|
Page 3
<br />Form W-9 tRev. 3-?02'l)
<br />Cerlain Fvee-s and paYnlents are exenlpt from backup withholding-
<br />See Sembt ipyee coile, later, and the separate lnstructions for the
<br />Requester of Form W-9 for more information.
<br />See afso Fsfabtishrng [/.S. saafus forpuryoses o{ chapter 3 and
<br />chapter 4 withholding, earlier.
<br />What ls FATCA RePorting?
<br />The Foreign Account Tax Compliance Act IFATCA) requires a
<br />oartrcioalinq forerqn financial institution io rePort all [.!'S" account
<br />irolders thaiare sfiecified U.S. persons. Certarn payees are +xempt fronr
<br />FRTCA reportinq"'See Fxemplr6n from 1ATCA reporting 12de' later" and
<br />the lnstru;tions for the Requester of Form W-9 ior more informalion'
<br />Updating Your lnformation
<br />You rnrlst pror,ide updated information to any pe6on to !'/hom you
<br />claimed to be an exempt payee if you are no long*r an *xemPt pa-vee
<br />and anticipaie recei'.ring reportable payments in tlre future irom thts
<br />oenon. fir exanrple. y-ou may neeci t6 provide updated rnfor,ration if
<br />Lou are a C corporation that alects to be an S corporation' or if you are
<br />iro lonqer tax exempt. ln addihon, you must fumish a neur Form W-9 if
<br />fhe naire or TIN changes for the account. for example' if ihe grantor oi a
<br />granlor trust dies.
<br />Penalties
<br />Failure to ftrrnislr TlN. lf you fail tr: fumish your con ect TIN to a
<br />requester, you are subject to a penalty of $50 fr:r each such failure
<br />unless youi failure is due to reasonable cause and not to v,rillful neglect'
<br />Civit penaltv for false itrforttlation witlr respect to withholding' lf you
<br />make'a fal$ statement rvith no reasonable basls that resuhs tn no
<br />backup withholding. you are subject to a 5500 P€nalty.
<br />Crinrirral penalty for falsifying information' Willfully falsiflrng
<br />certifications or affirmations may subiect you to cnminal penalties
<br />iocluding fi nes and;'or impnsonnrent.
<br />Misuse of TlNs. lf the requester discloses or uses Tll{s in vrolalion of
<br />federal lavi. ihe request€r may be subiect to civil and criminal penaltiF-s'
<br />Specific lnstructions
<br />Line 1
<br />You must enter one of lhe follovring on this hne: (lo no! [eave this lin*
<br />btank. The name shottld match the name on your tax relum'
<br />lf lhrs FonI \n/-9 is for a ioint accouni (other than an accourit
<br />maintarned by a foreign financial inslitution (FFlll' list lrrst' and then
<br />circle, the name of lhe person or entity whose number you entet*d in
<br />Part I of Fomr W-9. lf y,ru are provrding Form $/-9 to an FFI tr) document
<br />a joint account, each holder of the account that ls a U.S p€rstn must
<br />provide a Form Vl-9-
<br />. lnelividual. Generally, enter the na{ne shown on y'rur tan return lf you
<br />ha,re changed your lait name e/ithout infomring lhe Social SecunlY
<br />Admuristration ISSA) of the name change, enter your first name, lhe last
<br />name as shol'rn on your social secunty card, and your rrel'r last nam*
<br />Note for lTlN applicant: Enter your individual name as lt u,'as entered
<br />on your Form W-7 application. line 1a. This should also be the sams as
<br />the nalne you entered on the Fr:rm 1040 vou filed n'ith your applicatlrn'
<br />. Sole proprietor. Enter your individual nanre as shorvn on your Fom
<br />10.1o o; line 1. Enter you; business, ?rade, or "doinE business as" fDBAi
<br />name on line 2.
<br />. ParttrershiP, C corporation. S corporation' or l-LC, otlrer than a
<br />tlisregartlecientity' Enter the entrty's name as sho'.ln Dn the entitf's ta':
<br />retum-on line 1 and any business. lrade, or DBA name on line ?.
<br />. Other entities. Enter your name as ghown on required U.5" lederat la':
<br />documents on line 1. This name should malch the name shown on the
<br />charter or other legal document creating the entity- Enter any busirress.
<br />trade, or DBA nanle on line 2.
<br />. DisreSareled entity" ln general. a business *ntrty that has a srngle
<br />o,lner. including an LLC. and is not a corporation' is disregarded as an
<br />entrt,, saparate irom tts ovrner {a disregarded entityi. See Regulatior's
<br />section i0 L2701 -2(c)(2). A disiegarded enlity shc,uld check lhe
<br />aoorooriaie box for the tax classificati,ln of its owner- Enter lha ovln*fs
<br />oame'on line 1. The name ot the owner entgrgd orr line 1 sheuld nerer
<br />b+ a disregarde,J entity. The name on line I shoutd be ihE namr shovrn
<br />on the inc6me tax reiurn on uhrch the i'rcome should he report+d For
<br />exarnole. r,f a foreiqn LLC that is treated as a disregarded entity fot l.}'S'
<br />aA;A il purpos:es has a sngle owner thal is a U S. person, the U S'
<br />o,,tney's nameis requirerJ to bd provided on line 1 tf the direct owner of
<br />the entitY is also a disregarcled entity. enter the first o\ryner that is hot
<br />disregariled for fudera! tbx purposes- Enter the disregarded entity's
<br />narne-on line 2.. tf the ownel of the disregarded enlrty s a foreignperson,
<br />ihl o*net rnust complete afl approprhte Fonn W-& instead,of a Fomr
<br />W-g- This is th.e case e'ren if the foreign person has a U'S- TIN'
<br />Line 2
<br />lf you hav.e a business narne, trade name" 08A name. or disregarded
<br />entitv name. enter it on iine 2.
<br />Line 3a
<br />Check. tbe appropnata box on line 3a for the U.S. federal tax
<br />classificatioo of t'he person whose narne is entered on line t Check only
<br />one box on line 3a"
<br />!F the entitylindividual on line J
<br />is a{$,. "
<br />THEN check the box for
<br />Corporation Corporahon
<br />. lndividual or
<br />. Sole proprietorship
<br />lndividual/sole proprietor
<br />. LLC classrlied as a Partnership
<br />for U-S- federal tax PurPoses or
<br />. LLC that has filed Fomr 8832 or
<br />2553 electing to be taxed as a
<br />corporalion
<br />Limited liability comPanY and
<br />enter the appropriate tax
<br />classification:
<br />P = Partnership.
<br />C=Ccorporalion,or
<br />S = S corporation.
<br />. Partnership
<br />. Trustlestate Tius0'estate
<br />Line 3b
<br />Check this box if you are a parinershrp iincfuding an LLC classrfied as a
<br />oartnershro for U-S. federal tax purposss). trust. or eslate that has an;''
<br />iorergn partners. ovr'ners, or beneficiaries, ancl you are providing thts
<br />fom-io a oarln€rshlo, trust. or estate in whrch you havg an ovJnershtp
<br />,nt*r"jt. You must iheck th. box on lrrre 3b d you recelv? a Form W-3
<br />(or docum4nlary evidencel from any pafiner, o!Yner.-'1r braneficiary
<br />estabtishinE ioreign status or if you recerv+ a Fomr W-9 from any
<br />partner. ovr-ner, oi beneFcrary lhat has che':ked the box on lrne 3b
<br />Note: A, pattnership that provid'es a Form rrV-9 and checks box 3b may
<br />be requiied to coniplete Sclredules K-2 an'J K-3 {Form 1065} For nore
<br />infr:mration. se€ the P3rlnership lnstructrons ior Schedules K-2 and K-3
<br />(Form 1065).
<br />tf vou .v+ requtred to comptQre llne 3b bltit iajl to do so. you may not
<br />reieive th* rnformatron necessary to lile a conect inforrnation rel'um r'{ith
<br />the IRS or fumlsh a corect payea statenreftt to your partners or
<br />benehctaries. See, for examp{i. sections 6698. 6i22. and6774ior
<br />penaltres that may aPPlY.
<br />Lis're 4 Exemptions
<br />if vou are ex+rnot from backup v"ithhofdlnq andior FATCA reporttng
<br />eriter in th+ appropnatt spaci :n [n+ .1 anl codetsl that may apply to
<br />yorLr.
<br />Exernpl payee coele.
<br />. Generaltry. indi'liduals (includin solla proprieiorsl ate not e;iernpt irorn
<br />b,ackup rvithhofding,
<br />. Except a9 provided belo!'r c'lrporatrons are exemPl fronr backup
<br />v,rithhokling f'orr certain patrrents, Lnckrding interest anti dividends"
<br />. comoralr:ns rre not exem.pl fronr backup v,ithholding for paymgnts
<br />*"d*ln a"ttl"tent oi paymenI card or thtrd-parh/ neh"ork irailgaclh]ns
<br />. Corporatrons are not exernpt from backup vvrtrhholding wrth respect to
<br />attorniys' fees or gross proceeds pard to ar'torneys, and corporationr
<br />that provicle nredical or lilealth care ser.;ices are nc]t exempt lvith respect
<br />io payment$ repcrrlable on Fornr 1099-MISC
<br />The folfo',ting codes identify pa'r'ee's that 3re +xempt from backup
<br />*rithhofding. Enter ihe appropnate cod+ rn the space qn line J
<br />1 -An orEarliaaborl +xempt fnrm tan unda,r seclion 501lai. any IRA' or
<br />a custcdralaccount under section '103ibll7l if the account satlsfies lhe
<br />requirenrenis of section .lo trlf)(21
<br />Kittitas County Agreement for Services {rev.5/74125l'
<br />Page 20 of 23
|