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Form W-9 (Rev. 3-2024)
<br />Page rJ
<br />Part II. Certification
<br />To establish to the withholding agent that you are a U_& person, or
<br />resident alien, sign Form W-9. You may be requested to sign by the
<br />withholding agent even ii item 1, 4, or 5 below indicates otherwise.
<br />For a joint account only the person whose TIN is shown m Pad I
<br />should sign (when required}. in the case of a disregarded entity, the
<br />person identified on fine 1 must sigh. Exempt payees. see Exempt payee
<br />code, earlier.
<br />Signature requirements. Complete the certification as indicated in
<br />items 1 through 5 below.
<br />f. Interest, dividend, and barter exchange accounts opened
<br />before 1994 and broker accounts considered active during 1983.
<br />You must give your correct TIN, but you do not have to sign the
<br />certification.
<br />2. Interest, dividend, broker, and barter exchange accounts
<br />opened after f983 and broker accounts considered inactive during
<br />1993. You must sign the certification or backup withholding will apply. If
<br />you are subject to backup withholding and you are merely providing
<br />your correct TIN to the requester, you must cross out item 2 in the
<br />certification before signing the form.
<br />3. Real estate transactions. You must sign the certification. You may
<br />cross out item 2 of the certification.
<br />4. Other payments. You must give your correct TIN. but you do not
<br />have to sign the certification unless you have been notified That you
<br />have previously given an incorrect TIN. `Other payments" include
<br />payments made in the course of the requester's trade or business for
<br />rents, royalties, goods (other than bills for merchandise). medical and
<br />health care services (including payments to corporations), payments to
<br />a nonemployee for services, payments made in settlement of payment
<br />card and third -party network transactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attorneys (including payments to corporations).
<br />S. Mortgage interest paid by you, acquisition or abandonment of
<br />sec tired property, cancellation of debt. qualified tuition program
<br />payments (under section 529), ABLE accounts (under section 529A),
<br />IRA. Cove rdall ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your correct
<br />TIN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this type of account:
<br />Give name and SSN of:
<br />1. Individual
<br />The individual
<br />2. Two or more individuals t}oint account)
<br />The actual owner of the account or,
<br />other than an account maintained by
<br />if combined funds, the first individual
<br />an FR
<br />an the account'
<br />3- Two or more U.S_ persons
<br />Each holder of the account
<br />point account maintained by an FFTJ
<br />4. Custodial account of a minor
<br />The minor
<br />(Uniform Gift to Minors Ace!
<br />5. a. The usual revocable savings first
<br />The grantor -trustee'
<br />(grantor is also trustee)
<br />b_ So-called trust account that is not
<br />The actual owner'
<br />a legal or valid trust under state lava
<br />6. Sole proprietorship or disregarded
<br />The ovmer3
<br />entity owned by an individual
<br />7- Grantor trust filing under optional
<br />The grantor"
<br />Firing Method 1 (see Regulations
<br />section 1.671-4(b)(2Hil(A))..
<br />Kittitas County Agreement for Services (rev. 5/14/25)
<br />Page 21 of 23
<br />For this type of account
<br />Give name and EIN of:
<br />S. Disregarded entity not owned by an
<br />The owner
<br />individual
<br />9. A valid trust, estate, or Penton bxr-t
<br />Leo entity-`
<br />10- Corparahon or LLC al_=2 cwPcratr
<br />Th-acxPoarion
<br />status on Form 8832 or F o 2353
<br />11. Association, dub, religious, diardahie.
<br />The afganizanon
<br />educational, or other tax-exempt
<br />organization
<br />12.Partnership ormultrmemberLLC
<br />Thepartnership
<br />13. A broker or registered nominee
<br />The broker or nominee
<br />14. Account with the Ot"Ment of
<br />The public entity
<br />Agriculture in the narne of a public
<br />entity (such as a state or local
<br />government school dslrict. or ansori
<br />that receives agricultural program
<br />payments
<br />15. Grantor trust filing Form 1041 or
<br />The mist
<br />under the optional Fling Method 2.
<br />requiring Form 1099 (see P_-Wabons
<br />section 1.671-4(bH2)@(B))"
<br />' List first and circle the name of the person whose number you fumish.
<br />If only one person on a joint account has an SSN, that person's number
<br />must be fumished.
<br />' Circle the minor's name and fumish the minors SSN.
<br />`You must shove your individual name on line 1. and enter your business
<br />or DBA name. if any, on fine 2. You may use either your 59N or EIN (if
<br />you have one). but the iRS encourages you to use your SSN-
<br />'List first and circle the name of the trust, estate, or pension trust. (Do
<br />not famish the TIN of the personal representative or trustee unless the
<br />legal entity itself 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 />"For more information on optional fling methods for grantor trusts, see
<br />the Instructions for Form 1041.-
<br />Note: If no name is circled when more than one name is listed, the
<br />number will be considered to be that of the first name listed.
<br />Secure Your Tax Records From Identity Theft
<br />Identity theft occurs when sonleorie uses your personal information.
<br />such as your name. SSN, or other identifying Information, without your
<br />permission to commit frond or other ciirnes. An identity thief may use
<br />your SSN to get a lob or may file a tax return using your SSN to receive
<br />a refund.
<br />To reduce your ask -
<br />• Protect your SSN.
<br />• Ensure your employer is protecung your SSN, and
<br />• 14e careful when choosing a tax return preparer-
<br />If your tax records are affected by identity, (heft and you receive a
<br />notice iron the IRS. respond right away to the narne and phone number
<br />printed on the IRS notice or letter_
<br />If your tax records are not currently affected by identity theft but you
<br />think you are at risk due to a ket or stater pease or veafler, questionable
<br />credit card activity. or a questionable credit report contact the IRS
<br />identity Theft Hotline, at BOD--906-4490 or submit Form 14039.
<br />For more information, see Pub. 5027, Identity Theft Information for
<br />Taxpayers.
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