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Form W-9 (Rev.3-20241 Page 5
<br />Part ll. Certification
<br />To establish to the withholding agent thet you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requesled to sign by the
<br />withholding agent even if ilem l, 4, or 5 below indicates othenvise.
<br />For a ioint account, only the person whcse TlFl is shown in Parl I
<br />should sign (when required). ln the case of a disregarded enlity, the
<br />person identified on line -l musl sign. Exempt payees, see Exempt payee
<br />code, earlier.
<br />Signature requirements. Complete the cerlilication as lndicated in
<br />itemsl through5below.
<br />1. lnterest, dividend, and barter exchange accounts opened
<br />hefore JOB4 and broker accounts considered active during 1983.
<br />You must give your correct TlN, but you do nol have to sign the
<br />certification.
<br />2. brlerest, dividend, broker, and barter exchange accounts
<br />opened after 198i! and broker accounls considered inactive during
<br />1083. You must siqn the certification or backup withholding lrill apply' lf
<br />you are subject to backup withholding and you are merely providing
<br />your corect TIN to the requester. you must cross oul item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactiolls. You must sign the certiflcation. You may
<br />cross out item 2 of the certification.
<br />4. Other paynr€nis. You must give your conect TlN. but you do not
<br />have to sign the certification unless you have been noli{ied that you
<br />have previously given an inconect TIN. "Other paymenlsn include
<br />payments made in the course of the requester's trade or business lsr
<br />rents, royallies, goods (other than bills for merchandise), medical and
<br />health care services (including payments to corporations), payments to
<br />a nonemployee for services, payments made in seidement of payment
<br />card and third-party nelwork transactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proreeds paid to
<br />attomeys (including payrnents to corporations!.
<br />5. Morlgage interest paid by ycu, acquisition or abandonmenl of
<br />secured property, cancellatiorr of debt, qualilied tuilion progralrl
<br />1>ayments {untler eection 529), ABLE accounts (under section 529A),
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br /><listrihutions, and pension dirtributions. Yotr must give your conect
<br />TlN, but you do not have to sign the certificalion.
<br />lil/hat Name and Number To Give the Hequester
<br />For this ol account:Give name and SSN of:
<br />The individual
<br />For this of account:
<br />B. Disregarded entity not Dwned by tr
<br />individual
<br />9- A valid trust, estate, tr Fereiffi 1rust
<br />1 o- Corporation or LLC electing corporate
<br />status on tom 8832 or Ftrm 25.ff
<br />11. Assmiatim, club. religiors, chritable,
<br />educational. or olher td-exmpt
<br />orgnniation
<br />12- Partnership or mufti-mmber LLC
<br />13. A broker or registged nominee
<br />14. ,Account with the Departmml of
<br />Agriculture in the name ol a public
<br />entity isuch m a slate or ltral
<br />govemmtrt, school district, or pri:on)
<br />ihat rmeives agriculir:ral program
<br />paym€nts
<br />15. Griltor trust liling Frm 1041 or
<br />under ihe Optional Filinq Method 2,
<br />requiring Fom 1 0o9 {e* Flegulatiom
<br />srction 1.671-4{bX2XiXBD"
<br />Give name antl EIN oJ:
<br />Theorer
<br />Legal entityr
<br />The rsporalion
<br />The organialim
<br />The prhersfrip
<br />The broks or nomiree
<br />The public er*ity'
<br />2. Two or more individuals Ioint accounti
<br />other than an account nraintained by
<br />an FFI
<br />3. Two or more U.S. persons
<br />loint accounl maintained by an FFI)
<br />4. Custodial account o{ a nrinor
<br />(Unifom Gift to Minors Act)
<br />5. c. The usual revocable savings trusl
<br />(grantor is dw trustee)
<br />b. Seqlled trust accdnt that is not
<br />a legal or valid trust under state lavl
<br />6. Sole proprietorship or disregarded
<br />enlity owned by an individual
<br />7. Grantor irust filing under Optional
<br />Filing Method t {see RBgulations
<br />strtion 1.671 -4{b)(2)ii}(A)}"
<br />The aciua! owrer of the rccount or.
<br />iJ mmbined funds. the firei individual
<br />cn the accounl1
<br />Each holder of the arcounl
<br />The minor2
<br />The grstar-trusi#:
<br />The actual ownerl
<br />The ovrneF
<br />The grr,tor'
<br />Th€ trust
<br />l List first and circle the name of lhe person whose number you fumish.
<br />lf only one person on a joint account has an SSN. that person's number
<br />must be iumished.
<br />2Circle the minor's name and fumish the minor's SSN.
<br />sYou must show vour individual name on line 1. and enter your business
<br />or DBA name, if ahy, on line 2. You may use erther your SSN or EIN (if
<br />you have one), but the IRS encourages you to use your SSN.
<br />I List first and circle the name of the lrusl, eetate, or pension trust. (Do
<br />not lumish lhe TIN of the personal representalive or trustee uniess th€
<br />legal entity itsell is not designated in the account lllle.)
<br />'Note: The grantor must also provide a Forrn W-g to $e truslee of lhe
<br />trust.
<br />" For more information on optional filing methods lcr grantor trusts, see
<br />lhe lnstructions for Form 1041.
<br />Note: lf no name is circled when mcre than one iame is listed, the
<br />number will be considered lo be that of the {irsl name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />identrty theft occurs when someone uses your p€rsona! inlormation,
<br />such as your name, SSN, or oiher identii;ing information, wilhotrt your
<br />permission to commit fraud or other cdmes. An idenlity thief may use
<br />your SSN to gBt a job or may {ile a tax retum using your SSN to receive
<br />a refund-
<br />To reduce your risk:
<br />r Protect your SSN,
<br />. Ensure your employer is prolecting your SSN, and
<br />. Be careful when choosing a tax relum preparer,
<br />ll your tax records are affecled by identity lheft and you receive a
<br />nolice from the lRS, respond righl away to the name and phone nurnber
<br />pnnted on the IRS nottce or letter.
<br />lf your tax records are nol cunently affe€ted by tdentity thefi but you
<br />think you are at risk due to a losi or stolen purse or wallet, questionable
<br />credit card activity, or a queslionable credit report, contact the fRS
<br />ldenlity Theft Holline at 800-908-4490 or submit Fotm 14.S39.
<br />For more information, see Pub. 5027, ldentityTheft lnformatisn for
<br />Taxpayers.
<br />Kittitas County Agreement for Services (rev.5/!a/251
<br />Page 2l of 22
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