|
w-g Request for Taxpayer
<br />ldentification Number and Certification
<br />> Go to www.irc.govlFofmwg lor instructions and the latest information.
<br />Form
<br />(Rev. Octobsr 2018)
<br />Department of the Treasury
<br />lnternal Fevenue Service
<br />Here
<br />Give Form to the
<br />requester, Do not
<br />send to the lRS.
<br />I Name(asshownonyour tax Name ls on this line blank.
<br />4 Exemptions {codes apply only to
<br />certain snlities, not individuals; see
<br />instructions on page 3):
<br />Exempt paye€ code (if any) _
<br />Exemplion {rom FATCA reporting
<br />code {if any)
<br />(Appfies to accounts mintainod outsida tne U.S)
<br />Requester's namo and address (optional)
<br />Kittitas County Auditor
<br />205 West Sth Ave . Suite105
<br />line 1 to avoid
<br />However, for a
<br />For other
<br />How to get a
<br />Date )
<br />. Form 1099-DlV (dividends, including those from siocks or mutual
<br />funds)
<br />r 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 />r Form 1 099-5 {proceeds from real estate transactions)
<br />. Form .1099-K {merchant card and third party network transactions)
<br />r Form 1 098 (home morigage interest), 1098-E (student loan interest),
<br />1098-T (tuition)
<br />. Form '1099-C (canceled debt)
<br />. Form 1099-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 subiect to backup withholding. See What is backup withholding,
<br />later.
<br />La
<br />2 entity name, if
<br />dba Jazzin
<br />7 List account numb6r(s) here {optlonat}
<br />Signature ol
<br />U,S, person )
<br />above
<br />c)E)(!o
<br />c
<br />ttco
<br />.J5
<br />o
<br />E
<br />.9:E(,
<br />ll,ao
<br />ooa
<br />OJo
<br />oz.E
<br />o.
<br />Enter your TIN in the appropriate box. The TIN provided must match the name given on
<br />backup withholding. For individuals, this is generally your social security numoer lsstrt;.resident alien, sole proprietor, or disregarded entity, see the instructioni for part l, later.
<br />entities, it is your employer identification number (ElN). lf you do not have a number, seeIlN, later.or
<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 for guidelines on whose number to enter.
<br />Under penalties of perjury, I certify that
<br />l 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 subject 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 resuit of a failure to report all inleresi or dividends, or (c) the IRS iras notified me that I amno 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 currently subject to baokup withholding becauseyou have failed to report all interest and dividends on your tax return. For teal estate transactions, item2 does not appiy. For mortgage interost paid,
<br />acquisiiion or abandonment of secured property, cancellation of debt, conkibutions to an individual retirement arrangement 1tnn;,-anid generally, payments
<br />other than interest and dividends, you are not required to sign the certification, bul you musi provide your conect Tlli. See the initructi6ns for Fart ti, tat"r.
<br />General lnstructions
<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 to www.irs.gov/FormW9.
<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) whlch may be your social security number
<br />{SSN), individual taxpayer identification number (lTlN), adopiion
<br />taxpayer identification number (ATIN), or employer ldentification number
<br />(ElN), to repod 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 />r Form 1099-lNT (interest earned or paid)
<br />3 Cheok appropriate box for f€deral tax classification of the person whose name is entered on ljne 1 . Check only one of the
<br />following seven boxes.
<br />I lndividual/sole proprietor or Z c Corporation n s corporation f] Partnership n Trusyestate
<br />single-member LLC
<br />fJ LimiteO liability company- Enter the tax classitication (C=C co.poration, S=S corporation, p=partnershiF) )
<br />-*,.*Note: Check the appropriate box in the line above for the tax classificalion of the singl€-membet owner, Do not check
<br />LLC if the LLC is classitied as a single-member LLC that is disregarded from tho owner unless tho owner of lhe LLC is
<br />another LLC that is not disregarded from the owner lor U.S. federal tax purposes^ Otherwiss, a single-member LLC
<br />is disregarded from the owner should check the appropriate box for the tax classificaiion ol ils owner.
<br />Olher instructions) >
<br />, slreot, and apt. or
<br />P.O. Box
<br />no instruclions
<br />EI
<br />state, and ZIP code
<br />98926
<br />number
<br />Part I
<br />identification number
<br />9 1 1 2 1 1 1 7 3
<br />Part 1l
<br />Cat. No. 10231X Form W-9 (Rev. I 0-201s)
|