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Fqrm W-9 {Rev.3-2024)Pase 5
<br />Part ll. Certification
<br />To establish to the withholding agant lhal you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requested to sign by the
<br />rvithholding agenl even if item 1, 4, or 5 below indicates oihendse.
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign {when required}. ln tie case of a disregarded enlity, lhe
<br />person identified on line 1 musl sign. Exempt payees, see Exernptpayee
<br />code, earlier.
<br />Signature requirements. Complete the certification as indieated in
<br />itemsl throughSbelow.
<br />l. lnterest, dividend, and barter exchange aceounts opened
<br />belore 1984 and broker accounls considered active cluring 19S&
<br />You must give your correct TlN, bul you do not have to sign the
<br />certification.
<br />2. lnterest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounls considered inactive during
<br />'l98il. You must sign the certification or backup withholding rTill apply. I{
<br />you are subject to backup withholding and you are merely providing
<br />your conect TIN to the requester, y6u must cross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the certilication. You may
<br />cross out ilem 2 of the cedification.
<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 that you
<br />have previously given an inconect TlN. "Other payments' include
<br />payments made in lhe course ol the requester's trade or business lor
<br />rents, royallies, goods (other than bills for merchandise), medical and
<br />health care services (including payments to corporations), paymenls to
<br />a nonemployee for services, payments made in setdemenl of payment
<br />card and third-parly nelwork transactions, payments to ceftain f,shinE
<br />boat crew members and fishermen, and gross prcceeds paid to
<br />attomeys (including payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualiliecl tuition progranr
<br />paynrents {under section 529), ABLE accosnts {under section 529A},
<br />lRA, Goverdell ESA, Archer MSA or HSA contribtdions or
<br />distributions, and pension distributions. You nrust give your corect
<br />TlN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this type of account:Give name and SSN o{:
<br />For lhis of accounl:
<br />5- lieregarded mtity not o\rined by m
<br />individusl
<br />9" A vaiid trust, estate, Dr pensim ltust
<br />'lQ, Carpomtion or LLC electing corporate
<br />stslus 0n Fffi 8832 or Ftrm 2553
<br />1 1- Asstriatim, club, religirus, chritable,
<br />e*rmtional. or other tax-exffipt
<br />orqaniation
<br />12" Partrership or mult|mwber LLC
<br />'!3- A broker cr re4istered nominee
<br />14. Amwi witr the Departmmt of
<br />Agricultura h the name ol a public
<br />mtity {such a a slate or lmal
<br />govemmmt. schml district, sr prison)
<br />lhat receires agriculfural program
<br />payments
<br />15. gmlor trust filing Form 1o41 or
<br />mder the Optional Filinq Method 2,
<br />requiring Fom 10€9 {se Fegulatiom
<br />s*tion 1.671 -4{bX2HiXB})"
<br />Give name and EIN of:
<br />The owner
<br />Legal entity{
<br />The caporation
<br />The organization
<br />The parhership
<br />The broks or nominee
<br />The public mtity
<br />1. lndividual
<br />?. Two or morc individuals (joint account)
<br />other lhan an accounl mainlained by
<br />an FFI
<br />3, Two or nrore U-S. persons
<br />tioint irccount maintained by an FFI)
<br />4. Custodial nccount of a mins
<br />(Unifom Gift to Minors Act)
<br />5. a. The usual revocable savings lrust
<br />{grantor is alsc trustee)
<br />b. Srmlled trust accwnt that is not
<br />a legal or valid trut under state law
<br />6. Sole proprietorship u disregarded
<br />entity owned by an individual
<br />7- Grantor trust filing under Optional
<br />Filinq Method 1 (see Regulaliom
<br />srction 1.671 -a(bX2XiXA))"
<br />The individual
<br />The actual owner of the fficount or.
<br />if combined funds. the firet individwl
<br />on the rccounll
<br />Each holder ofihe rccount
<br />The minor2
<br />The grmtcr-trustee1
<br />The actual ownerl
<br />The owneF
<br />Thg grantor'
<br />The trust
<br />l List iirst and circle the name of the person whose number you furnish.
<br />lf only one Ferson on a joint accounl has an SSN, that person's number
<br />must be fumished.
<br />2Gircle ihe minor's name and fumish the minor's SSN"
<br />sYou must show your individual nafire on line 1, and enter your business
<br />or DBA name, if ahy, on line 2. You may use either your SSN or EIN df
<br />you have oneJ, but the IRS encourages you to use your SSN.
<br />ilist Jirst and circle the name of the lrusl, estale! or pension ttust. tDa
<br />not fumish lhe TIN of the personal representative or truslee unless the
<br />legal entity ilsell is not designated in the account title.)
<br />'Note: The grantor must also provide a Form W-9 to the trustee of the
<br />trust.
<br />- Fcr more information on optional filing methods for grantor trusts, see
<br />the lnstructions for Form 1041.
<br />Note: lf no name is circled when msre lhan one name is lisled, the
<br />number vrill be considered to be thal of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentily theft occurs rvhen someone uses your personal information,
<br />such as your narne, SSN, or other identiiTing information, without your
<br />permission to commit fraud or olher crimes. An idenlity thief may use
<br />lour S$N tc get a iob or may lile a tax retum using your SSN lo receitre
<br />a refund.
<br />To reduce your riskl
<br />r Protecl your 3$N,
<br />r Ensure your employer is prolecting your SSN, and
<br />. Be careful when choosing a tax reium preparer.
<br />ll your tax records are affected by identity theft and you receive a
<br />notice from the lFlS, respond righl away to the name and phone number
<br />printed on lhe IRS notice or letter.
<br />It your tax records are nol cunenlly affected by idenlity theft but you
<br />think you are at risk due to a losl or stolen purse or wallet, questionabie
<br />credit card aclivity, or a queslionable credit report, contact the IRS
<br />ldentity Theft Hotline at 800-908-4490 or submit Form 14039.
<br />Fsr more information, see Pub. 5027, ldentily Theft Information for
<br />Taxpayers.
<br />Kittitas County Agreement for Services (rev.5/74/251
<br />Page L8 of 22
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