ond
<br />-~· Co,1~y _that FATOA o. o~a(o! ontored on this form (If an1).lc1dloilttno Unll yolJ nre
<br />oKorr,pl r10111 U1 0 Fi\TOII ropo(I ng, le oo rrool, Sae Whal 13 FM'OA 1qportlng1 on
<br />png_o l! lut rmhor lllfO!mllllen.
<br />I
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<br />'.d'at. No, 10231X Porm W-9 (Flciv, 12-20141
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