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Paqe 3 <br />Form W-9 (Rev.3-20241 <br />Certain oavees and pavments are ex€mpt from backup wrthholding' <br />Sei txempt'payee code,'later, and the separate lnstructions {or the <br />Requester of Form W-9 for more information. <br />See also Establishing U.S- status for putposes of chapter 3 and <br />chapter 4 withhalding. eatlier. <br />What ls FATCA RePorting? <br />The Foreign Account Tax Comphance Act (FATCA).requires a <br />participating foreign financial institution to report all U.S. account <br />irolders tnaiare siecified U.S. persono. Certain payees are exempt from <br />f niCA t"porting .'See Exemption from FATCA rcpofting 9o-de' later' and <br />the lnstru;tionsior the Requester of Form W-9 for more information' <br />Updating Your lnformation <br />You must provide updated information to any pelson to lvhom you <br />claimed to be an exempt payee if you are no longer an exempt payee <br />and anticipate receiving rep6rtable payments. in the future {rom this <br />ploon. i5.i*u.ple, y-ou may nee<i t6 provrde updated information rf <br />Lou are a C corooration that elects to be an S corporation. or if you are <br />iolonq.t tu" exempt. ln addition, you must fumish a newForm W-9 if <br />ine naire or TtN changes for the aicount, for example, if the grantor of a <br />grantor trust dies. <br />Penalties <br />Failure to fumish TlN. lf you fail to fumish your conect TIN to a <br />requester, you are subieci to a penalty of $50 for each such..fuilure <br />unless youi failure is due to reasonable cause and not to willful neglect' <br />Civil oenaltv for false information with respect to withholding' lf you <br />maki a fal# statemenl vrilh no reasonable basis that results in no <br />backup withholding. you are subiect to a S500 Penalty. <br />Crinrinal penalty for falsitying inforrnation. Willfully falsifying <br />certificati6ns or iffirmationi may sublect you to criminal penalties <br />including fi nes and/or imprisonment' <br />Misuse of TlNs. lf the requester discloses or uses TlNs in violation of <br />federal lar.r, the requester may be subject to civil and criminal penalties' <br />Specific lnstructions <br />Line 1 <br />You must enter one of the fotlowing on this line: do not leave this line <br />blank. The name should match the name on your tax retum' <br />lf this Form W-9 is for a joint account (other than an account <br />maintained by a foreign financial institution (FFl)). list first' and then <br />crrcle, the name of th6 person or entity whose number you enlered in <br />Part I of Form W-9. lf you are provrding Form W-9 to. an FFI to document <br />a ioint account, each holder oi the accounl that ls a U'S' person must <br />prcvide a Form W-9. <br />. lndivitlual. Generally. enter lhe name shown on your tax retum' lf you <br />have changed your last name without informing the Social Security <br />Administra"tion iSSAi of the name change, enter your first name. the last <br />name as shorrn on your social security card' and your new last name- <br />Note for lTlN applicant: Enter your individual name-as il r"as ente'ed <br />on vour Form W-7 applicalion, line la. This should also be lhe same as <br />the name you entered on the Form 1040 you filed with your application" <br />. Sole oroprietor. Enler vour individual name as shown on your Form <br />1 040 on line I . Enter youi business. trade, or "doing bLsiness as" {DBAJ <br />name on line 2" <br />. Partnershin. C corporalion, S corporation, or LLC. other than a <br />disiegardecl'entity. Enter the entity's name as shovrn on the enbly's t&( <br />retum on line 1 and any business. trade. or DBA name on line 2' <br />. Other entities, Enter your name as shown on required U'S- {ederal tax <br />documents on line 1. This name should match the name shown on the <br />itrarter or other tegal document creating lhe entity. Enter any business' <br />trade, or DBA name on line 2. <br />. Disregardeci errtity. ln general. a business enlily thal has a single <br />owner, i"ncluding an LLC. anO is not a corporation' is disregarded as an <br />entitu seoarate irom its owner (a dtsregarded entityl. See Regulations <br />iectl'on iot.zzot -2(c|(2). A disiegarded entity should check the <br />aoorooriate box for'the iax classi-fication of ils owner. Enter the owner's <br />n"ru on line 1. The name of the owner entered on line 1 should never <br />be a disregarded entity. The name on line 1 should be the name shornrn <br />on the inc6me tax retum on lvhich the income should be reported' For <br />lF the entity/individual on line I <br />is a(n) ., . <br />THEN cheek the box lor <br />r Corporation Corporation- <br />. lndividual or <br />. Sole proprietorship <br />tndviduallsole ProPrietor, <br />. LLC classified as a partnersh;P <br />for U.S. federal tax purPoses or <br />. LLC that has filed Form 8832 or <br />2553 electing to be iaxed as a <br />corporation <br />Limited liability comPanY and <br />enter the appropriate tax <br />classification: <br />P = PartnershiP. <br />C=Ccorporation,or <br />$ = S corporation. <br />. Partnership <br />. Trusuestate Trusuestate. <br />examole. if a foreion LLC *rat is lrealed as a divegarded entity {ot U'S- <br />tederit tax purposis has a single ownel that is a US'.person, the u':t' - <br />owneds narne is required to be provrded on line 1' lf sle direct owner ol <br />lhe entity is atso a disregarded entiFJ. enter the frrst owner that is not <br />disreqaried for federal 6x purposes" Enter lhe disregarded entity's <br />name on line 2. lf the owner of the drsregarded enlity rs a torel-gnperson' <br />lhe owner must complete an approprbte Form W-8 inste-ad-ot a Form <br />W-s. Tttis is the case e*ren if the forergn person has a U'S' TIN' <br />Line 2 <br />lf you have a bustness name. lrade name' OBA narne' or disregarded <br />entity name, enter it on line 2' <br />Line 3a <br />Check the appropriate box 'ln line 3a ior the U.S. federal tax <br />itas"inc"rion'ot t'he person whose nanre is enlersd an line 'l- Check only <br />one bcx on line 3a. <br />Line 3b <br />Check this box ri you are a partnership {including an LLC classified as a <br />oartnershto for U.'S" federal tax prrposesl' trust. or estate that has any <br />ioreign partners. orvners. or bensficiaries, and you are providing this <br />form-to a parlnership, trust' or esiale. in which you have an ownership <br />i.i"i""t.-%u rn*t dheck the bo* on line 3b if you receir"e a Form W-8 <br />lor documentan'evtdence) from any partner. owner' or beneficiary <br />establishrng {o;ign slatus or il you reee$e a Form W-9 from any <br />partner. oui-ner, oi beneficiary that has checked lhe br:x on line 3b' <br />Note: A partnership that provides a Form W-9 and checks box 3b may <br />be requiied to complete bctredulee K-2 and K-3 {Form l€65}' For more <br />inio#ation, see lhe Partnership lnstruc[ons for Schedules K-2 and K€ <br />{Fonn 1065}" <br />lf vnu are requtred to comdete line 3b but fajt to do so' you may not <br />r.i"l* U* 'nio't-atioo <br />necessary to file a conect i*fonnation retum with <br />lhe IRS or fumish a correct payee stateftrent to your partners or <br />beneficiaries. See" for example" se€tions 6698' 67?2' and 6721 tor <br />penalties that may appty- <br />Line 4 Exemptions <br />lf vou are exemDt from bacl'nrp rr*ithholdng and/or FATCA reportrng' <br />"rir'riln Ut* upfiropnate space on lrne -! ariY code{s! that rnay apply to <br />you. <br />Exempt payee code- <br />. Generally, individuals {nctuding sole prsprietorE} are noi exempt from <br />backup withholding. <br />. Except as provided belarv.. corporations are exempt from baekup <br />wittrtrotiing fbr c€rtain Fayments' rncluding interest and drvidends' <br />. Corcoralrons are not exempl from backup wilhholding for payments <br />made in setllement of payment card or thrd-party network transactlons <br />. Corporalions are not exempt from backup v;ithholding uvith respecl to <br />attomivs' tees or qross proceeds paid to attorneys' and corporations <br />th"t o-uid" mediial or health care services are not *xernpt with respect <br />to piyments reporlable on Form TO99-MlSC. <br />The following codes identify pay4€s that ar€ --xempt from backup <br />wilhholding. Eiter the appropnate cocJe rn lhe space on hne -{- <br />1 -An orqanreahon exempt from tar{ under section 501{al. any lRA, or <br />a custodiaiaccouni und€r seclion 403{bHrl if the accouftl satisfies the <br />requirements of section'lol (q(2i. <br />Kittitas County Agreement for Services (rev.5/Ia/25l, <br />Page t9 of 24