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Form W-9
<br />(Rev. December 2011)
<br />Department of the Treasury
<br />internal Revenue Service
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<br />Request for Taxpayer Give Form to the
<br />Identification Number and Certification requester. Do not
<br />send to the IRS.
<br />Name (as shown on your Income tax return)
<br />Laughing Horse Arts Foundation
<br />Business nameldisregarded entity name, if different from 4W%fo
<br />D.B.A. Jazz in the Valley
<br />Check appropriate box for federal tax classification:
<br />❑ Individual/sole proprietor 0 C Corporation ❑ S Corporation ❑ Partnership ❑ Trust/estate
<br />❑ Llmlted liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ► ILI Exempt payee
<br />❑ Other (see irimn fictions) 0,
<br />Address (number, street, and apt, or aiulte no.)
<br />P.O. Box 214
<br />Clfy, state, and ZIP code
<br />Ellensburg, WA 98926
<br />List accovivi number(s) here (optional)
<br />Requester's name and address (optior
<br />Kittitas County Auditor
<br />205 West 5th Ave - Suitel05
<br />Ellensburg, WA 98926
<br />ff MM Taxpayer Identfication Number ff IN)
<br />Enter.ycur TiN In the appropriate box. The TiN provided must match the name given on the "Name" line I Sadat security number
<br />re ident backup withholding. Far stager a this ty your social security number n page
<br />3. Fo ver, fora
<br />resident alien, sole proprietor, or disregarded entity, sea the Part I Instructions on page 3. For other
<br />entities, it is your employer Identification number (EIN). It you do not have a number, see How to get a
<br />77N on page 3.
<br />Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose Employer ideneification number
<br />number to enter.
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<br />Certificatio_n__
<br />Under penalties of perjury, I certify that:
<br />1. The 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. lam not stjbject to I:,ackup withholding because: (a) I am exempt from backup wiltiholding, 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 i pport all inleiest or dividends, or (c) the IRS has notified me that I am
<br />no longer subject to backup withholding, and
<br />3. 1 am a U.S. citizen or other U.S. person (defined below).
<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 abaoVnment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
<br />generally, payments otherth in rest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the
<br />Instructions on page 4. — _--
<br />QXWJI Signature of
<br />Here I U.s. pr3mnn i
<br />General Instructions '
<br />Section references are to the Internal Revenue Code unless
<br />noted.
<br />Purpose of Form
<br />A person who is required to file an information return with the IRS must
<br />obtain your correct taxpayer identification number (TIN) to report, for
<br />example, income paid to you, real estate transactions, mortgage interest
<br />you paid, acquisition or abandonment of secured property, cancellation
<br />of debt, or contributions you made to an IRA.
<br />Use Form W-9 only if you are a U.S. person (including a resident
<br />alien), to provide your correct TIN to the person requesting it (the
<br />requester) and, when applicable, to:
<br />1. Certify that the TIN you are giving is correct (or you are waiting for a
<br />number to be issued),
<br />2. Certify that you are not subject to backup withholding, or
<br />3. Claim exemption from backup withholding if you are a U.S. exempt
<br />payee. If applicable, you are also certifying that as a U.S. person, your
<br />allocable share of any partnership income from a U.S. trade or business
<br />is not subject to the withholding tax on foreign partners' share of
<br />effectively connected income.
<br />Date ► Cl — a1 '20 1
<br />Note. If a requester gives you a form other than Form W-9 to request
<br />your TIN, you must use the requester's form If It is substantially similar
<br />to this Form W-9.
<br />Definition of a U.S. person. For federal tax purposes, you are
<br />considered a U.S. person if you are:
<br />• An individual who is a U.S. citizen or U.S. resident alien,
<br />• A partnership, corporation, company, or association created or
<br />organized in the United States or under the laws of the United States,
<br />• An estate (other than a foreign estate), or
<br />• A domestic trust (as defined in Regulations section 301.7701-7).
<br />Special rules for partnerships. Partnerships that conduct a trade or
<br />business in the United States are generally required to pay a withholding
<br />tax on any foreign partners' share of income from such business.
<br />Further, in certain cases where a Form W-9 has not been received, a
<br />partnership is required to presume that a partner is a foreign persoi i,
<br />and pay the withholding tax. Therefore, if you are a U.S. personflim, is a
<br />partner in a partnership conducting a trade or business in the United
<br />States, provide Form W-9 to the partnership to establish your U.S.
<br />status and avoid withholding on your share of partnership income.
<br />Cat No. 10231X Form W-9 (Rev. 12-2011)
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