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Form W-9 Request for Taxpayer Give Form to the
<br />(Rav. December 2014) I dentification Number and Certification requester. Do not
<br />Oeparuru,nt ot ll)e Trt<aslllY send to the IRS.
<br />lntomal Rover.uo 8er\-fco
<br />1 Name (!IS shown on your ll'l0ome lilllC return}. Name la n,qub'ed on lhls line; do not leave I his llne blank.
<br />Co.unty of Kittitas
<br />c-i 2 &i:slf\SSS nam<ildlaniglildecl en6ly name. If dil'forant f1qm above
<br />f Kittitas County
<br />3 Check approp,fa!JI box for ledel:al lllx dassfficatl011; q190k 01\ly one ot Iha following seven bmco:i: 4 Eicempllons (cod~ llflP.ly onlY to C
<br />0 0 lsldlvtduol/«>le. proprietor or D C CotpoTiltlon 0 ,S Corpo111tlon D Par1norah fp D TIUSt/estate ~ enUUea, not lndMdu~a: aee
<br />!~ slng~barl.LC
<br />Instructions on page 3):
<br />D l.,nil tod llabllty company. ~ tho \ill clasallTcalion (C:C corporallon, S..S corpol\ll/on , Papartn arship),. Eiwmpt payee cod& or BIIYl 3
<br />... ti Elwnpl/on "°"1 FATCA repar\lng ii Mole. For a U!f!)&-merpber UC thal is di#egacde<I, do not check LLC; check the appropriate box In the Un e above for
<br />Iha tax clnssiffcatlon ot the~ owne,. codeOlanyJ
<br />a. 0 0 Other (see INlll'VCllonsJ ,.
<br />,._,,,.._, ___ illoU,SJ
<br />!i: 5 ~~ (number, swet, and apt. 01' .u!Q.no .) Requester's name arld addres5 (oJ)lfonaQ
<br />0
<br />GI 205 West 5th Ave Suite 105 Q.
<br />(II e City, ntAto-, and ZIP aode I Ellerisburg , WA 98926
<br />7 Ust account numb8l(sl '1!)19 (opllo!t&J
<br />•=,.:1 •• Taxp ay er Ide ntification Number (TIN)
<br />I Soala l security numbot I En ten your TIN In tho apprqprfata box. The TIN ~ded must match the name given on li ne 1 to avoid
<br />backup withholding. For lndivldull,ls, this Is generally your scdal security number (SSN). However, ror a ITO [D I I I r I
<br />r&sldliAt alien, sole proprietor, or d fsngarded entity, see'the Part I lnslrucUoM t?n page 3'. For other --
<br />entitles, it Is yo ur emp loyer lde.nUJ1catlon number (BN). If you do not have a number, see 1-(oiv to get a . . _ _ _
<br />ffion~a M
<br />Note. If the account Is In more than one name, see the instructions for line 1 and the chert on page 4 for '"I em=-p--:l,--oy.,..•-r,_.,..,c1o,..--:.,u'"'r,=-cat1--:_ ""o_11_n_Ultlb-:-tw-· -----.
<br />guidelines on whose number to enter.
<br />Ce rtifi c ation
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this fonn Is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and
<br />2. .1 am not sub]ecMo backup withholding becauso: {a) I am ~xempt from baoku p withholding, or (b) I have not been notified by the Interna l Revenu e
<br />Service (IRS) that I am sub]ect lo backup wlthholcflng as a result of a l,11J lure to report all' Interest or d ividends. or {c) the IRS has notified me that I am
<br />no longer sub]ect to backup wllhholdlng; and
<br />3 . I em a U.S. citizen or other U.S. person (defined below); end
<br />4. The FATCA code(s) entered on this ronn Of any) Ind icating that I am exempt from FATCA reporting Is correct.
<br />Certification Instructions. You must cross out Item 2 above ff you have been not\Oed by the IRS thn! y6u are CUll'enUy subject to backup wltnhofdlng
<br />because you have failed to report all Interest and dividends on your tax return. For re~I estljte transactlo-ns. Item 2 does not irpply. For mortgage
<br />interest paid; acquls.fUo n or abandonment or secultld props~y . cancellat!on of debt, contrtbuUons ·lo,an Individual retirement arrangement QRA), a.r:id
<br />getteralfy, paymehta o!he r than Interest ana dlvldeod(I. you are not required to sign lhe certmcatlon, but you ,:nust provide your co~t TIN. See the
<br />lns truollons on pa,ge 3.
<br />S ign Signature of
<br />H ere U.S. person,.
<br />General ln structlonsL/
<br />Secti on references are to the lnlemal Revenue Coda unless otherwise noted.
<br />Future developments. lr:1fonn11tion llbo\lt deYolopman t:s.a/fecU ng Form W-9 (such
<br />as leglslatlon enacted al!er wo rafQS$9 II) Is Ill WWW.ll'$.fJ<1V/fw9.
<br />Purpose of Form
<br />An Individu al or eJllllY form W-9 requestet) who b requl'8d to ma an Information
<br />re t1J1n with the IRS ~l oblaln your C01Tlli:t t.upllyer lde,iUlk:allan number (TlN)
<br />which ""1Y be yoursocfal sttcuritynumbcr (SSl'l),lndMduol llll<payer ldenU~C\1Jlon
<br />numb11r OTIN), adoption taxpayer ldenURc.allon number (ATill(J, OI' empk>Yer
<br />tdontlnce1tlon number(EIN), to Teport on an lnforma llon rlllum th& ornoontpald 10
<br />11ou, or 0U1er amollfl t repor1abfe on an 1nr~1loruet11rn. Example or lnrormntlon
<br />rowma 11\ctud&, but are nol Uml je<I 10. tho rolfo\\:ll!Ql
<br />• Form 1099-INT Onterest earned or paid)
<br />• Form 1099-0IV (dividends, Including those from stocks or mutual runds)
<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 real estate transactions)
<br />• Form 1099-K (merchant card and third party network transactions)
<br />Data),,
<br />• Form 1098 (home mortgage Interest), 1098-E (student Joan interest), 1098-T
<br />(tuition)
<br />• Fonn 1099-C (canceled debt)
<br />• Fann 1099-A (acquisition or abandonment of secured property)
<br />Use Form W·9 only If you ar& a U.S. person llncludlng a resident alfen), to
<br />provide your correct TIN.
<br />/f you d<> nor /'IJ/CJ{n Fotn1 W-9 to the ~ierwllh II TIN, you might be subject
<br />to blJckup w/rMoldfllg. 504 What Is b~ckup wfUlholding? on page 2.
<br />By signing the filled-out form, you:
<br />1. Certify that the TIN you are giving Is correct (or you are waiting for a number
<br />lo be Issued),
<br />2. Certify that you are nol subject to backup withholding, or
<br />3. Claim ex&mplfon from b$clWp ""ilMoldJog II yw ar~ a U,S. exompt_ pm nyea, 11
<br />nJ)pllcllbia, you 1!18 alao con jfylng that es a U.S. ~n. )'OIIT ellocabliuhoNI ol
<br />any ,pertneret1)P fneotner,om a· U.S. trudil or bu1lrless le not 11ubfoot 1o·tho
<br />wllhholdlng lax on foralgn partl181'9' alWe of•arfoctlvoly <:OMBCtod "1coma, and
<br />4. Certlly ll1al l'ATCA uodo(,l en lerad on this form (II an~ ku:floamg that you 1ua
<br />e~mpt rrom Iha FATCA reportll)g, Is correct. Saa What Is l'ATCA reporllng? 011 ,
<br />pBge Nor !urtl18r ,1nrormatlot1.
<br />Cat No . 10231X Form W-9 (Rev. 12-2014)
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