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Form W-9 Request for Taxpayer Give Form to the
<br />(Rev. October 201 B) Identification Number and Certification requester. Do not
<br />send to the IRS. Department of the Treasury
<br />Internal Revenue Service ~ Go to www.irs.gov/FormW9 for instructions and the latest information.
<br />1 Nlll'ne (oa shown on your lf'l~.orne lax I tul'n). N;nmn li:'r«tuh·ed on 1h19 llno. do not ,leava 111111 ff nr. blMk.
<br />H V S. P / L € F R.1 etJ D ~-
<br />2 Business name/disregarded entity name, If different from above
<br />c<i 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to Q)
<br />Cl following seven boxes. certain entities, not individuals; see "' C.
<br />~· C Corporation
<br />instructions on page 3):
<br />C D Individual/sole proprietor or 0 S Corporation 0 Partnership 0 Trust/estate 0
<br />• II) single-member LLC Exempt payee code (ii any) Cl) C: ---a. 0
<br />l' ti D Limited liability company Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) ~
<br />5 2 Note: Check the appropriate box in the line above for the tax classification of the single-member owner . Do not check Exemption from FATCA reporting t: t, LLC if the LLC is classified as a single-member LLC that Is disregarded lrom the owner unless the owner of the LLC is code (if any) ·-C: another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC ,1/:litl ---a. u is disregarded from the owner should check the appropriate box for the tax classification of its owner. !E u 0 Other'(soo lruifrUf;IIOns) ~ (Applies to 11ccoun/s mainfained oursidl'J rhe U.S.} Cl) a. 6' /\_ddr~ (r11niu,er , street, ilfld apt. or suite no,} se,, lr1&lrua1lorjl). f.l.,qllesto r's_ name and ~(!dress to pllQ!181) ti)
<br />Q) '?02.. S. M'lif-tr,...J e<·r Q) Kittitas County Auditor's Office (/)
<br />6 City, state, and 'Z IP code
<br />c?!!,92..,(p 205 W. 5th Ste 105
<br />El/~ns 6u.r1 tA,44-. E llens bura. WA 98926
<br />7 List account number(s) here {~Uonnl)
<br />•!J?I: •• Taxpayer ldenfiflcation Nurnber (TIN)
<br />I Sociv l security number l Enter you~ TIN in_ the app_ro~ri~te box. :h~ TIN provided must_ match t~e name given on line 1 to avoid
<br />backup withholding. For 1nd1v1duals, this 1s generally your social security number {SSN). However, for a
<br />resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
<br />entities, it is your employer identification number {EIN). If you do not have a number, see How to get a
<br />TIN, later.
<br />[IIJ -DJ -I I I I I
<br />or
<br />Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and
<br />Number To Give the Requester for guidelines on whose number to enter.
<br />I Efrjployar ld ontmcauon number
<br />Certification
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this fomn 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 (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
<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. The 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 because
<br />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,
<br />acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments
<br />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 11, later.
<br />Sign
<br />Here I Signature of
<br />U.S. person ~
<br />General Instructions
<br />Section references are to the Internal Revenue Code unless otherwise
<br />noted.
<br />Future developments. For the latest information about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />after they were published, go to www.irs.gov/FormW9.
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who is required to file an
<br />information return with the IRS must obtain your correct taxpayer
<br />identification number (TIN) which may be your social security number
<br />(SSN), individual taxpayer identification number (ITIN), adoption
<br />taxpayer identification number (ATIN), or employer identification number
<br />(EIN), to report on an information return the amount paid to you, or other
<br />amount reportable on an information return. Examples of information
<br />returns include, but are not lirn ited to, the following.
<br />• Form 1099-INT (interest earned or paid)
<br />Cat. No. 10231X
<br />Date~
<br />• Form 1099-DIV (dividends, including those from stocks or mutual
<br />funds)
<br />• Form 1099-MISC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />• Form 1099-8 (stock or mutual fund sales and certain other
<br />transactions by brokers)
<br />• Form 1099-S (proceeds from real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />• Form 1098 {home mortgage interest), 1098-E (student loan interest),
<br />1098-T (tuition)
<br />• Form 1099-C {canceled debt)
<br />• Form 1099-A (acquisition or abandonment of secured property)
<br />Use Form W-9 only if you are a U.S. person (including a resident
<br />alien), to provide your correct TIN.
<br />If you do not return Form W-9 to the requester with a TIN, you might
<br />be subject to backup withholding. See What is backup withholding,
<br />later.
<br />Form W-9 (Rev. 10-2018)
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