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Form l{-9 tFler, 3-202.1)FaEe 4
<br />2-The Uniled States Dr any of ils sgencies or instrumentdilies.
<br />g-A state, th€ District of CDlumbia. a U.S_ c+rmmon+real|.fi lrr l€rrtorj,.
<br />,rr any of their political subdivisi:ns or instrunreiltalities.
<br />{ -A f,rreign govemment Dr any of its palitical suhdi'.'iisions- ag*ncies'
<br />ar irr strumentalilii:s.
<br />5-A c,:rp+rotion.
<br />6 -A clealer in securities or comnrqdities, re.quire.cl tl ne'grster in the
<br />United States. the District of Colunrbia. or e U"S.. cammnfiweshh tr
<br />teffitory.
<br />7-A futures ccmmissicn msrchatrt registx*J ',rilh th+ Camrntrditf
<br />Frrrlures Trading Comnrission.
<br />8-A real estate inv*siment trust.
<br />I -An entity registered at all times during lhe t*t 1'ear urnder th*
<br />lnve=tm€nt Cc,mpany Act of 1940.
<br />10-A conrmon trust ftlnd operated by a bank un,ier s€ction 56"tial'
<br />1 1 -A iinancial institution as defined under s€c{ir:n 56-1.
<br />'12-A nriddlenran krrown in the investrnent comrflunitry a$ a nonrinee or
<br />custodian.
<br />l3-A tnlst exempt fronl tal{ under section E6+ +r described in section
<br />4547.
<br />The following chart sho'.vs lypes ,rf payments that may b€ exetnpt
<br />fronr backup withlrolding. The chart apPllF-s lo the €,\ernPt p'alees listed
<br />above. l through 13.
<br />lF the paynrent is for fHEN the paytilerit is exenrpt
<br />for,..
<br />. lnlerest and di'ridend payments All exenrpt payees e.{':eP1
<br />for 7.
<br />. Broksr transacttDns E,x+nrpt payees 1 thr:r:ugh { and 6
<br />thraugh 1 1 anct all C cr:rptrratiorrs.
<br />S corporatians rrttqst n,1,1 Pnt€r x.n
<br />exenrpt pai'e€ l*Jr h'er-:use thel
<br />are e:<empt 'rnly for ssles o{
<br />n onccvered seci.t tities acquired
<br />t,3 20.1!.
<br />. Barter Exempt ca'9ees 1 thrau,Eh .1,
<br />and
<br />. Peyffi€nte over 5600 r*qrrired to
<br />be rey-'Ia4 and direct sales over
<br />55.0001
<br />. Paynlents rnade in setl,lement cf
<br />paymsnt carrJ or thireJ-patty
<br />net.'/ork lransactrons
<br />1 See Fcrrn l0s9-fu1lSC. Miscellaneous lnfomraticn. anri: its instruction*.
<br />tHowever. the follorvirig payments nrade tc a coql,a{athln and
<br />repofiable on Form 1099-MISC are not exernpt frurfl, t:sck-Llp
<br />'.vilhholding: rnedical and health tar+ payments, sttltnel*" fee=. qrosr
<br />proceeds Iaicl tc an attr]rney reportai'le under sP.cti*n 6fi'15{fJ. and
<br />paymeni:;Ior ee*-ices paid byi a federal +xecutive aqeniy-
<br />Exenrption fronr FATCA repoding c*qle' The f,ello'.t'ing clrdes idenl*1
<br />payees that are exenrpt from reporting und*r F,t{TqlA- The:e t*de=
<br />apply to pergons suL'mttting tfiis f,rrnr for accounls maintaine'l qtrtside
<br />of thi,e Uniled Ftates by cettain for+igrr financral iflstitu'tions. Thare{urs. if
<br />you are only sut'n'littin'g this farm loian account 1'ru ht'ld in' th,e United
<br />States. l/ou may leave this field blank. Consult lrit-h the Ferson
<br />requesling this f,:rm if yoLr are ltncertain i{ the fina-nrial isslituliDn is
<br />stLbjer:|to lhese requirernenis- .4 requesier ma'rr indic;ste that s cele is
<br />nol'rectuirs{l br,, providincl ',/rru wilh a Fornr ViLg rtith 'F{*t.applicaH*" for
<br />any sirnrlar indlcat ion) eniired on the line for a FiTCF, + ;enrpti'ln corJe-
<br />A- P,n arganization ex*mpt ftom ta;'t under se*tiofl 5t:11 ial 'Jr ar!!'
<br />individual retirement platr as defined in sectlon ;T0'1iaj{3li
<br />B-The United Slates or any cf its agencies crr inslr:nren{alities-
<br />C-AstaIe. the Dislrict of Coltrmbia. a U..:. .,:rmmon!'r€altf-r r
<br />lemlory. or any of their political subcfivisinn= Dr inslrumentalitiBs.
<br />D-A crsrporatirsn the,3tock .-'f wl-rich is regularl'l traded ':n one or
<br />more estgL'lishecJ securities' nrark+ts. ae Cescfibed iin Reqtila?ions
<br />section 1 .1.172-1 {r:)(1 )(i).
<br />E-A crrprration that is a rnember of the sarl-,e exparld€d affiliated
<br />group a3 a corporatiDn descnbed in Eegul+trnns settian n,1+f,!-licl{liiii
<br />F-A dealer ilr securitieg. cornrnc"lities. or dPrir'atire irna:rr:ial
<br />instnrnrer-ts linciuding noi*nal principai corilracts. flih,rn-*s. f'onra;'js'
<br />and c,ptionsf lhat is registerred as sr*J: und*r the lalts +f th+ {-hite'l
<br />Siales ar an'f EtEi*.
<br />G-,{ resl estata in'Je.liflerrt ttusil.
<br />H -4. rsg'ulat+rJ inliestmarrt dotnpaFg as defii:ed inr s*Jti. n ts51 5r Jn
<br />entity registered at all timre*,*,;ring tfr* taa 3ear ur}del tie kr'd*sttn+{'ri
<br />CDrnFtsn:J Act ai 1948,
<br />l-A commfin truet iundi as dsfirr€di in *rytil:srr 5*liai.
<br />J-A irank ae defined in seatior! 53'1..
<br />K-& broher.
<br />L-A tlst e;t*crFt frem tax undsr sectjr+-: 064 cr dqstribtd irr s€{lion
<br />19.17{aii1i.
<br />fu{-A lax-exernpl trust under 3 s€etimfi {tH'tb] piar 'ar s'ertic'n +5ll51l
<br />plan.
<br />llote: You nray *ish t+ c*nsult vrrth the frnsn[iai inslrtuti*n r*luesting
<br />this fi:rnr to det,+mrin*',,'-'hetfien ih* FATCS. caclle arrcl",ir e;empt pa1'ee
<br />code shotlld be complet+d,
<br />Line 5
<br />Enter your address inumber. stteet- ar{d aportm*nt nr zuite numb*lr'[-
<br />This is vrhere the requester oi this F+rm {'{-9 '""rill nrar} i'r:ur infarrinaticn
<br />r+turns. lf this adclress di{fets frcnfi lh* ,lfle'the r':q:uester alreedy has on
<br />file. enier 'ilFlJ" at the top- if a nevv address is pnr"'ided. lhere is still a
<br />chan€e the *ld adCress ,.f ill b"? rs*d until the pa'o.sr *hanqeE lr$ur
<br />sddress in iheir records.
<br />Line 6
<br />Entsr your city. state. gfld ZIP tsde-
<br />Part l. Taxpayer ldenttfication Nunrbe!' {TlN}
<br />Enter your Tli,l in lhe apprc,priate trox" lf irrr-;r are a r+5idtr-tt a:ii€n and
<br />l.'ou dc, n.rt ha're. Jnd are nr,t eligih,l'1 t.,} get' al-; S'$iJ. :r'our- Tlll i; !'rur
<br />iRS tlfl. Enter it in lite sfitr.,' !#a,re i.:{ the Sr'rial s*.:utitt' nrirrnber. ii }-or-,
<br />dcr nc,t have an lTll'.l. see H4',y ft rjet a IXl,,l helri,',i.
<br />lf i'ou are a srrle pr,:prietcl anil i"ou llaus an Elll. 'ttll riai'' el'rtet tithar
<br />1'aur -iSP,l ,:r ElfJ-
<br />lf y,',:u .er* a +ingle-ni*nrber LLti that is disregsrded as ar :rilit'i
<br />qenarate frcur fs il,'iner, e nler lhE ,:'-tr*r's. S.iFl tor ElFl. rf thr'r:'r*rrer has
<br />onel if the LLC rs il;-:srii*ti as 3 a/airFt:tall'2n +r p'arttl*ishiF entsr th'e
<br />entilv's Elll,
<br />Note: See lllhat i,'ame anC I'Jum&er I-q Gr* ffr* ,qEef,uesi*r. !ai*r' f+r
<br />fur-tlrer riarifrcalir.:n -J{ nanie and TllJ q,oi:r*inlliar'€.
<br />HolT t{, qet a Tlfi"ll. if y66 de tu:t hane a Tll't' app'|1" far cn* rrnnre<liately'
<br />Tl app\r'for an SSN. g€t Form :35-5. ,f'pglicatiln iar a 5,:cial:3ecuiti"
<br />Carc!. frpm your h':al 5$A r,flire ':r g*'t fiis farnr lrline al
<br />r'..,r'w'.55A.5r,:v. You may elso g*t tlrus {*rrn bir callinrq '3Cj:L;;3-1!-l3 l-.15e
<br />F,:rrr rtV--. Applicadcn f'x IFS lndi'.qdlreii-Fsrga'1er lider',lificali':r'
<br />I'Jumber. t-o dplll tttr an filfi. or Fcrm 1$-'t, rspp'{ir*ti:il f':r Eru:pl':ier
<br />ldenlificati,:n l,{umb":r. ta applir i':,r an !ll'1. Yot;r cafi apFiid {':{ arl Elf'l
<br />cnline by acc*ssing the IES r,tehsit* at t'r'r'1"14' rrs-gFralFJ{- !3r to
<br />rrr.r.,v.ie-go',.,,Fr-rr.m5 1:t:, $ie\,'r- doii,nlaad. ':r pcint Frrrn'rY-? errdi''lr F'],f:li
<br />J.+a. Oiiyau tan g.r t,: 1.1'r,n'er--'rs.,ff['.{if.L"€iFirr3s trr FIar:* ar', c'r-der ard
<br />ha,re Ferm W-7 an,tr'ar Fsrm 95'.J rnaiiedi ta 1;.:'-: '.'r'ill-rin 15 busirreBs
<br />days.
<br />lf i,:u are rtkqJ Vs tr]mFi€te F,:mr {rrl $ blt dc' ru:t ha-+ l Tlltll- appl'y
<br />f,:r a Tll't and ent*r "Applied Fqr. iti liie sFdr..e fta' tfte Tlf'{- sirlin *nd 'iat*
<br />the'fr:rw, and give il l,: tlr* r*qu'*,tet. F?' itlter€sl ardi diui'Jerd
<br />paym€nt3. and certain payrfientE n:ade'.'.'ith /e*Fe';t t+ sead:il! lradab:e
<br />insiruments. y6u !'rill gsnerulli have 61 days tc '3ei a Til'l and 'trirte rt to
<br />thd rtif]ueslE be{'trz 'i'tt ar* s{rL}le{l !,1 L's-,h.t-:p .r'rtl-h:!liln-q':rr
<br />payrnents. The t'D-<liv rule d':+s n';t apFl:r'10 ':ilh€r tl.rpes 'rt psi'm+nts
<br />:{,:u
<br />',qrli be sLrbjert tc' backup r,r'rtlrl-,rc{ding r.n ,*}l; :uri-r pel.q'aents unlil
<br />i-ou pr*vide 1'our Tlltl tll th* rsquo-st€t..
<br />Note: Ent';ring ''Applied Foi'' meatr; iha.t l!r:u l'xle alr+ad1'r appli+'Jit:r t
<br />Tlll
<br />"r
<br />thet y.:u inter!{l ta apply f':r *ne'+:.:r. 5e* is':Eslab-"i:ltlrg '} 5.
<br />status f*r puryo:,es of chalpieir I ato :,tapfes -l rujtth*Jniirg. eatlie{, fc'r
<br />'ruhen ;-cu may rrrctearJ be suh!*:t tu it'illrrhll'Jir,g{ und*r rl-,apter 3 cr -9 ai
<br />lhe C,rde.
<br />Carfiiott: A.,j!5rgr.Jalde{J U.ii, *ntil'y rlrai ha= a {*re'i,3n '-1'.'rriqr nnrlsl u:ca
<br />the apprrpriate Fonn W 8'
<br />Gener:lty. Bi{emFt Fra'te€s
<br />1 tlrrough 5,:
<br />Lrenrpt palrrees 1 throu,$h 4.
<br />Kittitas County Agreement for Services (rev. 5/Ia/25)
<br />Page 2O of 22
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