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Form
<br />{Rsr. Decemb€r2011)
<br />Department of the Treasuy
<br />ht€mal Revenuo Servico
<br />Name (as shown on your income
<br />Laughing Horse Arts Foundation
<br />Business name/disregarded entity nam€,
<br />D.B.A. Jazz in the
<br />Certifi cation instructions.
<br />because you have failed to
<br />interest paid, acquisition or
<br />other
<br />4.
<br />Sign
<br />Here
<br />General lnstructions
<br />Section references are to the lntemal 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 fIlN) 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 lRA.
<br />Use Form W-9 only if you are a U.$. person {including a resident
<br />alien), to provide your conect TIN to the person requesting it (the
<br />requester) and, when applicable, to:
<br />1. Certify that the TIN you are giving is conect (or you are waiting for a
<br />numberto 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. lf applioable, you are also certiffng that as a U.S. person, your
<br />allocable share of any partnershlp income from a U,S. trade or business
<br />is not subject to the withholding tax on foreign partnete' shar€ of
<br />effectlvely connected income.
<br />Request for Taxpayer
<br />ldentification Number and Gertification
<br />w-g Give Form to t|te
<br />requester. Do not
<br />send to the lRS.
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<br />I Exempt payee
<br />name
<br />You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
<br />For real estate transactions, item 2 does not apply. For mortgage
<br />debt, contdbutions to an individual retirement anangement {lFA), and
<br />all int€rest and dividends on your tax retum.
<br />of secured property, cancellation of
<br />and dividends, you are not required to sign the certification, but you must provide your correct TlN. See the
<br />Kittitas Coung Auditor
<br />205 West Sth Ave - Suite105
<br />Ellensburg, WA 98926
<br />Ent€r your TIN in the appropriate box. The TIN provided must match the name given on the "Name" line
<br />to avold backup withholding- For individuals, this is your social 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 identiflcation number (ElN). lf you do not have a number, see How to geta
<br />IIAI on page 3.
<br />Note- lf the account is in more than one name, see the chart on page 4 for guidelines on whose
<br />number to enter-
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this form is my correct taxpayer identiflcation 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 lntemal Revenue
<br />Service (lBS) that I am subject to backup withholding as a result of a failure to report all interest or dMdends, or (c) the IRS has notified m€ that I am
<br />no longer subject to backup withholding, and
<br />3. lam a U.S. citizen or other U.S. person (defined below)-
<br />Date>4 -2s-t
<br />Note. ll a requesler gives you a form other than Form W-9 to request
<br />your TlN, you must use the requester's form if it is substantially similar
<br />to this Form W-9.
<br />Defnition of a U.S, person- For federal tax purposes, you are
<br />considered a U.S. person if you are:
<br />o 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 />r A domestic irust (as defined in Regulations section 301.7701-7).
<br />Speclal 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 oertain cases whero a Form W-9 has not been received, a
<br />partnership is required to presume that a partner is a foreign person,
<br />and pay the withholding tax. Therefore, if you are a U.S. person that is a
<br />partner ln a partnership conducting a trade or business in th6 Unit€d
<br />States, provide Form W-9 to the partnership to establlsh your U.S.
<br />status and avoid withholding on your share of partnershlp lncome.
<br />Check appropriate box for foderal tax classification:
<br />! lndividual/sole prcprieior EI C Gorporation f] s corporation I earrnerstrip f] trusVestate
<br />I UmiteU liability company, Enter the tax classification (C=C corporation, S=S corporation, P=partnership] >
<br />f! otnerlsee
<br />Address (number, sv€ot, and apt. or
<br />P.O. Box 214
<br />stato, and
<br />wA 98926
<br />cod6
<br />Number
<br />Social number
<br />Part I
<br />Employer id€ntification number
<br />I 1 1 2 1 1 1 7 3
<br />Part ll
<br />Signaturc ot
<br />u.s.
<br />Cat. No.10231X ronn W-9 1nev. 12-201'l)
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