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Form W-9 (Rev. 3-2024)Frue 5
<br />Part ll. Certification
<br />To establish to the withholding agent that you are a U.S. persoi!, or
<br />resident alien, sign Form W-9. You may be requested to sign by the
<br />withholding ageni even if item l, 4, or 5 below indicales othenvise.
<br />For a joint account, only the person whose TtN is shown in Part I
<br />should sign {when required}. ln the case of a disregarded entily, the
<br />person identified on line I must sign. Exempt pay*es, see Fxempt paye€
<br />code, earlier.
<br />Signature requirernents. Complete the certificalion as indtcated in
<br />itemslthrough5below.
<br />L lnlerest, dividend, and barter exchange accounts opened
<br />belore 1984 ancl broker accounls consiclered aciive during l9&3.
<br />You must give your correct TlN, but you do not have 1r: sign the
<br />certification.
<br />2. hrlerest, dividentl, brnker, ancl barter excbange accounls
<br />opened after 1$83 and broker accounls considered irractive during
<br />1083. You must sign the certification or backup withholding vrill apply. [{
<br />you are subject to backup withholding and you are mereiy providing
<br />your conect TIN to the requester, you mugt 6ross ollt item 2 in the
<br />certification belore signing the form.
<br />3. Real estale lransactions. You must sign the cedification. You may
<br />cross out item 2 of the cetlification.
<br />4, Other paynrents. You must give your conecl TlN, but you do not
<br />have to sign the certification unless you have been nstlfied that you
<br />have previously given an inconect TIN- "Other payments" include
<br />payments made in the course of the requester's trade or busitress far
<br />rents, royalties, goods (other than bills for merchandise), medical and
<br />heallh care services {including payments to corpcrations}, payments tD
<br />a nonemployee for services, payments made in setdement Df payment
<br />card and third-party network transactions, payments to certain fishing
<br />boat crew members and fishemen, and gross pmceeds paid to
<br />attorneys (including payn-lents to cotporations).
<br />5. Mortgage interest paid by you, acquisilion or abandonnreltl of
<br />secured property, cancellatiorr of debt, <lualiliecl tuition progratn
<br />payruents {under section 529}, ABLE accounts {under sectiott 529A}.
<br />lRA, Coverdell ESA, Archer MSA or HSA contribtrtiolrs or
<br /><listributions, and pension <listribulions. You nrust give yout coirect
<br />Tll'.1, but you do not have to sign ihe cenification.
<br />What Name and Number To Give the Requester
<br />For this of accolrnt:Give name and SSN ol:
<br />For this of account:
<br />B" Dbregarded eniity not owned by m
<br />individual
<br />g. A vnlid truct, eslate, or pecsiffi trust
<br />10. Csrponti€n or LLC electing corp*ate
<br />stalus on Form 8832 or F0rm t553
<br />1 1 - Assciatim, club, religirus. chsitable,
<br />educattonal. or olhBr td-;ailpt
<br />organintion
<br />12. Partn€rship or mufti-mmber LLC
<br />'!3- A broker or registered nominee
<br />14- Actrunl with the Departm*l of
<br />Agricutture h lhe name of a public
<br />entity {such m a slate or lmal
<br />govemment, schoal dbttict, or pnson)
<br />that receives aqricultural grogram
<br />payments
<br />15- Grmtor trust flling Fonn 1O41 or
<br />under the Optional Fiiinq fulethod 2,
<br />requiring Fom 1 S99 {s* Flegulatiom
<br />s€ction 1.671 -a{bX2Xi){B)}"
<br />Give name and EIN ot:
<br />Jhe omer
<br />Legal eniitya
<br />The cuporation
<br />The orEanirllion
<br />The parlrership
<br />The broks or nqminee
<br />The public entity
<br />1. lndividual
<br />2. Two or more individuals {oint arcouni)
<br />other lhan an account mainlained by
<br />an FFI
<br />3. Two or more U.S. persons
<br />(joinl account maintained by an FFI)
<br />4. Custodial account of a minor
<br />{Uniform Gift to Minors Act)
<br />5. a. The uslal revocable srvings trust
<br />(grantor is also trustee)
<br />b. S*mlled trust accwnt thal is not
<br />a legal or valid trust under state lav/
<br />6- Sole proprietorship or disregarded
<br />entity owned by an individual
<br />7. Granlor trust fling under Optional
<br />Filing fvleihod 1 {see Flegulations
<br />srction 1.671-a{bX2XiXA})"
<br />The
<br />The actual +wner of the accounl or.
<br />if combined funds. the firet indiuidml
<br />on the aDcounll
<br />Each holder of tha mc*unt
<br />The minor:
<br />The grmtor-trustmr
<br />The acluri ounerl
<br />The ovlnets
<br />The grutar'
<br />Th€ trust
<br />'List first and circle the name of the person whose nurnber you fumish.
<br />lf only one person on a joint account has an SSN. that person's number
<br />must be fumished.
<br />rCircle lhe minor's name and fumish the.qninor's SSN.
<br />sYou must show your individual name on line 1, ard enter your business
<br />or DBA name, il ahy, on line 2. You may use either your SSN or EtN ff
<br />you have one), but the lFlS encourages you to use your SSN.
<br />aList first and circle ihe name of lhe irust. eslale, or pension trust. (Do
<br />not lumish the TIN of ihe personal repr€sentative or trustee unless the
<br />legal ertity itsell is not designated in the account tille.)
<br />'Note: The grantor must also provide a Form W-g to the trustee of the
<br />trust.
<br />l'For mcre infcrmation on optional filing methods for grantot busts, s€e
<br />the lnstructions for Furm 1 041 .
<br />Note: ll no name is circled when more lhan one narne is listed, the
<br />nurnber will be considered to be thal of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldenlily theft occurs rvhen someone uses your personal inlomtation,
<br />such as your name, SSN, or other identiiTing information. wilhottt your
<br />permission to cornmit fraud or other crimes. An idenlity thief may use
<br />your SSN to get a job or nray {ile a tax retum using your SSN lo receive
<br />a refund.
<br />To reduce your risk:
<br />r Protecl your 35N.
<br />. Ensurc your employer is protecting your SSN, and
<br />. Be careful when choosing a tax return preparer.
<br />ll your tax recrrds are aflected by identity lheft and you receive a
<br />nolice from the lRS, respond right away to the name and phone nurnber
<br />pnnted on the IRS notice or letter.
<br />It your tax records are not cunently affected by identity theft but you
<br />think you are at risk due to a losl or stolen purse or wallet, questionable
<br />credit card activity, or a questionable credit report. contact the IRS
<br />ldentity Theft Hotline at 800-908-4490 or submit Foffi 1 4039.
<br />For more infornration, se€ Pub. 5027, ldeniity Theft lnlormation for
<br />Taxpayers-
<br />Kittitas County Agreement for Services (rev.5/74/25)
<br />Page 18 of 22
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