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Form W-9 {Hev. .}2{124}Faoe 5
<br />Part Il. Gertilication
<br />To establiah to the withholding agent that you are a U.S. person, or
<br />residefit alien. sign Forn W-9. You may be requested to sign by rhe
<br />r.{ilhtrtoldnE agFnt even if hern 1, 4. or 5 below indicates othen*ise.
<br />Fon a joint acoount, only the person whose TIN is shown in Part I
<br />should sign {rr'rh*n reguired}. ln the case of a disregarded entity, the
<br />person identified on line 1 musl sign. Exempt payees, see Exernplpayee
<br />code, earfier.
<br />Signature requiremefits. Cornplete the certilication as indicated in
<br />itenrs'l tfirouglr 5 beloqv.
<br />l. lnterert, dividend, and barter exchange aceounts opened
<br />belore {9€4 and broker accounts considered active during 1983.
<br />You rnurst gftie your carreet TlN, but you do not have to sign the
<br />certifrcation.
<br />2- lnterest, dividend, broker, and barter +xchange accounls
<br />opened after {983 and brcker aecounts considered inactive during
<br />1983. You must sign the cerlification or backup withholding will apply. if
<br />you are subject 1o backup withholding and you are merely providing
<br />your conect TIN to the requester, you must eross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the certification. You may
<br />cro€s qut ilem g of tfie certitication.
<br />4- Oiher payments, You rnust give your conect TlN, but you do not
<br />have to sign the certification unless you have been noti{ied lhat you
<br />have previously given an inconect TlN. "Other payments" include
<br />payments made in the course of the requester's trade or business for
<br />rents, royahies, goods {dther than bills for merchandise), medical and
<br />heallh car* senices {including payments to corporations}, papnents te
<br />a nonemployee for services, payments made in setdement of Paym€nt
<br />card and third-party neiwork transactions, paymenls to certain fishing
<br />b6at crew members and fishermen, and gross proceeds paid to
<br />attomeys {including payrnents lo corparations}.
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured proFerty, cancellation of debt, qualilied tuition progranr
<br />paynrents {under section 52S}, ABLE accounts (under section 529A1,
<br />lRA, Covendell ESA, Archer MSA or HSA contributions or
<br />distribulions, and pension distributions, You must give your coirect
<br />TlN, but you do not have to +ign the certification.
<br />What Name and Number To Give the Requester
<br />For this of account:Give name and SSN of:
<br />For this of account:
<br />B" Disregctded entfu lot ovrned by an
<br />if,dividml
<br />9" A valirj lnxt estete, sr peBhn h*t
<br />10- Corpmlion or LLC electiinq rsrpsate
<br />ctalus on Fam 8B3e cr Frym 2553
<br />11- Assmiatim" cilub, rahgirus, ctrs'tilble,
<br />edrcatiooal. or oiher t€x-ef;f,tEpi
<br />orEoniatiion
<br />12. Pcrlrership or mufr-mmher LLC
<br />13- A koker 0r re€isiiered nmiinm
<br />14. Aclwnt sid! the Departmml cf
<br />Agricuffile ir the name cif * public
<br />mtity {such c * state or hcelgo'mm( schoc,l e[stti€t, or pnsni
<br />lhat rmeiws auricoltrral proqrffi
<br />peyrnents
<br />15- Grantsrtrustfili:g Fcm'i0t4'l or
<br />mderthe Oplional Filinq l.lethtd 2,
<br />raquirirg Fom 10€9 {.** Flegulations
<br />sEctiori 1.671-4{biri2l{ii{E}lr-
<br />Ttnrganialim
<br />Ttre partrrersfiip
<br />The broks or nominee
<br />The public srtity
<br />aList firct anrd cirrle thre nanine af the ltust, estate, or pension irust.
<br />not fumish lhe TIN of tlle personal representalive or trustee unless
<br />fegal entity ilset{ is not designated in lhe account liile.}
<br />tDo
<br />tfie
<br />'Note: The grantor must aNso prcvide a Forrn W-9 lo the truslee of lhe
<br />lrust"
<br />" For rnone infonnationr onr optional filing methods lor grantor tust$, see
<br />the lnslructions for Forrn 1t]41.
<br />Note: lf nc ruarne is circled when more lhan one name is listed, the
<br />nurnber r.rill be considered to be that of lh€ lirst name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs +rhen :iomsone uses yqur personal information,
<br />such as prur narne, S5lti, or other identiiTing information, wilhout your
<br />permission to cornrnit fraud or cther crimes. Ar idenlity thief may use
<br />your SSFI io get a jnb ar may life a tax retum using your SSN lo receive
<br />a refund.
<br />To reduce your rlsk:
<br />r Protect your $SN.
<br />' Engure yolrernployer is protecting your S$N, and
<br />. Be careful when c,tloosir€ a tax relum Freparer.
<br />l{ your tax records are affected by identity theft and you receive a
<br />notice fron:r the lRS' respornd righl away to the name gnd phone nurnber
<br />pnnted cn lhe IBS natice or letter.
<br />lf l$ur lar records are nol cunently affected by identity theft but you
<br />think you are at risk due to a losl or stolen putse 6r wallet, questionable
<br />credit card activit . qr a ques€ionable credit report, cantact the IFS
<br />ldentityTheft F|otline at 8n0-go8-449o or sllbmit Form 14039.
<br />Fcr more informatisn, see Fuh- 5027, ldentity Theft lnfonnation for
<br />Taxpayers"
<br />Give name and EIN of:
<br />The owrer
<br />LBgalentirya
<br />The cuporaiion
<br />Th€ tn st
<br />1 List firsl and oircle the narne of the penion whose number you fumish,
<br />lf onfy one person sn aiaint acc..ount haB an SSN, that peson's nurnber
<br />must hsfumished"
<br />rCincle lhe rninor's name and fumish the minor's SSN.
<br />sYou must shor'{ vor.rn individual nalne on line 1. and enter vour business
<br />or DBA name, rf ahy, on line 2. You may use either your SSN or EIN (if
<br />you harre one], but tfte IRS encoutages you to use your SSN.
<br />1. lndirridual
<br />2. Two or mG indiuiduals (loint accountl
<br />other lhan an rccwnt mcihtained by
<br />an FR
<br />3, Tws or mre U.S. persons
<br />loinl acowl meifttained by m FFI)
<br />4. Custodid aaoffii o{ a nins
<br />flJnifmm Gift to Minors Ar$
<br />5- a, The usual rerwble mvings lrust
<br />{grmtm is alm Austee}
<br />b. S*mlled tnst mcrunt that is not
<br />a legal u valld trct mdtr 3tate law
<br />6, Sole proprietorehip or disregarded
<br />antily owned by m indiddual
<br />7. Grantmtrusl ilinE under Optbml
<br />Filing Nlerhod I {see Regulations
<br />mtion 1.671 -a{bl{21{il{Ail"
<br />The individual
<br />Jhe aclual owner ofthe rccount or,
<br />if ambined funds. the fist iadividml
<br />on lh€ accountl
<br />Each lrolder of the rccount
<br />The mino/
<br />The grmtor-trusteet
<br />ThE actual ownei
<br />The ownera
<br />The granior'
<br />Kittitas County Agreement for Services (rev.5l14/25)
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