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Form w-g Request for Taxpayer
<br />ldentification Number and Gertification
<br />) Go to www.irc.govlFormW9 tor instructions and the latest information.
<br />Requester's name and address
<br />Give Form to the
<br />requester. Do not
<br />send to the lRS.
<br />4 Exemptions (codes apply only to
<br />certain entities, not individuals; see
<br />instructions on page 3):
<br />Exempt payee code (if any)
<br />Exemption from FATCA reporting
<br />code (if any)
<br />(Applies to aeounts maintained oulside ihe U.S.)
<br />(Rev. October 201 8)
<br />Department of the Treasury
<br />lnternal Revenue Service
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<br />1 Name (as shown on your on do not leave line blank.
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<br />2 Business name/disregarded entity name, if different from above
<br />7 List account number(s) here (optional)
<br />ldentification Number
<br />Enter your TIN 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 proprietor, or disregarded entity, see the instructions for Part l, later. For other
<br />entities, it is your employer identification number (ElN). lf you do not have a number, see How to get a
<br />TIN, 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 the Requester Ior guidelines on whose number to enter.
<br />or
<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. I am not subiect to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the 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 correct.
<br />Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are cunently 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 (lRA), 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 />Sign
<br />Here
<br />General Instructions
<br />Section references 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 , go lo www.irs.govlFormW9.
<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 [IlN) 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 />(ElN), 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 limited to, the following.
<br />. Form 1099-lNT (interest earned or paid)
<br />Signature of
<br />U,S. person )
<br />Employer identifi cation number
<br />Date >
<br />r Form 1099-DlV (dividends, including those from stocks or mutual
<br />funds)
<br />o Form 1099-MISC (various types of income, prizes, awards, or gross
<br />proceeds)
<br />. Form 1 099-8 (stock or mutual fund sales and certain other
<br />transactions by brokers)
<br />o Form 1 099-5 (proceeds from real estate transactions)
<br />. Form 1 099-K (merchant card and third party network transactions)
<br />. Form 1 098 (home mortgage interest), 1098-E (student loan interest),
<br />1098-T (tuition)
<br />. Form 1 099-C (canceled debt)
<br />. Form 1 099-4 (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 Check appropriate box for federal tax classification of the person whose name is entered on line 1 . Check only one of the
<br />following seven boxes.
<br />n tndividuat/soteproprietoror E ccorporation E SCorporation n Partnership E TrusVestate
<br />single-member LLC
<br />! LimlteO liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) > _
<br />Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
<br />LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC is
<br />another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC that
<br />is disregarded from the owner should check the appropriate box for the tax classification oi its owner.
<br />! Otner (see instructions) >
<br />5 Address (number, street, and apt. or suite no.) See instructions.
<br />6181 Wilson Creek Rd
<br />6 City, state, and ZIP code
<br />Ellensburq, WA 98926
<br />Social security number
<br />Part I
<br />4 6 3 4 1 I I 6 7
<br />Palt ll
<br />Cat. No. 10231X rorm W-9 1Rev. 10-2018)
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