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Prge 3
<br />Form W-9 (Rec.3-2024,
<br />Certain oavees and pavments are exempt front backup withholding'
<br />$ee Exempt'payee code.'later. and the separate lnstructions for lhe
<br />Requester of Form W-9 for more information.
<br />See also Estabtishing U.S- saatus for purposes of chapter 3 and
<br />chapter 4 withholding. earlier.
<br />What ls FATCA RePorting?
<br />The Foreign Account Tax Compliance Act (FATCA)-requires a
<br />participating foreign financral institution to report all U.S. account
<br />holders thaiare specified U.S. persons. Certain payees ar* exempt from
<br />FAiCA reporting .'See Exemption from FATCA repofting code,later, and
<br />the lnstruclionsior the Requester of Form W-9 for mora information'
<br />Updating Your lnformation
<br />You must provide updated information to any person to lvhom you
<br />claimed to be an exempt payee if you are no longer an exempt Payee
<br />and anticipate receiving reportable payments. in the future from this
<br />person. f6r example, y-ou may need td provide updated information if
<br />vou are a C corporation that elects to be an S corporation, or if you are
<br />io lonqer tax exempt. ln addition, you must fumish a new Form W-9 if
<br />the naire or TIN changes for lhe account. for example, if the grantor of a
<br />grantor trust dies,
<br />Penalties
<br />Failure to frrrnislr TIN' lf you fail to fumish your correct TIN to a
<br />requester, you are subject to a penalty of $50 for each such failure
<br />unless youi failure is due to reasonable cause and not to willful neglect'
<br />Civil oenaltv for false irrfornration with respect to witlrholding' lf you
<br />make a fals6 statement lvilh no reasonable basis that results in no
<br />backup rvithholding, you are subiect to a 5500 p€nalty.
<br />Crinrinal penalty for falsifying information. Willfully falsifying
<br />certificati6ns or iffirmations may subiect you to crinrinal penalties
<br />including fi nes and/or imprisonment'
<br />Misuse of TlNs. lf the requester discloses or uses TlNs in violation of
<br />federal law. the requester may be sublect to civil and criminal penalties'
<br />Specific lnstructions
<br />Line 1
<br />You must enter one of the iollowing on this line: do not leave this line
<br />blank. The name should match the name on your tax relum.
<br />lf this Form W-9 is for a ioint account {olher than an account
<br />maintained by a foreign financial inslitution (FFl))" list first, and then
<br />circle. lhe name of the person or entity whose number you entered in
<br />Pad I of Form W-9. lf you are providing Form W-9 lo- an FFI to documenl
<br />a ioint account, each holder of the accounl that is a U S- person must
<br />provide a Form W-9.
<br />, lnclividual. Generally, enter the name shown on yout [ax retum- lf you
<br />have changed your last name without informing the Social Security
<br />Administra-tion iSSA) of the name change, enter your first name. the last
<br />name as shovrn on your social security card, and your new last name"
<br />Note for lTlN applicant: Enter your indivrdual name as it was entered
<br />on vour Form W-I applicalron, fine 1a- This should also be lhe same as
<br />the name you entered on lhe Form 1O4O you filed with your application'
<br />. Sole proprietor- Enter your individual name as shown on your Form.,
<br />1040 o; li;e 1. Enter youi business, trade, or'doing business as" (DBA|
<br />name on line 2.
<br />. Partnershin. C corporation, S corporation, or LLC' other than a
<br />disregarded'entity. Enter the entrty'd name as shown on lhe entitls tax
<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. federal tax
<br />documents on line 1- This name should match the name shown on the
<br />charter or other leEal document creating lhe entity- Enter any business'
<br />trade, or DBA name on line 2.
<br />. Disregarded entity. ln general, a business entity that has a single
<br />orvner, including an LLc, and is not a corporation, is disre-garded as an
<br />entitv seoarate iom its owner (a disregarded entity). See Regulations
<br />section dol.iTol-2tcxzl- A disregarded entity should check the
<br />aoorooriate box lor the tax classification of its owner- Enter the owner's
<br />nL*" on line l. The name of lhe owner entered on line 1 should never
<br />be a disregarded entity. The name on line 1 should be lhe name shown
<br />on the inc6me tax rettim on:vhich the income should tre reported' For
<br />lF rhe entity/individrral on line {
<br />is a{n} .. .
<br />THEN check the box for
<br />. Corporation Corporation.
<br />. lndividual or
<br />. Sole proprietorship
<br />lndividuallgr{e ProPrietor
<br />. LLC c{assffied as a partnershiP
<br />for U.S. federal tax Purposes or
<br />' LLC that has filed Form 88{12 or
<br />2553 electing to be taxed as a
<br />corporation
<br />Limiled liability comPany
<br />enter the approPriate tax
<br />classification:
<br />P = Partnership.
<br />C=Ccorporation,or
<br />S = S corporatton.
<br />and
<br />. Partnership Partnership-
<br />r Trusyestate Trustr'estate"
<br />examole. rf a foreicn LLC that is lreated as a disregarded entity for U'S"
<br />i"J"ii i"* p"rp"s"es has a single owner that is a US'.person, the U'S'
<br />o*nur'* n".*"i* required lo bi provided on line I ' lf the direct owner of
<br />the entity is also a disregarded entity. enter lhe firsl owner that is not
<br />d,sreqaried for federal t?x purposei. Enter lhe disregarded enti$'s
<br />nurnJon line 2. lf the olvner ol the disregarded enlity is a foreign person'
<br />iiil o*net.utt *omplete an approprbtE Form lV-Blnstead-of a Form
<br />W-9. This is the case even if the foreign person has a U'S' Tlt't'
<br />Line 2
<br />lf you have a business name. Itade name' DBA name, or disregarded
<br />entity narne, enter it on line 2.
<br />Line 3a
<br />Check the appropriate box on line 3a for tha U.S. federal tax
<br />ctassincatien 'ot tite person whose name is enter€d on line 1- Check only
<br />one box on line 3a.
<br />Line 3b
<br />Check this box if you are a partnership {including an LLC classified as a
<br />oMnershto for U.'S federat tar purposes). trust. or estate lhat has any
<br />'foreign partners. ownerc, or beneficianes' and you are providing this
<br />form-to a partnetship, trust. or astale' in which you have an ownership
<br />i^i*i*tt. Vou rnust dheck the box on lure 3b if you receive a Form W-6
<br />(or documentarv evidencel from any partner, ourner' or beneficiary
<br />Ltubtishing foriign status or if you recerve a Form W-9 from any
<br />partrrer, crniner, oi beneficiary that has checked tl're box on line 3b'
<br />Note: A partne.ship that provides a Fornr W-9 and checks box 3b may
<br />be recuried !o contolele Schedules K-2 and K-3 {Forrn 1065}' For more
<br />information, see lhe partnership lnstructrons for Schedules K-2 and K-3
<br />(Form 1065),
<br />Ii vou are requtred to complete line 3b but fail tn do so' you may nat
<br />.""ei"u ttra,ntormagon necessary ter file a conecl information retum erilh
<br />the IRS or fumish a correct paye* stateflT€flt to your partners or
<br />beneficiaries. See, tor eaample' sections 6698- 6722' and 6724far
<br />penalties that may aPPlY,
<br />Line 4 Exernptions
<br />lf vou ara exemot froar backup wilhhotdng andlor FATCA reporling'
<br />*ritui,n tl,* appropnate spacd qn line s any codeisl that rnay apply to
<br />You-
<br />Exempt payee coele.
<br />. Generally. indi','iduale tinchrding sole proprietorsl are not exempt from
<br />backup vrithholding-
<br />r Except as providerJ belovr, eorporatrons are exempt from backup
<br />withholiling for eertaifi Payments. including intetesl and dividends'
<br />. Comorclions artl not exempl from bact+up wrthholdrng for payments
<br />.Ja*in
<br />""tU*n'tent
<br />oi paymeirt card or thitd-parl-; netwotk lransaclions'
<br />. Corporations are not exenrpt frcrxr bachup withholding 'ntlh respect to
<br />atfomeys' fees or gross proceeds paid to attomeyg, and ccrporations
<br />that pr;vide medrcil c,r health care services are not exempt't/ith re€pect
<br />lo payments reportable on Form lffl9-fullSC"
<br />The follorving codes identify paye€s that are exernpt from backup
<br />withholding- Eiter the approfnat* code rn ihe sPace on hne 4'
<br />I -An organizatrsn exempt fiom tax und€r section 5o1(ai, any IFA' or
<br />a custodiaiacc,:unt trnder section .lS3{Fl(71 if the account satisfies the
<br />requirernents of section 40 l{f}{21.
<br />Kittitas County Agreement for Services (rev. 5/M/251
<br />Page 19 of 23
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