|
Form W-s (Rev.3-20?4)Pas" 3
<br />C€rlarn payees erld paymen6 aro exempl irom backup ffthholdinq
<br />See ae-it irayee code.'lat:r. Efid lhs s€parate lnsltuclions ior the
<br />Reque3t6r of F6rm W-9 for rnre informetion.
<br />See also Fstab/ishi4l U.S. sbtus fot a.rrpo*s of chapbr 3 atd
<br />chqter 4 wittfuding, e€'lif''.
<br />What ls FATCA Reporting?
<br />The Foreign Account Tax Ccnpliance Act (FATCA) tequires a
<br />parti:ipating fore(;n fingrcial insliMion lo rePort all U.S. accour*
<br />iolders thai are specifiect U.S. persons. Cenarn payees ate exempl frorn
<br />FArcA reporting. See E:tempon tiom FATCA reponng code. lalEr. and
<br />ttre lnstuitiore*for the Requester of Form W-9 ior morc in{onnalion.
<br />Updating Your lnformation
<br />You must provide updabd information to any Person to whom you
<br />- - chimed to be an exempt pa!,ee if yor are no longer an erempt pay€e
<br />erld entcioate r€ceMno reoortBble oayma{rls in lhg lmrte trom lhs
<br />persm. Firr example. y-ou inay need d povide u@ated Itfotmatron d
<br />you are a C oorporation tha elects !o be an S corporation' or if you are
<br />no lorger tar eiempt ln addition, you trust fumish a n6w Fom w-9 if
<br />the naiire or TN c*rbge for lhe aicount, for example, if lhe grantor of a
<br />gtantorttlstd€s.
<br />Penalties
<br />Failure to frrmish Tll{ lf you fatr to fumistl your ootrect TIN to a
<br />requester, iru ate subjeci to a penalty of $50 lor each such- hilure
<br />unless pui tailure is dre to reasonabb cause and not io willfi-d neglect-
<br />Civil oenalty $or talse lrlormation wtth respecl to wilhholdrq. l{ you
<br />rnate a fdsri staetnenl with no ressofiable basis tha reeults in no
<br />bao*up withholding, you de s*{ect lo s $50o per}atty.
<br />Criminal penally for falsi$ilg htonnation. WillfuD {alsifoing
<br />eertificai6ns or iffirnaions rnay srtrl'ect you to c.iminal pemlties
<br />includng fines andor inpdsonrnent
<br />Mbuso oflllrb. frhe requcbrdisdoses or usesTlNs in vidation ol
<br />federal lar, tre reqr.ester may be u.6iecn lo civiland crimind penafties'
<br />Specific lnstructions
<br />Llne I
<br />You must ents otE of ltre folowing on this line; do not leave tlis lhe
<br />blanlc The name stlould madt the name on your te)( retlm.
<br />tf this Form W-9 is for a jcinl *cont (olhet than trl acEount
<br />maintdned by a foreign firwrcial in$ihrtion (FFU), [stfts-t, and lhen
<br />circle, the nsne of the pgson or ent'ty whose nutrber you entered in
<br />Part lof Form W-9. lf pu ara prwidry Form W-9lo4q FFlto docum€nt
<br />a ioint accounl eech holder of $e accotfll lhat b a U.S. person musl
<br />provide a Fotm W€.
<br />. hdividoal Generdy, enEr the rnrne shown on your ts( tetun lf lou
<br />luve ctrarqed pur last tsne wihcffi irforming tha Social S€curity
<br />Ackninbtration {SSA} oflfre narne ctrenge, efltet yol' filll natne' the las{
<br />name as sho$rri on yolr social secrrily card, ard your neur last natne-
<br />Note for fiN applicd Enter pur individual nene as it wd eniercd
<br />on your Form W-7 appicalion, line 1a Thb SrotJd also be ttp sarne as
<br />lhe narfle yu.r enfiered on lfte Form l04Oyoufiled with yourepttaation
<br />. Sola pmprienor- Enter yorr indivi&d mme as $pum on your Form
<br />1 O10 on fine 1 . fuer 1our bushess, trade, or 'doirg bushess asf {DBA)
<br />narneon linez
<br />. Partnership, C corporation, S corporetiot! or LLC. otfiet Slar a
<br />disregarded €nti/ty. Enler the entrty's name as slrown on lhe entity's tax
<br />redr.rm on lne 1 eid arry business, trade, or DBA natne on lire 2.
<br />. Other entitbe Enter yorr nanw as *rown on reqried US- fedenl ta<
<br />docufiients on lt]e 1- Thb nanF sfidld tnatch tfte narle shown on the
<br />charler or other legd docrmenl creding tlE entity. Enter arry business,
<br />tade, orDBA ngnE onlircZ.
<br />. Disegrded enlity. kt general, a h$iness enfiy thal has a single
<br />ormer, incfudrg an LLC, and b not a cdporrlbo. is dsregaded as an
<br />ent ty =parate trorn rts owner (a dsr€Oard€d entttyl, See Regdstiotl6
<br />s€ctj-on 301.201-zEle). A dlsre$ded entity shotdd check the
<br />apgogiate box for'Sre iax Uassrtc*ion of i6 owner. Erder the owner's
<br />name on line 1. The r re of tfie ormer entered on lire t ghould never
<br />be a disregadsd enlity" Tne narne on line 1 shotld be lhe netne shown
<br />on the inc6me tax renirn on which the incorne $ro.dd be reported, Far
<br />. Trust/estde
<br />o Parbenhip
<br />. LLC classified as a pathetship
<br />for U.S. federal tax purpos€s or
<br />. LLG that ha filed Form 8832 or
<br />2553 electing to be taxed as a
<br />corporation
<br />. lndivirlud or
<br />r Sole progietochip
<br />. CoForation
<br />lF ihe entityfindividual on line {
<br />isaln)...
<br />TrusY€tsF,
<br />Parfle ship.
<br />Limited liabilty conpany and
<br />enter the appropriale la,(
<br />claseifcdbn:
<br />P= Partrechip,
<br />C=Ccorporalim,or
<br />S= S corpoolion.
<br />lndividud/sole proprietor
<br />Coruoration,
<br />THEN dreck the boxfor ' .
<br />extrnDl*. ri a foreion LIC thal rs treated ss a dlSregatded entity lor U.S.
<br />teOerif fex ournos-es has a $nqle ownet lhat is a Lt S person. lhe U.S
<br />orvner's naineis requirsd lo bi provrded on line l. lf lhe direct ovtner ci
<br />lhe entity is also a dsregrarded entity, efiter the fitst owner that is not
<br />dbreoaried for lederd 6r pupoeei. Enter lhe disregarded entiffs
<br />name-on lne 2. lf tre ownei of'the dsregaded entity is a fDr€ign p€tson,
<br />the owner must complete an approPtiate Form W-8 inEtead-of a Form
<br />W-9. This is the c€se even il the foreign person has a U.$' TlN.
<br />Line 2
<br />lf you have a business name, lrade name' DBA name' or dsregarded
<br />entiry name. enter it on line 2.
<br />Llne 3a
<br />Check the appropiate bor on line 3a for the U.S. bderal tar
<br />classification bf t'tre petsoo whose narne is enleted on lin€ 1. ched( orily
<br />onebox on line 3a
<br />Line 3b
<br />Ched( tis bor if you ate a PattnetshiP {ncluding an LLC classifiEd as a
<br />parhership for U.$. ftdral tar prposes), trust, ot 6late lhd has arry
<br />iodgn parfners. owners. or bensficiaries' and you are providing th6
<br />torm-roi oartnerstrin. tn-61. ot eslale, in which you have m owngstfp
<br />interest Vou musl dfrecL tre box on lire 3b if ydr recdve a Form W-8
<br />(or documentary evidence) fiorn any F tnet, onmet or beneficiary
<br />&taHi$rino loreiryr sElw cr if you teceive a Form W-9 lrom any
<br />parurer, oriner, oi benefciary Sat heo checled the bs on line 3b.
<br />ilob: A patnershp thal provides a Form W-9 and checks box 3b may
<br />be requried to corpbte Sc*re&les K-2 and K-3 {Fgnn 1065.)j For npre
<br />inrorniat;on. ss€ the P8tlrErsttip lngruaions for Schedul€s K-2 atd K-3
<br />(Fom106sl.
<br />lf rrou arB required to conrdete lire 3b br.rl latl to do sc. l,ou tnsy not
<br />receive fre ir$olrmaion tEcr&ssry ro file a conecl rdofmatioo retum with
<br />the IRS or fumi$ a conect p4/ee statetnent to your partlets or
<br />beneficianeg See, forexarnple, sec{ims 669a, 6722, sd 6721b,r
<br />perdliesthat may +ply.
<br />Line 4 Exemptions
<br />lf you Ire e.xempl frorn backup wihholding ald/or FA-l CA teporhng.
<br />eriter in tre appropflate space on line 4 3fly code{st fHl may apPly 1o
<br />you-
<br />Erenpr payee co'de.
<br />r GeneralV, indMdrnls (nclrdfurg sole proprierols) are not exsnpl tom
<br />backup withholding.
<br />. Exceptes pmvided below, corpo€tktns are exempfifron backup
<br />witrholding for cefiain payrnents, including inieraet atd dvidends.
<br />. Corporations ars nol exernpt trom beckp wilhholdng lor paymants
<br />rnade in setrlerneot oi paymenl cad or thidaarty rEt roft trerEectbns,
<br />. CorFordior6 ar€ not exernpt from bd(tD wilt$otttE tt i*t tespeci to
<br />attonreys' fees or $oss proceede paid to attomevB, dld cspontiots
<br />that prwide medicat or heallh care seryices ate not ercrFt with t€sp€et
<br />lo paynEnts Gpo,table on Folm 1099-ltllsc.
<br />The folowing codes identify pryeeo lttat ae exenpt firom backtp
<br />withhoHing. Enterlie appopride oode in *te space oa [ne 4.
<br />t -An orgpti2ation d.empt lronr tax rmdersection 5o1(a), any_lR& or
<br />a cuslodal account undr secfion 403FXf f the account sffes the
<br />requiremenls of secti{rn 4{t1(t€I
<br />Kittitas County Agreement for Services lrev.5/1al25l
<br />Page 15 of 19
|