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Fom W-9 {Rev.3-2024)Pase 5
<br />Part ll. Gertification
<br />To establish to the withholding agent that you are a U.S. person! or
<br />resident alien, sign Form W-9. You may be requesled to sign by the
<br />withholding agent even if item 1. 4. or 5 below indicates othenryise.
<br />For a joint account, only the person whose TIN is shown in Parl I
<br />should sign (when required). ln the case of a disregarded entily, lhe
<br />person identified on line 1 must sign. Exempt payees, see Exempt payee
<br />code, earlier.
<br />Signature requiremenls. Complete the c€rtilication as indicat€d in
<br />itemsl throughSbelow.
<br />L lnteresl, dividend, and barter exchange accounls opened
<br />before 1984 and broker accounts considered active during 1983.
<br />You must give your correct TlN, but you do not have to sign the
<br />certification.
<br />2. lnterest, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considered inactive during
<br />1983. You must sign lhe cerlificalion or backup withholding will apply. lf
<br />you are subiect to backup withholding and you are merely providing
<br />your conect TIN to ih€ requester, you must croas oul item 2 in the
<br />certification before signing the form.
<br />3, Real estate transactions. You must sign the cetiificalion. You may
<br />cross out item 2 of the certification.
<br />4. Other payments. You must give your conect TlN, but you do not
<br />have to sign lhe certification unless you have been nolified lhat you
<br />have previously given an inconect TlN. "Other paymenls" include
<br />payments made in the course of lhe requester's trade or business for
<br />rents, royalties, goods (other than bills for merchandise), medical and
<br />health care services fncluding payments to corporations), payments to
<br />a nonemployee for services, payments made in setdement of payment
<br />card and thiid-party network transactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attomeys {ncluding payments to corporations).
<br />5. Mortgage interesl paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualified tuition program
<br />payment! {undei section 5291, ABtE accounts (under section 529A),
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must 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 of account:Give name and SSN ol:
<br />1. lndividual
<br />2. Two or more individuals [oint account]
<br />oth€r than an account mahlained by
<br />an FFI
<br />3. Two or more U.S. persons
<br />fioint aeount maintained by an FFlf
<br />4. Custodial account ol a minor
<br />(Uniform Gift lo Minors Act)
<br />5. a. The usual revocable savings trust
<br />(granlor is also trustee)
<br />b. So-called lnrsl account that is not
<br />a legal or valid trust under state lav/
<br />6. Sole proprietorship or disregaded
<br />eniity ovrned by an individual
<br />The
<br />7. Grantor trust filing under Oplional
<br />Filing Method 1 (see Regulations
<br />seclton 1.671 -4(bX2XiXA))"
<br />Kittitas County Agreement for Services (rev.5/!4/25)
<br />Page 17 of 19
<br />For this of account:
<br />8. Disregarded entity not ovmed by an
<br />individual
<br />9. A valid kust, estale, or pension trust
<br />10. Corporalion or LLC electing corporate
<br />status on Form 8832 or Form 2553
<br />1 1, A$eociatioo, club. relilioos, charhable,
<br />educational, or other tax-exempl
<br />organ ization
<br />12. Partnership or multi-member LLC
<br />13. A broker or rggistered nominee
<br />14. Account witr lhe Oepartment of
<br />Agriculture in the name of a public
<br />enti$ (such as a slate or local
<br />govemmenl, school dblrict, ot p,sonl
<br />lhat receives agricultural p.ogram
<br />paymenls
<br />15. Granlor trusl filing Form 1o4l or
<br />under lhe Optional Filing Method 2,
<br />requiring Form 1099 (see Regulations
<br />section i.671 -4(bX2Xi)(Bl)"
<br />Give name and EIN of:
<br />The ovvner
<br />Legal entitt'
<br />Tho caporation
<br />The organizalion
<br />The parbership
<br />The brokec or nominee
<br />The publie enrity
<br />The actual omer of the account or,
<br />if combined funds. the firsl individual
<br />on lhe accountl
<br />Eactr holder of the account
<br />The minor2
<br />The grantor-lrustee?
<br />The actual omerr
<br />The ovmerg
<br />The grantor'
<br />Th€ trusl
<br />t List lirst and circle the name of the person whose number you fumish.
<br />lf only one person on a joint account has an SSN, that person's number
<br />must be fumished.
<br />2Oircle the mino/s name and fumish lhe minor's SSN.
<br />rYou must show vour individual name on line 1, and enter vour business
<br />or DBA name, if ahy, on line 2. You may use either your SSN or EIN (f
<br />you have one), but the IRS encourages you to use your SSN.
<br />{List first and circle the name of the lrust, estate, or pension trust. (Do
<br />not fumish the TIN of the personal representative or truste€ unless the
<br />legal entity itself is not designated in the account tille.)
<br />'Note: The grantor must also provide a Form W-9 to the trustee of the
<br />trust.
<br />" For more information on optional filing methods for granlor tusts. see
<br />the lnstructions for Form 1041 .
<br />Note: lf no name is circled when more than one name is listed, the
<br />number will be considered to be lhal of lhe first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />tdentitv theft occurs when someone uses your petsonal information,
<br />such a's your name, SSN. or other idendfing information, without your
<br />permission to commit fraud or other crimes- An identity thief may use
<br />your SSN to get a job or may lile a tax tehrm using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />. Proieci your SSN,
<br />. Ensura your employer is protecting yogr SSN, and
<br />' Be careful when choosing a tax refum prepater.
<br />lf your tax records are affected by identity lheft and you receive a
<br />noiice from the lRS, respond dght away to the name and phone number
<br />printed on the IRS notice or letter.
<br />lf your tax records are not cunenlly affected by identity theft but you
<br />think you are at risk due to a lost or stoten purse or wallet, questionable
<br />credit card aclivity, or a questionable credit report. contact lhe IRS
<br />ldentity Thefl Hotline at 800-90&4490 or submit Form 14tx|9.
<br />For more information, see Pub. 5027, ldenlity Theft lnformalion for
<br />Taxpayers.
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