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Form W-9 [Flev.3-2024)Pcge 3
<br />Certain payees and paymeflts are exempt from backup withholding.
<br />See Exempt payee code, later, and the separate lnstructions lor the
<br />Requester of Form W-9 for more information.
<br />See also Fstahlisfring U.S. slatus for putpases af ehapter 3 end
<br />chaptet 4 witiholdng. earlier.
<br />What ls FATGA Reporting?
<br />The Foreign Account Tax Compliance Act (FATCA) requires a
<br />padicipating foreign financiai institution to report all U.S. accounl
<br />holders that are specified U.S. perssns. Gertain payees are exempt from
<br />FATCA reporting. See Erempfior fnm FATCA repcfiing code,later, and
<br />the lnshuctions for lhe Requester of Form W-9 lor mare information"
<br />Updating Your lnformation
<br />You must provide updated infarmation to 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 payments in the future from this
<br />person. For example, you may need to provide updated information if
<br />you are a C corporation that elects to be an S corporation, or if you are
<br />no longer lax exempl ln addition, you must fumish a new Form W-9 if
<br />the name or TIN changes for the account, ior example, if the grantor of a
<br />grantor trust dies.
<br />Penalties
<br />Failure to lurnish TlN. lf you fail to furnish your correct TIN to a
<br />requesier, you are subject to a penalty of $50 Jor each such failure
<br />unless your failure is due to reasonable cause and noi to willful neglect"
<br />Civil penalty lor {alse itrfomation with respect to wilhholding. lf you
<br />make a false slatement wilh no rgssonable basis that results in no
<br />backup withholding, you are subject to a $500 penalty.
<br />Crirninal penalty for falsifying irl{onnation. Willfully falsifying
<br />cedifications or aftimations may subject you to criminal penalties
<br />including fi nes ancl/or imprisonment.
<br />Mistrse ol TlNs- lt the requester discloses or uses TlNs in violation of
<br />{ederal lal.r, the requester may be subjeci to civil and criminal penalties.
<br />Specific lnstructions
<br />Line I
<br />You must enter one of the followinq on lhis line: do not leave this line
<br />blank. The name should match the name on your tax relum.
<br />lf this Form $J-9 is for a ioint account {olher than an account
<br />nraintained by a foreign financial inslitution {FFl)}, list firsl, and then
<br />circle, the name of the person or entity whose nurnber you entered in
<br />Part I of Form W-9- lf you are providing Form W-9 to an FFI lo docilment
<br />a joint account, each hclder of the accounl lhat is a U.S. person nlust
<br />provide a Form W-9.
<br />. lndiviclual. Generally" enter the name shown on your tax returrr. lf you
<br />have changed your last nanre withoui infarming the Social $ecurity
<br />Administration {SSA} of the nanre change, enter your first nanre, the last
<br />name as shorvn on your social security card, and your new last name.
<br />Note for lTlN applicant: Enter your individual name as it lvas entered
<br />orr your Form W-7 application, line la. This should alsc be the same as
<br />lhe name you entered on the Form 1040 you filed with your application-
<br />. Sole proprietor. Enter your individual name as shown on your Form
<br />'1 040 on line 1 . Enter your brsiness. trade, or "doing business as" {DBA)
<br />name on line 2,
<br />r Partnership, C eorporation, S corporation, clr tLC, olhertlran a
<br />disregardetl entity. Enter the entity's name as shown orr the enlity': tax
<br />retum on line 1 and any business. lrade, or DBA name on line 2.
<br />. Other entilies. Enter your name as shown on required U.S. federal lax
<br />documents on line 1. This rame should match the name shown qn the
<br />charter or other legal document creating the entity- Enter any business,
<br />trade, or DBA nanre on line 2.
<br />. Disregartled entity. in general, a business entiiy that has a single
<br />owner, including an LLC. and is not a corporation. is disregarded as an
<br />entity separale from ils owner {a disregarded entity}. $ee Regulations
<br />section 301.7701 -2{c)(2i. A disregarded entily shauld check the
<br />appropriale box lor the tax classification of its owner- Enter the owner's
<br />llame on line 1. The nante of lhe orvner entered on line 1 should never
<br />be a disregarded entity. The na.rne on line 1 should be the name shown
<br />on tlle income tax rehtm on which lhe incorne should be repofted. For
<br />Kittitas County Agreement for Services (rev.5l7a/251
<br />Page LG of 22
<br />example, if a foreign LLC lhat is tneated as a disregarded entity for U.S.
<br />lederal tax purp+ses has a singie owner thal is a U.S. person, the U.S.
<br />owner's name is required to be prouided on line 1. ll Sre dircct owner of
<br />the entity is alsn a disr.egarded entity, enter the firsl owner that is not
<br />disregarded for federal tax purpcoes. Enter the disregarded entity's
<br />name on line Z. ll tfte owner o{ the disregarded eniity is a foreign person,
<br />the owner must cornplele an apprcpriate Fonn W€ inst*ad ol a Form
<br />W-9. This is the case even if the toreign person has a U.S. TlN.
<br />Line 2
<br />lf you have a business rame, trade ram€. DBA name, cr disregarded
<br />entity name. enter it on line 2.
<br />Line 3a
<br />Check the approprlate box cn lin* 3a for the U.S. {edetal tax
<br />classificatiqn of ihe person whose name is enlered on line .1. Gheck only
<br />one box on line 3a.
<br />Line 3b
<br />Check this box it you are a padnership {including an LLG classified as a
<br />partnership for U.S. federal ts.x purposesl. lrust, or estate that has any
<br />for€ign partne.s" ownerc. or beneficiaries. ard you are providing this
<br />fom to a partnersfiip, lrust, Dr €slate, in which you have an ownership
<br />interesl. You musl cheak the box on line 3b if you receive a Fomt W-8
<br />(or documentary e'ridencel from any partner, r,wner. or beneliciary
<br />establishing foreign status or if you receive a form W-9 from any
<br />pa*ner. owner, or beneficiary tfiat has chetked the box on line 3b.
<br />Note: A partnership ihat provides a Form llrt-9 and checks box 3b rnay
<br />be required to compbte Schedules K-l and K-3 {Foffn 1065}- For more
<br />information, see the Partnership lnstructions for Schedules K-2 and K-3
<br />(Form 1065J.
<br />lf ycu are required to conrplete iine 3b but fail to do so, you may noi
<br />receive ihe infonnation necessary ta file a correct informaiion reium with
<br />the IRS or furmish a caxecl payee statement to your partners or
<br />beneficiaries. See. for exarnple, sec.tions 6698, 6722. and 6724 Ior
<br />penalties thal may appty.
<br />Line 4 Exemptions
<br />lf you are exempt from backup wilhh,:iding ard/or FATCA repotting.
<br />enter in lhe appropriate space sn li*e 4 any code{s) that may apply to
<br />you.
<br />Exernpt payee cocle.
<br />. Generally, indir,iduals iinctuding sale propnetors] are nol €x€mpi from
<br />backup withholding.
<br />. Except as prouided below, *crrporations are exempl fiom backup
<br />withhr:ldrnE for certai. Fayrnents, in.cludirrg interest and dividends.
<br />. Corporalions are not exempi lrum backlp wilhholding for paynrents
<br />made in settlement o{ paymeni card or third-party netwofi transaclions.
<br />. Corpcmtions are not exempl {mm backup wilhholding wilh respect to
<br />attonreys' fees or gross proceeds paid to attomeys. and corporations
<br />that provide rnedical or healih cane services are nol exernpt with respect
<br />to payments repodable on F,:rrn 1Dg9-ltIiSC-
<br />The follorving ccdes identfy Fay€€s that are exempt from backup
<br />wilhholding" Enter the app{opriate aode in the space on line 4.
<br />1-An organization exempl from tax under section 501{a), any lRA, or
<br />a custodial accounl under sectjon 403{b}{7f if the accoilnt satisUes the
<br />requirements of s+cticn 4D1{4{21.
<br />IF the entitylindividusl on line 1
<br />isa(n) ...
<br />THEN check dre box for
<br />Ccrparation Corporation.
<br />. lndividuai or
<br />. Sole proprietorsirip
<br />lndividual/sole pr,:prietor
<br />r LLC classilied as a paflnership
<br />for U.S. lederal tax purposes or
<br />. LLC that has filed Fom 8832 or
<br />2553 electing to be taxed as a
<br />corporalion
<br />Limited l:ebili:y company and
<br />enter lhe appropriate tax
<br />classification:
<br />P = Parlnership.
<br />C=Ccarporation.or
<br />$ = S corporation.
<br />. Parlnership Partnership"
<br />. Trust,/€state Trusiiestate"
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