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Farm W-9 iRav. 3-?0?4)Frue 5
<br />Part ll. Certification
<br />To establish to lhe withlrr:iding agent thal yatr are a U.S. Ferscn, or
<br />resident alien, sign Fonn W-9. Yar.l mey be requested to sign by the
<br />uithholding agent even if itern 1. 4, or 5 below indicates slhen'.'ise.
<br />For a joint accounl. oniy the person urhcse T1l{ is shoum in Fart I
<br />shor,rld sign (when required). ln tfie case of a disregarded entity, lhe
<br />person identified on line 1 rnustsiEn. Exemptpayees. see Er.ernptpayee
<br />code, earlier,
<br />Signature requirements. Complele the certificaticn as indicated in
<br />items 1 through 5 belovr.
<br />L lnterest, diviclend, ancl berter exchange accottnts opened
<br />before 1984 and broker accounts considerecl active during 1983'
<br />You must give lrquv 6trr.tt TlN, but you do nol hau,'e to sign the
<br />certification.
<br />2, lnterest, dividenrJ, broker, ancl barter exchange accounts
<br />otrenecl after 1983 and broker accounts ccnsiderecl inactive during
<br />1093. You nrust sigrr the certificaticn or backup withholding vrill apply. lf
<br />you are subject to backup withholding and you are merely providing
<br />your con'ect TIN to the requester, you must cross out item 2 in tfie
<br />cerbfication before signing ihe form.
<br />3, Real estate trangactions. Yor-r must sign the c€rtification. You may
<br />cross out item 2 of the certification.
<br />4. Other payments. You must give your Gorrect TlN, but yau do not
<br />have to sign the certification unless you have been nolilied that you
<br />have previously given an inconect Til{" "Other payments" include
<br />paynr'ents nrade ln the course of the requester's trade or business {or
<br />rents, royalties, gocds (other than bllls for rnerchandise), medical and
<br />healih care services {including payments to corporaiions}, pa}'ments to
<br />a nonemployee for services, pa'y'ments made in settlement of paynrent
<br />card and thiid-party network lransactrons, pa:ments to certain fishinE
<br />boat crew members and fisherme*,, and grc'ss proceeds paid to
<br />attom€ys {including payments to carpotationsi"
<br />5. Mortgage interest paid by ycu. acquisitian $r abandcnment of
<br />secured p.operty, cancellation of clebt, quali{ied tuition ptqgrqT-
<br />- _paynrenti (u'ndei section 52S), ABLE accsunt$ (under section 529A).
<br />lRA, Coverdell ESA, Archet MSA or HSA contributions or
<br />distrihutions, and pensicn distrihutfrons. Yau must giue yout conect
<br />TlN, but you do nct have to sign the c*rtificatian.
<br />What Name and Number To Give the Requester
<br />For this of account;Give narne and SSN oft
<br />For this of accounl:
<br />S. Disrequrd€d entiti. not aff€d tly ffi
<br />indtuiduol
<br />9- A rnfid tret, estata. or pmion trust
<br />tro" GorFgratisn sr LLG elscting corponte
<br />st3llJs on Fs{ m BgA2 cr Form 1553
<br />11. Associatlcn, club, raligicus. chmilabl*,
<br />edu:afuomsl, or qther tu-esem pt
<br />orEanizaticn
<br />1?" Partnechip cr multi-mmber LLC
<br />13- A hloker or rcgistered naminee
<br />14. Account uith the DeFartmffit of
<br />Agriculture in the nme ai a pubtic
<br />miit/ br:eh s d $tata or lffil
<br />go'€mment, echool digttict, or prisonf
<br />that receivea agricullural progrom
<br />payments
<br />15. Gri.nttr trust filing Form lo4! or
<br />under ihe Optional Filinq l'lethod 2,
<br />requiring Fom 1G9 (see Flegulation:
<br />section 1.071 -4{bXzXiXED"
<br />Give nanre and EIN ol:
<br />The o,*tner
<br />LBgd antitf
<br />The csporsiion
<br />The wEanizad+n
<br />The parher*hip
<br />Ttre brsker cr nomiftee
<br />Ttw public entity
<br />1. lndividr:al
<br />?, Twa or ffio!€ individuals foint acmuniJ
<br />other lhrn sn accounl maintained by
<br />an FFI
<br />3, Twc or more U-9. pe,rzonz
<br />foini account mcintain*d by an FFll
<br />4. ()ustsli^l
<br />^ccount
<br />of a minor
<br />(Urrifom Gift io Minore Acil
<br />5- a. The usual revocable savings trust
<br />(granior is ako trusiee)
<br />b. Semllad ln:st accounl that it not
<br />a legal or r,alid trut under state bv/
<br />6. Slle proprietor:hip cr disreEarded
<br />entily ovrned by an individual
<br />7, Granlor trusl filing urder Optional
<br />Filing lvlethod 1 (see Regulation*
<br />strtion 1.6r1 -albx?){ixAl}"
<br />Kittitas County Agreement for Services (rev.5/14/25ll
<br />Page 2L of 22
<br />The trust
<br />'List firgt and circle the name of the person vrhose number you fumish.
<br />lf only one p€rson on a ioint account has an S-qN, lhat person's number
<br />must be fumished.
<br />?Circle the minor's name and fumish the minor's SSN'
<br />r You must show vour individual nanle on line 1 , and enter vour business
<br />or DBA name. il ahy, on line 2. You rnay trse erther your SSN or EIN (if
<br />you have ona), but the IRS encourages yEu to use your SSN"
<br />i List first and circle the name of the trust. estate, or pension trust- {Do
<br />not {umish the TIN of the Femonal r€presentative cr trustee unless th€
<br />legal entity itsell is not designated in the account title.l
<br />'Note: The grarrtor must also pruvide a Fann W-9 to tie trusiee of the
<br />truEt-
<br />'" For nrore information on optional fiTing rnethods fcr Erantor trusis, see
<br />llre lnstructions lon Fonm 1041-
<br />Note: lf nq name is circled when rnsne thanr lTle nanie is {isted, the
<br />number'.till be sonsidered to be thal of the finst narne listecl.
<br />Secure Your Tax Records From ldentity Theft
<br />ldenlity theit occurs ruhen someone uses !oilr p€rsonal information,
<br />such a-s your name, SSNI, or other identifying infurmation. lr'ithout your
<br />permission to cornmit fraud or other crirnes. An identity thiel may use
<br />'your.SSN lo get a iob ar may file a tax return using yc'ur SSN to receive
<br />a re-fllnd.
<br />To reduce your risk;
<br />. Protect your S-$N.
<br />. Ensure your employer is prclecting yout $SN, and
<br />. Be careful when choosing a tax return preD€'rer.
<br />lf yor-rr tax reccrds are affected byr identity lheft and you receive a
<br />noiice from the lRS, respond right away to the narne and phone number
<br />printed on the IBS notice or letter.
<br />ll yc,ur tax records are not cunently affucted by iclentity theft but you
<br />thin( 1,grJ are ai risk due to a losl or stolen ptlrse or wallet, questionable
<br />credit card activity, or a questionable credit report, contact the IRS
<br />ldentity Theft Hotline at 800-$08-,1490 or subrn;t Form 1 4039.
<br />For nrore informaticn' see Pub" 5o3l' ldentfu Theft lnfr:rmation for
<br />Taxpayers.
<br />The indisidual
<br />The actual o'mer of the rccornt ar.
<br />if combmed funds. the fiel individual
<br />an ihe acmunll
<br />Each holder of the accounl
<br />The minorZ
<br />The grsntrr-trusteB'
<br />The actual p,me/
<br />The qvrnef
<br />The grantar'
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