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Form \ry-g {tlev.3-2O!$Page 5
<br />Part ll" Certification
<br />To establish to lhe withholding agent that you are a [J.S. persan, or
<br />resident alien, sign Form W-9" You nray be requested to sign by the
<br />rvithholding agent even if itern l, 4, or 5 belor$ indicates othervrtse.
<br />For a joint aecount. only the peaon vrhose TnN is slho"sn in Fart I
<br />should sign {when required). [n the case af a disreEarded entit], the
<br />person identified on line 1 musl sign. Exernpt payees, see Exempt payee
<br />code, earlier"
<br />SiEnattrre requirements. Conrplete the certification as indicaled in
<br />iiems 1 firougir 5 belo',v.
<br />I " lnterest, dividenel, and barter exchange aceounts openecl
<br />betore 1984 and broker accounts considered active dttring {983"
<br />You must give your correct Tlhl, bu! you do not have lo sign ihe
<br />certification.
<br />2" lnterest, dividend, broker, and barter exchange aeco*nts
<br />opened after 1S83 and broker accou$ts consiqJered lnactive during
<br />1083. You must sign the certification or backup withholding will apply. lf
<br />you are subjecl to i:ackup r,vrthholding and you are metely providing
<br />your correct TIN to the requester, yqu tnust cross out itern ? in the
<br />certFrcat'on before signing the form.
<br />3. Aeal estate transactions. You musl sign the certification. You may
<br />cross out item 2 of the certification"
<br />4. Other payments. You must give your correct TlN, but you do not
<br />have to sign the cerlification unless you have been notified thal you
<br />have previously given an inconeci TlN. "Olher payrnents" include
<br />payments made in the course of the requester's trade or business ior
<br />rents, royallies. goods fother lhan brlls for merchandise), medical end
<br />health care services {including payments to corporations), pa}.{nents to
<br />a nonemployee for servicas, paynrents made in settlement ef payment
<br />card and third-party net'r/ork transactions. payrnents to ce(ain fishrnE
<br />b{)at crew members and fishemren, and gross proceeds paid to
<br />anomeys {including payments to corporations).
<br />5. Moltgage interest paid by you, a*quisitiorr or abanelonnretli of
<br />secured property, cancellatinn of cfebt, qualified tuitiotr prograftl
<br />paymenti {rrncler section 529}, AgLg accou$ts {under section 5294},
<br />lRA, Coverdell ESA, fucher MSA or H$A contritrutions or
<br />distributions, and pension clistrihtations. You tnust give your conect
<br />TlN, but you do not have to sign the certification.
<br />What Name and Number Tc Gitre the
<br />For lhis of accourrt:Give nanre and $SM of:
<br />indi",idual
<br />Fcr this of acrco!imt:
<br />g. 0isregarded:ntrt/ mt dnid bi afi
<br />individual
<br />9" A \€lid trusl' 6ltt*' or Fre$iof,d iir6t
<br />10. CorForstron or l-l-C electihg carpmale
<br />staius ,fi Foffi E6SZ 6 F6o ?5i3
<br />1L lLgsoc,iaticn. cluh. rebEiizus. ciffiiabLb"
<br />edustioml, or otfiet liet€xmpt
<br />organi:atoo
<br />12. Psrtntrshjp 6r muitrirrwnhry Ll-C
<br />'i3. A brok*r or iegisteredl nosin*t
<br />14. A':count #idT theOeptrir$iitof
<br />Agrimltwa a the mrne of a pubk
<br />ef,tiry ituch as a. s,tnt: 0r lccal
<br />gcvemmeni. shmf Jctnet. or pnson,
<br />lhai r*reives agris{rtum! grcgrm
<br />Faymenls
<br />15. Griltork6.tfilmq Form1*"*1 or
<br />rnder the Optional Fi[Dg f'{ethcd 2"
<br />requirinq Form 1C:99 (s€e Riq.uhtms
<br />sec5on t -671 -l{tll2;i!}(B}}'-
<br />6iiEe n'ame and EIN of:
<br />The ovrnet
<br />LEqd
<br />"ntity{'lihe,wpryalion
<br />Th* organmnon
<br />Tho pa'n*rslirF
<br />Thr brqi{fl or nminee
<br />Th* public mrty
<br />The minor:
<br />The griltor-tffirer.'
<br />Th* actual osrnerr
<br />The ol,rnerl
<br />lihe,artrtor
<br />Kittitas County Agreement for Services lrev.5/1'4/25)
<br />Page 22 of 23
<br />lh€ tftsl
<br />:List first and circle the rrame of the Fersgn onhose nurnber you fumish
<br />lf only one person on a joinrt acto!,rn! has an SSN' tha! person's number
<br />nrusl be furnished-
<br />: Circle lhe mrnor's name and fumish ihe ninofs SSN.
<br />r You must shs.v your individual narn+ on line 1 . and gnter your busirress
<br />or DBA name. ifany. on fine 2- '(ou nlay use edher your SSN or Elltl [f
<br />you have one). but th* lFtS enc+uraEes y'lu to use your SSN
<br />r Lisl firsi and circle the name of ihe trusi, estate. or pefision trust (Do
<br />not iumish the TiN ol the gersonal repr+sentative or &ustee untess the
<br />legal entrty ilsslf is not deslEnated in &e account tjtle.i
<br />'Note: The grantot must also prcvrda a Forr"r fJ-9 tc tl-re trustee of the
<br />trusi.
<br />'" For rnore intbrmation onr optional fdrng r-nethods ior grantor trusts, se€
<br />the lnstruciions ior Forrn 1 J+l.
<br />Note:. li no nanre is crrcled rthen rnore ihan one oame is listed. the
<br />number lrill be considered ic bE ihat of'lhe frrst name listed.
<br />Secure Your Tax Recare{s Fror* ldentity Theft
<br />fdenti$ theft occurs whe* so:rrle.rne uses ycrill personal infomratiorr,
<br />such as your name, SSFI. or o'ther iden0,fying infor:mation, *ithout your
<br />perrnission io conunrt fraud or ot]ler cimes,. Atr identi$ thref may us*
<br />your SSFI to get a job. or nrayr frle a tai( f eturr't ttsing your SSF[ to reeeive
<br />a refund.
<br />To reduce yourr nsl;:
<br />" Protect your S.qf{'
<br />. Engure your employer rs protectungt ,loun SShl, and
<br />, Be cerefuf ',vhefl,chu^osrnq a ta/. refurn prepairer.
<br />[f your tax rrecol'ds are aftected, by rdianttit threft and you receive a
<br />notice frorrr tJhe lflS. responc.li nglrt avre; to the name and phcne nurnber
<br />pnnted,]n the lRSl so,h:c€ or leit')r
<br />if vour iaz rec.lrds are ncr cunently affecled by rdentit'7 lheft bul you
<br />thin( you areat osk due to a I'e,st or dtolen purs+ or'r/3llet. queshonable
<br />cred( c€rd art!,yrfy', o,r a qu€s{ionab,lb cred"it report, cofitaat the !RS
<br />tderrtity Thett H:o$ine aii 8oo- gtla: +490, or subntit Farrn 1'1639.
<br />For more rnformatron. see Fub. 5027, ldentrty Theft fnfonnaljon for
<br />Taxpal.ers.
<br />1. lndividuat
<br />! Tno or msr" ifrdr.,duals llrint iccount)
<br />othgr than an aactrunl mantarned by
<br />an FFI
<br />.3. Tyr* or mor* U.S. p:mons
<br />{jornl ac.ruftt naintaineC hy rr FF}}
<br />'! Custc'dial account of a mm,v
<br />lUnrform Grit to L4inors Actl
<br />5 a. Th= reual re-.,ccabi+ 3aving.s fui
<br />{grmlor rs ajsq trusltel
<br />b. Srrcall+d ftust acccunl tfiat rs {st
<br />a lega! or ra!'d trusi und€r $tats iav/
<br />,f So!: prqprietomhrp rr drsr*q:rded
<br />antrtl ovlned by 3ft nd'i';rdual
<br />7. Grantor trust fi[n,? under Opt6nal
<br />filne l"lethad 1 fs.e Flegulaiions
<br />seclion 1.6i1 -qbli2ilil{A}t"
<br />Tbe actual olanar of the a":count or.
<br />rf s,mbinqd funds. the iist individual
<br />on thr 3ccountl
<br />Fa.h h.fd:r of ih. iccount
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