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,o,, llll-9
<br />(Rev. October 2018)
<br />Department of the Treasury
<br />lntornal Revenue Service
<br />Sign
<br />Here
<br />General
<br />Section references are
<br />noted.
<br />lntemal Revenu€ Code unless otherwise
<br />Future developments. For the latest infonnation about developments
<br />related to Form W-9 and its instructions, such as legislation enacted
<br />aft er they were published, go lo www. i rs.gov I Fo mwg.
<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 corect taxpayer
<br />identification number (IlN) which may be your social security number
<br />(SSN), individual taxpayer identification number (lTlN), adoption
<br />taxpayer identification numbor (ATIN), or employer identification number
<br />(ElN), to report on an information retum the amount paid to you, or other
<br />amount reportable on an information return. Examples of information
<br />retums include, but are not limited to, the following.
<br />r Form 1099-lNT (interest earned or paid)
<br />Request for Taxpayer
<br />ldentification Number and Certification
<br />) Go to www.its,govlFormWg for instructions and the latest information.
<br />Give Form to the
<br />requester. Do not
<br />send to the lRS.
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<br />2 Business name/dlsregarded entity name,
<br />4 Exemptions (codes apply only to
<br />cenain entitles, not individuals; se€
<br />instructions on page 3):
<br />Exempt payee code 0f any)
<br />Exemptlon from FATCA reporting
<br />code (f any)
<br />(Appfies lo ac@nE mhhtned olidde the U.SJ
<br />R€qusster's name
<br />7 List account numbe(s) here (optionaO
<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 identitication number (ElN). lf you do not have a number, see How to get a
<br />I/N, later.
<br />Note: lf tho account is in more than one name, see the instructions for line '1. Also see What Name and
<br />Number To Giva the Requesfer for guidelines on whose numb€r to enter.
<br />Under penalties of perjury, I certify that:
<br />1' The number shown on this form is my correct taxpayer identification number (or t 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 />Servlce (lRS) that I am subject to backup withholding as a result of a failure to report all interest 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 correcl
<br />or
<br />3"0-3Oate >
<br />. 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 />o 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 />e 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 />o Form 1099-C (canceled debt)
<br />. Form 1099-4 (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 conect TlN.
<br />lf you do not return Form W-g to the requestar 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 classitication of tha person whose name is entered on line 1. Gheck only one of the
<br />following seven boxes,
<br />n lndividuaysoleproprietoror E CCorporation fJ Scorporarion n eartnersnip f] trusVestate
<br />single-member LLC
<br />fl t-imiteO liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partn€rship) >
<br />Other lnstructions) >
<br />5 Addrsss (number, street, and apt. or suit€ no.) Sa€ instructions.
<br />110 West 6th Avenue PMB #374
<br />6 City, state, and ZIP code
<br />Ellensburg, WA 98926
<br />Social numbor
<br />Part I
<br />Employer
<br />9 1 1 8 I 3 8 4 0
<br />Part ll
<br />Slgnature ol
<br />U.S. person
<br />Cat. No.10231X Form W-9 1Rev. 10-2018)
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