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Form W-9 (Rev.3-2024)Fage 3
<br />Certain payees and payments are exempl trom backup wilhholding.
<br />See Exempt p.yee code, laler, and the separate lnstructions lor lhe
<br />Fequester of Form W-9 for mare information.
<br />See also Fstab/ishing U.S. slafus forpurposas of chapter 3 and
<br />chaptet 4 withholding, earlier.
<br />What ls FATCA Reporting?
<br />The Foreign Account Tax Compliance Act {FATCA) requires a
<br />participating foreign financial institulion lo report all U.S. account
<br />holders that are specified U.S. percons. Certain payees are exempt ficm
<br />FATCA reporting. See Exemption frcm FATCA repafting cde,later, and
<br />the lnstructions forthe Flequester of Form W-9 for more informalion.
<br />Updating Your lnformation
<br />You must provide updated information ta any person to whom you
<br />claimed to be an exempt payee if you are no longer an exempt payee
<br />and anlicipate receiving reportable paymenls in the future from lhis
<br />person. For example, you may need to provide u@ated information if
<br />you are a C corporation that elects to b€ an S corporation, or if you are
<br />no longer tax exempt. ln addition, you must fumish a new Form W-9 if
<br />the name or TIN changes for the account, for example, if the grantor of a
<br />grantor trust dies.
<br />Penalties
<br />Faihre to turnish TlN. lf you fuil to fumislt your correct TIN to a
<br />requester, you are subject to a penalty of $50 for each such failure
<br />unless your failure is due to reasonable cause and not to willlul neglect.
<br />Civil penalty for false informalion with re$pecl to withholding. lf you
<br />make a false statement with no reasonable basis that resuhs in no
<br />backup wilhholding, you are subject to a $500 penalty.
<br />Criminal penalty for falsiffing information. Willfully falsifuing
<br />ceri!fications or affirmations rnay subject you to criminal penalties
<br />including fi nes and/or impriscnment.
<br />Misrrse of TlNs. lf the requester discloses or uses TlNs in violation of
<br />lederal law, lhe requeste, may be subiect to civil and criminal penalties.
<br />Specific Instructions
<br />Line I
<br />You must enter one of the following on this line; do not leave this line
<br />blank, The name should rnatch the natne on yoilr tax relum,
<br />lf this Form W-s is for a joint account (other than an account
<br />maintained by a loreign financial institution {FF[], list first, and then
<br />circle, the name of the person or enti$ whose number you entered in
<br />Part I of Form W-9. lf you are providing Form W-9 1o an FFI to document
<br />a joint account, each holder o{ the accounl that is a U.S. person must
<br />provide a Form W-9.
<br />. lndiviclual, Generally, enter lhe name shown on your tax retum. lf you
<br />have changed your last name withcut informing the Social Security
<br />Administralion (SSA) of the name change, enter your first name, the last
<br />name as shown on your social securily card, and your new last name.
<br />Note for lTlN applicant Enter your individual name as it was entered
<br />on your Form W-7 application, line 1a. This should also be lhe same as
<br />lhe name you entered on the Form 104{} you libd wilh your application.
<br />. Sole proprietor. Enter your individual name as shown on your Form
<br />1040 on line 1. Enter your business, lrade, or "doing business aa" (DBA)
<br />name on line 2.
<br />. Partnership, C corporation, S corporation, or LLC, ollrerthan a
<br />disregarded entity. Enter th€ enthy's name as shown on the entity's tax
<br />retum on line 1 and any business, Irade, ff DBA name on line 2.
<br />. Other entities. Enter your name as shown on reguired U.S. federal tax
<br />documents on line 1. This name should match the name shown on the
<br />charter or other legal document creating the entity. Enter any business,
<br />lrade, or DBA name on line 2.
<br />. Disregarded entity. ln general, a business €nlity that has a single
<br />owner, including an LLC, and is not a corporation, is disregarded as an
<br />entity separate from its owner (a disregarded entity). See Begulations
<br />section 301 .7701 -2(c)(2). A disregarded entity should check the
<br />appropriate box for the tax classification of its owner. Enter the owner's
<br />name on line 1. The name of lhe owner entered on line 1 should never
<br />be a disregarded entity. The name on line'l should be the name shown
<br />on the income tax rehrm on which the incorne should be reported. For
<br />Kittitas County Agreement for Services (rev.5/M/25l'
<br />Page LG of 22
<br />example, if a foreign LLC thal is treated as a divegarded entity {or U.S.
<br />federal tax pulposes has a sing[e owner that is a U.S. person, the U.S.
<br />owner's name is required to be provided on line 1- lf the direct owner of
<br />the entity is also a disregarded enlity, erfer the firBt owner that is nol
<br />dbregarded ior lederal tax purpo€es. Enter lhe disregarded entity's
<br />nare on line 2. ll the owner of the disregarded enlily is a foreign person,
<br />the owner must cornplete an apFropriate Form W€ instead ol a Form
<br />W-9. This is the case even il the foreiEn person has a U.S. TlN.
<br />Line 2
<br />lf you have a business nanre, fade oarne, DBA name, or dbregarded
<br />entity name, enter it on line 2"
<br />Line 3a
<br />Check the appropriate box on line 3s for the U.S. federal tax
<br />classificatiqn of lhe person whcse name is enl€rsd on line 1. Check only
<br />one box on line 3a,
<br />Line 3b
<br />Check this box if you are, a partnership {including an LLC classified as a
<br />partnership for U.S. federaf tax purposes), lrust, or estate thal has any
<br />foreign partners, owners, or beneficiaries, and you are providing lhis
<br />lorm to a parinership, lrust, or eslate, in which you have al ownership
<br />interest. You must check the box on line 3b il you receive a Form W-8
<br />(or documentary evidenceJ from any partner, owner. or beneliciary
<br />establishing foreign stalus or if you receive a Form W-9 from any
<br />partner, owner, or beneficiary that has cirecked the box on line 3b.
<br />Note: A parlnership lhat provides a Form W-9 and checks box 3b may
<br />be required to complete Schedulee K-2 and K-3 {Form 1065}. For more
<br />information, see the Partnership lnstnrctions for Schedules K-2 and K-3
<br />(Form 1065).
<br />ll you are required lo complete line 3b but fail to do so, you may nol
<br />receive the information necessary lo file a correcl information retum with
<br />the IRS or fumish a correct payee statement to yaur partners or
<br />beneficiaries. See, for example" sections 6698. 6722, snd 6724 lot
<br />penalties thal may apply^
<br />Line 4 Exemptions
<br />lf you are exempt from backup wilhholding and/or FATCA repoding,
<br />enter in lhe appropriate space on line 4 any code{sl that may apply to
<br />you.
<br />Exempt payee cocle.
<br />. Generally, individuals {including sole pnaprielors} are not exempt from
<br />backup withholding.
<br />. Except as provided beforv, corporations are exempl from backup
<br />wilhholding for certain payments, including interest and dividends.
<br />r Corporalions are not exempl lrom backup withholding for payments
<br />rnade in settlement of payment card or third-party nelwort transaclions.
<br />. Corporations are not exempl from backup withholding wilh respect to
<br />attomeys'fees or gross proceeds paid to atlomeys, and corporations
<br />thal provide medical or heallh care services are nol exempt with respect
<br />to payments reportable on Form 1099-M|SC.
<br />The following codes identify payees that are exernpt from backup
<br />withholding. Enter the appropriate code in the space on line 4.
<br />1 -An organizadon exempi lrom tax under seclion 501(a), any lRA, or
<br />a cusiodial account under s€cljon 403{biF} if the account satisfies the
<br />requirements of section 401{q{2I
<br />lF the entity/individual on line I
<br />is a(n) ...
<br />THEN check the box for
<br />. Corporation Corporalion,
<br />. lndividual or
<br />r Sole propdetorship
<br />lndividual/sole goprietor.
<br />r LLC classified as a partnership
<br />for U.S. federal tax purpose€ or
<br />' LLC that has filed Form 8832 or
<br />2553 electing to be taxed as a
<br />corporation
<br />Limiled liability company and
<br />enler lhe appropriate tax
<br />classi{ication:
<br />P = Parhership,
<br />C-Ccorporation.or
<br />S - S corporation.
<br />Parhership Partnership.
<br />. Trusl/estate Trustjestate.
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