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Form w-9 Request for TaxPayer <br />- <br />ldentification Number and Certification <br />Give Form to the <br />requester. Do not <br />send to the lRS. <br />code (if anY) <br />Wpli6 to accounts maintained outsid€ lhe U S ) <br />4 Exemotions (codes aPPIY only to <br />certain dntities, not individuals; see <br />insiructions on Page 3): <br />Exempt payee code (if anY) _- <br />Exemption from FATCA reporting <br />(Rev. December 2014) <br />Deoadment of the Treasury <br />lnt6mal Revenue Service <br />N <br />o(')(! <br />o- <br />co <br />6occloAE <br />oc+i <br />o.9 <br />o(, <br />CLo <br />ooa <br />Name shown on Your income <br />Bill Clarke <br />Business entity name, if different from above <br />Bill Clarke at Law & Government Affairs <br />7 List account <br />ts on this do not leave this line <br />Requester's name and address <br />For real estate transactions, item 2 <br />of debt, contributions to an individual <br />does not aPPlY. For mortgage <br />retirement anan gement (lRA), <br />orI/N on page 3. <br />Note. lf the account is in more than one name, see the instructions for line 1 and the chart on page 4 for <br />guidelines on whose number 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 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 ", " <br />r""rit of a failure to r"port urr ini"*.i ot 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 bythe IRS that you are currentlY subject to backuP withholding <br />because you have failed <br />interest paid, acquisition <br />to report all interest <br />or abandonment of <br />than and <br />and dividends on Your <br />secured can <br />s, you not <br />and <br />generally, payments other <br />instructions on Page 3. <br />Sign <br />Here <br />General lnstructions <br />Section references are to the lntemal Revenue Code unless otherwise noted' <br />Future develoPmerds. lnformation about developments affeting Fom W-9 (such <br />as iegislation enacted after we release it) is at www'irs'govlfv't9' <br />Purpose of Form <br />An individual or entity (Form W-9 requester) who is required-to lile an information <br />i"irin *itn in" lns niuit obtain your'coneci taxpayer identification number (flN) <br />*r.,i"n nluv 6" vow social security number (ssN), individyaltaxpayer identiJication <br />numner {lilN),'adoption taxpayeiidentitication number (ATIN), or employer <br />. <br />ii""iitiiJii""'"urntier (ElN), io report on an infomation retum rhe amount paid to <br />;;.;;t#; ftunt ieportaute bn an information return' Examples of information <br />ieturns include, but are not limited to, the iollowing: <br />. Form 1 099-lNT (interest eamed or paid) <br />. Form 1 099'DlV (dividends, including those from stocks or mutual funds) <br />. Form 1 099-MISC (various types of income, prizes, awards, or gross proceeds) <br />. Form 1 099-8 6tock or mutual fund sales and certain other transactions by <br />brokers) <br />. Form 1 099-5 (proceeds from real estate transactions) <br />. Form 1 099-K (merchant card and third party network transactions) <br />sign the certification, but you must provide correct TlN. See the <br />. Form 1098 (home mortgage interest)' <br />(tuition) <br />. Form 1099-C (canceled debi) <br />(student loan interest), 1098-T <br />. Fom 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 alien)' to <br />provide your conect TlN. <br />lfvoudonotreturnFormW.gtotherequesterwithaTlN,youmightbesubject <br />to nLiiii wlitnnotdrng. See what is backup withholding? on page 2' <br />By signing the filled-out form' you: <br />1. Certify that the TIN you are giving is conect (or you are waiting for a number <br />to be issued), <br />2. Certify that you are not subject to backup withholding' or <br />3. Claim exemption from backup withhotding if you are a U'S' exempt payee' lf <br />r#i""bi.. uo, Jre also certifying that as a U'S person' your allocable share of <br />III p'"rt-""t3n,p l"come from i u]s' traoe or business is not sublect to the <br />*itif,oiJi"g tji "" foreign partners' share of effectively connected income' and <br />4 cerlitu that FATCA code(s) entered on this form (if any) indicating that you are <br />""".ii ii jt il," rnrbn t"porting, is conect' See What is FATCA repofting? on <br />paqe 2 for further infomation' <br />Other <br />Not€. For a single-member <br />the iax classilication of the <br />boxes:SEVENofthefollowingonecheckclassificaiion:onlyfederalfortaxbox3Checkappropriate Trust/estateIPartnershipCorporationnCCorporationoltrproprietorlndividual/solen <br />LLCsingle'member P=partnership)corporationtaxthe(c=cclassification corporation,Entercompany.liabilityLimited forabovelineintheboxiheappropriatechecknotdoLLC;checkthatLLCtsdisregarded, <br />ownersingle-member <br />1 501 <br />street,apt. or suite <br />Way, Suite 203 <br />code, state, <br />wA 98501 <br />on Number <br />H <br />Part I <br />number <br />7 1 45126IF <br />Part ll <br />Date >Signature of <br />U.S, person > <br />Cat. No. 10231X Form (Rev.12-2014)