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w-9 Request for Taxpayer
<br />ldentification Number and Certification
<br />) Go to www.its.govlFormW9 tor instruclions and the latest information.
<br />9
<br />rctL L Date >
<br />Give Form to the
<br />requester. Do not
<br />send to the lRS.
<br />o
<br />oo)(E
<br />o-co,oocoo>i:
<br />oiE'6
<br />Go
<br />o(,oooo
<br />on your tax return). Name is required on this line; do not leave this line blank.
<br />of Kittitas
<br />2 Business name,
<br />4 Exemptions (codes apply only to
<br />certain entities, not individuals; see
<br />instructions on page 3):
<br />Exempt payee code {if any) 3
<br />Exemption {rom FATCA reporting
<br />code (if any)
<br />lAppl;es lo eccounts mninlainad outsida the U S.)
<br />Requester's name and address (oplional)
<br />account num
<br />Enter yourTlN in the appropriate box. The TIN provided must match the name given on line 1 to avoid
<br />backup withholding. For individuals, this is generally your social security number (SSN), However, for a
<br />resident alien, sole proprjetor, or disregarded entity, see the instructions for Part l, later. For other
<br />entities, it is your employer ideniification number (ElN). lf you do not have a number, see How to get a
<br />Il/V, later.
<br />Note: lf the account is in more than one name, see the instructions for line '1. Also see What Name and
<br />Number To Give tho Fequester for guidelines on whose number to enter,
<br />Under penalties of perjury, I certify that:
<br />1. The number shown on this form is my coftect 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 bythe lnternal Revenue
<br />Service (lRS) 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 corroct.
<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, cancellatron of debt, contributions to an individual retirement arrangement (lBA), and generally, payments
<br />other than interest and dividends, you are not required to sign the certification, but you must provide your correct TlN. See the instructions for Part ll, later,
<br />Form
<br />(Rev. October2018)
<br />Depa.hgnt o{ the Treasury
<br />lnternal Revenue S6ruice
<br />Sign
<br />Here
<br />General lnstru ons
<br />Sectlon reJerences are to the lnternal 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, golo www.irs.gov/FormW9.
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who is required to file an
<br />iniormation return wiih the IRS must obtain your conect taxpayer
<br />identification number fflN) which may be your social security number
<br />(SSN), individual taxpayer identification number (lTlN), adopiion
<br />taxpayer identification number (ATIN), or employer identification number
<br />(ElN), to report on an information return the amount paid to you, or other
<br />amount reportable on an information return. Examples of informaiion
<br />returns include, but are not limited to, the {ollowing.
<br />. Form 1099-lNT (interest earned or paid)
<br />ot
<br />-)0>
<br />(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 1099-5 (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 1 099-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 TlN.
<br />lf you do not return Form W-9 to the requester with a TlN, you might
<br />be subject to backup withholding. See What is backup withholding,
<br />later.
<br />3 Chsk appropriate box for fed€ral tax classification of the person whose name is entered on line 1 . Check only one of the
<br />following seven boxes.
<br />fl lnaividual/sole proprietor or n c corporation tr S Corporation D Partnership n TrusVestate
<br />singl6-member LLC
<br />fl t-imiteO liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) > _
<br />is disregarded from the owner should chrck the appropriate box for ihe tax classification of its owner
<br />Other
<br />CheckNote:the
<br />ifLLC LLCthe is
<br />another LLC that
<br />street, and apt. or suite no.,lnstruclion$,
<br />IJU"
<br />state, and code
<br />n NumberPart I
<br />€mployor
<br />I 1 6 0 0 1 3 4 I
<br />Part ll
<br />Signature of
<br />U,S. person
<br />Cat. No. '10231X Form W-9 (Hev. 10-2018)
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