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Form W-9 {Rev.3-202.1)Page 5
<br />Part ll. Gertification
<br />To pJtablish to the withholding agent that you are a U.S. person, or
<br />residenl alien, sign Form W-9. You may be requested to sign by the
<br />lrithholding agent even if item 1, 4, or 5 below indicates otherwise.
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign {when required}. ln the case of a disregarded enlhy, the
<br />pereon identified on line 1 must sign. Exempt payees, see Exemptpayee
<br />cdqeartier.
<br />Signature requirements. Complete ihe certification as lndicated in
<br />itemsl *rrough5below,
<br />l. lnleresi, dividend, and barter exchange accounts opened
<br />before 1984 and broker accounts cotrsidered aciive during 19ff1.
<br />You must give your correct TlN, but you do not have to sign the
<br />certification.
<br />2. lnlerest, dividend, broker, and baner exchange accounts
<br />opened after 1983 and broker accounts considered itractive during
<br />!98i1. You must sign the certification or backup withholding will apply. lf
<br />you are subject to backup withholding and you are merely providing
<br />your conecl TIN lo lhe requester, you must cross out item 2 in the
<br />certification belore signing lhe form.
<br />3. Real estate transactions. You must sign the certification. You may
<br />cro6s out item 2 of the celtification.
<br />4, Other payments. You must give your conect TlN, but you do not
<br />have to sign the certification unless you have been notified thal you
<br />have previously given an inconect TIN. "Other payments" include
<br />paymenls made in the course of the requester's trade or business fsr
<br />rents, royallies, goods (other than bills for nrerchandise), medica.l and
<br />heallh care services {including paymenis to corporations}, payments to
<br />a rnnemployee lor services, payments made itr seltlemenl of payment
<br />card and third-party network transactions, paymenls to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attomeys {including payinents to corporations)"
<br />5. Martgage ir)terest paid l>y you, acquisilion or abanclonment of
<br />secured property, cancellation of clebt, qualiliecl luition program
<br />paym€nts {under :ection 529), ABLE accounts (under section 529AJ,
<br />lRA, Coverdell ESA, Archer MSA or HSA contribtrtions or
<br />distrihutions, ancl pension distributions. You must give your conect
<br />TlN, but you do not have to sign the cerlification.
<br />What Name and Number To Give the Requester
<br />For this of account:Give name antl SSN of:
<br />1. lndividual
<br />2, Two or more individuals (ioinl account)
<br />other than an accounl mainlained by
<br />an FFI
<br />3- Tuo or nore U.S. persons
<br />fioinl account maintained by an FFI)
<br />4. Custodial accouni of a nrinor
<br />fhifom Gift to Minors Act)
<br />5. a. The usLal revocable savinqs trust
<br />{granior is also trusiee)
<br />b. Socalled trust accornl thit is not
<br />a lega.l or valid trust undir state lflw
<br />6- Sole proprielorship or disregarded
<br />*tity owned by an individual
<br />7. Grantor trust fling under Opiional
<br />Filinq Ntethod 1 {see Regulations
<br />setion 1.871 -a{bX2}iiXA})"
<br />The individual
<br />The acturl owner o{ the rccounl or.
<br />if combined funds- the fist individwi
<br />The minorz
<br />The grmtor-trusteer
<br />The aclual ownerl
<br />The ownerg
<br />The grantor'
<br />Kittitas County Agreement for Services lrev.5/M/25)
<br />Page 18 of 22
<br />For this of account:
<br />3. Disregarded entity not owned by m
<br />individml
<br />9- A valid trusi, estale, sr pensim trust
<br />'lO" C€rp€ralion or LLC electing corpcrate
<br />stslus qn Ftrm 8832 or Form 2553
<br />11- Ass*iatim, club, religirus. charitable,
<br />e,*jcatjonsl. gr olher td-exemFt
<br />organiation
<br />12- Partrwrship or mufti-mmber LLC
<br />13- A boker or registered nominre
<br />14- Artrml sith the Departmml of
<br />Agriculture in the name cf a public
<br />*ntity {such m a slate or lmal
<br />goreffiert, school dishicf, or prison)
<br />that r*eive.* agricultural program
<br />paymentc
<br />'15- $andor trust filing Fam 1O41 or
<br />mder the Oplional Filinq Method 2,
<br />requiring Fom 1099 {s* Fiegulatiom
<br />eec.tion 1 -671 -4{bX2Xi}{BD"
<br />Give name and EIN ot
<br />The owner
<br />Legal entity{
<br />The cuporation
<br />The crganization
<br />The parhership
<br />The broks or nominee
<br />The public entily
<br />on the accounil
<br />Each holder of the account
<br />The trust
<br />1 List first and circle the name of the person whose number you furnish.
<br />lf only one person 6n a joint acc€unt has an SSN, that person's number
<br />must be furnished.
<br />'lCircle the rninor's name and fumish lhe minor's SSN.
<br />rYou must shorv your individual name on line 1, and enter your business
<br />or DBA name, il a'ny, on line 2. You may rise erther your SS'N or EIN (if
<br />you have one), but the IBS encourages you io use your SSN.
<br />iList first and cirrle the name of the trust, estate, or pension trust. (Do
<br />not {urnish the TIN o{ the personal representalive or trusiee utrless the
<br />legal eniity ilsell !s nol designated in the account title.)
<br />'Note: The grantor must also provide a Form 1tr/-9 to the trustee of the
<br />trust.
<br />" For more information on optional filing methods lor grantor trusls, see
<br />the lnshuctions {or Form 1o4 l .
<br />Note: lf rji narne is circlecl wher more than one name is listed, the
<br />nun'rb€r rsill be considered to be'that of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldenlity theft occurs when someone uses your personal information,
<br />such as ycur name, SSN, or other identifiTing information, without your
<br />pernissionr lo commit fraud or other crimes. An identity thief may use
<br />your SSNtr t6 gBt a job or may file a tax retum using your SSN 1o receive
<br />a refund.
<br />To reduce your risk:
<br />r Protect your SSN,
<br />r Ensrre your employer is prolecting your SSN. and
<br />. Be car-eful when choosing a tax retum preFarer.
<br />ll your tax records are affected by identity theft and you receive a
<br />notice from the lRS" respond right away 1o the name and phone number
<br />print+d on lhe iRS nohce or letter.
<br />lI your tax records are nol cunenlly affected by identity theft bttt you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activily, cr a questionable credit report, contact the IRS
<br />ldenlity Theft Holline at 800-908-4490 or submit Folm 1 4039.
<br />For more information, see Pub. 5027, ldentity Theft Informa:ion for
<br />Taxpayers.
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