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Form
<br />(Rev. October 201 8)
<br />Department ot the Treasury
<br />lnternal Revenue Seruics
<br />Here Signature ot
<br />U.S. person )
<br />General lnstructions
<br />Seclion 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 inskuctions, such as legislation enacted
<br />afler they were published, go to wwulrs. gov/FormWg.
<br />Purpose of Form
<br />An individual or entity (Form W-9 requester) who is required to fjle an
<br />information return with the IRS must obtain your correct taxpayer
<br />identification number fflN) which may be your social security number
<br />(SSN), individuai taxpayer identification number (lTlN), adoption
<br />taxpayer identilication number (ATIN), or employer identification number
<br />(ElN), to report on an information return the amouni paid to you, or other
<br />amount reportable on an information return. Examples of information
<br />returns include, bui are not limited to, the following.
<br />r Form 1 099-lNT (interest earned or paid)
<br />Request for Taxpayer
<br />ldentification Number and Certification
<br />) Go to www.its.govlFormWg lor instructions and the latsst information.
<br />Requester's name address
<br />w-g
<br />(f)
<br />o
<br />l!o.
<br />co.o0rEo.o>E+b
<br />o(
<br />=tnr,o
<br />:!(,ocIo
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<br />on your income tax relurn).on do not looee this line
<br />Horse
<br />2 Businose entity name, if different from above
<br />7 List account numbe(s) here
<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 />enlities, it is your employer identification number (ElN). lf you do not have a number, see Haw to get a
<br />I/N, 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 lor guidelines on whose number to enter.
<br />Give Form to the
<br />requester, Do not
<br />send to the lRS.
<br />4 Exemptions {codes apply oniy to
<br />certain enlities, not individuals; see
<br />instructions on page 3):
<br />Exempt payee code (if any)
<br />--Exemplion from FATCA reporting
<br />code {if any}
<br />{/\ppti* loaccounls maintaind outsido ne U.S.}
<br />Kittitas County Auditor
<br />205 West sth Ave . Suite105
<br />wA 98926
<br />or
<br />Certification
<br />Under penallies 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 noi been notified by the lnternal Revenue
<br />Service (lRS) that I am subject to backup withholdjng as a result of a failure to repod all inleresi or dividends, or (c) the IRS iras 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 />Certitication inslructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding becauseyou have failed to report all interest and dividends on your tax return. For real estate transactions, item2 does not apply. For modgage interest paid,
<br />acquisition or abandonment of secured property, canceliation of debt, contributions io 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 Tlli, See the instructi|ns lor Fart li, later.
<br />Sign
<br />Date )
<br />. Form 1099-DlV (dividends, including those from stocks 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 />transactlons by brokers)
<br />o Form 1099-5 (proceeds from real estate transactions)
<br />. Form 1 099-K (merchant card and third party network transactions)
<br />r Form l09B (home mortgage interest), 1098-E (student loan interest),
<br />1098-T (tuition)
<br />r 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 />If you do not return Form W-9 to the rcquester 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 o{ the
<br />following seven boxes.
<br />I lnoividual/sols proprietor or Z C Corporation n S Corporation ! Partnership f] TrusVestate
<br />single-member LLC
<br />fl t-imiteO liability cornpany. Enter the tax classilication (C=C corporation, S=S corpo.ation, P=padnership) >
<br />Note: Check the appropriate box in the line above tor the tax classification of the single-member owner. Do not check
<br />LLC if the LLC is classified as a single-member LLC lhat is disregarded from the owner unless the owner ol the LLC is
<br />another LLC that is not disregarded from the owner for U,S. {ederal tax purposes. Otherwise, a single-member LLC that
<br />is disregarded lrom the owner should check the appropriale box for the tax classification ol ils owner.
<br />Other (see
<br />street, and apt. or suite no.) See instruclions.
<br />P.O. Box 214
<br />5 Address (num
<br />wA 98926
<br />6 Cily, state, and
<br />Ellensbu
<br />Number
<br />Social security number
<br />Part I
<br />identilication number
<br />I 1 1 2 1 1 1 7 3
<br />Part ll
<br />Cat. No. 10231X rormW-91Rev. 10-201s)
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