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Pase 5Form W-9 (Rev.3-20241
<br />Part ll. Certification
<br />To establish to the withholding agent that you are a U.S' penon. or
<br />resident alien, sign Form W-9. You may be requested to sign by the
<br />rvithholding agent even ;f item 1, 4, or 5 below indicates olhervrise.
<br />For a joint account, only lhe person whose TIN is shown in Part I
<br />should sign (when required). ln the case of a disregarded entity, the
<br />person idLntified on line 1 musl sign. Exempt payees" see Exempfpayee
<br />code. earlier.
<br />Signafure requirenrents. Complete the certification as indicated in
<br />itemslthrough5below.
<br />l. lnterest, diviclend, and barter exchange accounts opened
<br />before l9g4 and broker accounts considered aclive during {983.
<br />You nlust give your correct TlN, but you do not have to sign the
<br />cedification.
<br />2. lnterest, dividend, broker, and barter exchange accounts
<br />openecl after l993 and broker accounts considered inactive cluring
<br />.lb83. You must sign the cerlification or backup withholding will apply. lf
<br />you are subject to backup withholding and you are merely providing
<br />your conect TIN to the requester, you must cross out ltem 2 in the
<br />certification before signing the form.
<br />3. Real estate transactians. You must sign the certification. You may
<br />cross out ilem 2 of the certification.
<br />4. Olher payments. You must give your conect TlN. but you do not
<br />have to sign the certification unless you have been notified that you
<br />have previously given an incorrect TlN. "Otherpayments" include
<br />paym'ents madeJn the course of the requester's trade or business for
<br />rerits. 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 nrade in settlement of.payment
<br />card and'thiid-party netvrork'trdnsactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attomeys (ncluding payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualified tuition progranr
<br />paynrerrti (uirdei seclion 5291, ABLE accbunts (under section 529A)'
<br />lRA, Goverdell ESA, Archer MSA or HSA eontribtdions or
<br /><.listributions, arrd pension distributions. You must give your correct
<br />TlN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />The lrust
<br />' Ust first and circle the name of the person v;hose number you fumish'
<br />lf only one person on a ioint account has an S.SN' that person's number
<br />musl be fumished.
<br />?Circle the mino/s name and fumish the minols SSN-
<br />l You must shovr vour rndividual name on line I ' and enter your business
<br />oi bgA ni;ie, if airy, on line 2. You may use erlher your SSN or EIN (if
<br />you have one), but the IRS encourages you to use your SSN"
<br />aList first and circle the name of the trust, eslate' or p€neion trust" (Do
<br />not fumish the TIN of the personal representative or trustee unless the
<br />legal entity itself is not designated in the account title'l
<br />'Note: The grantor must also provide a Form tit -9 to the trustee of the
<br />trust.
<br />" For more information on optional tiling methods far grantor trusls, see
<br />the lnstructions for Form 1041"
<br />Note: lf no name is circled qrhen rnore lhan one name is listed. the
<br />number will be considered to be ihat of the first narne listed.
<br />Secure Your Tax Records From ldentity Thett
<br />ldentitv theft occurs r,vhen someone uses your persdnal information'
<br />such a! your name, SSN. or olher identifiTing information, witfrout yoor
<br />permission to eommit fraud or otfter crimes" An identity ttri*f may use
<br />your SSN to get a iob or may lile a ta< return usinel trour SS0'l to receive
<br />a refund.
<br />To reduce your risk
<br />. Protect your SSN,
<br />. Ensure your employer is protectlng your SSltl. and
<br />. 8e careful when choosing a tax return preFarer"
<br />lf your tax records are affected by identity lheft and yctr receive a
<br />notiie from the lRS. respond right away ts the narne and phone number
<br />printed on the IFS notice or letler,
<br />lf vour tax records are no! cunently affected by rdentty ttreft but you
<br />thlnli you are at risk due to a lost or itolen purse or wallet, questionable
<br />crediicard act;vity, or a questionable c.edit r€Fort. contact lhe IRS
<br />ldentity Theft HoUine at 8OO-9{l&"{4gG sr submfi Fotm 1'lt]39.
<br />For more information, see Fub" 5927' ldentitv Theft lnformalion for
<br />Taxpayers.
<br />For this of aceount:
<br />8. Disregarded entity not oraned by s
<br />individual
<br />9. A valid trust. estate, or pension lrust
<br />lo, Corp€ration or LLC electing corFomt*
<br />sialus on Fom 8832 qr Fom 255.3
<br />1 1 . Assmiation. club, religirus. chtriiabla'
<br />educational. or other ld'extrnpt
<br />organization
<br />1?. PartreEhip or mufti-mmber LLC
<br />13" A, b{oker or registered nominee
<br />t+- Account with the Departntrt of
<br />Agriculture in the nme oi a Public
<br />entity (such os a slate or l€nl
<br />govemmenl, school dblrict, or griscnf
<br />that rec€ives agricultuml Progro
<br />payments
<br />15, Granto. trust filing Fm lo-dl or
<br />under ihe Optional Filing Method 2.
<br />requiring Fom 10€9 isee Regufati:ns
<br />sction r.671 atb)(2XiltB))'"
<br />Give name and EIN of:
<br />Th* orn+r
<br />Leqal mtifi/{
<br />The c,zpcratrm
<br />The argffii"a[oD
<br />Ihe partrrship
<br />fhe broher or nominee
<br />Ih: pghlic rfltfu
<br />For lhis of account:
<br />1. lndividual
<br />2. Two or more individuals (ioint account!
<br />other than an acmunt mainiained by
<br />an FFI
<br />3. Two or more U.S. pe.sons
<br />fioint account maintained by an FFIJ
<br />4. Custodial aaount ol a mins
<br />(lJnifom Gift to tulinors Actf
<br />5- a- Tho reual tevocable svings trust
<br />(qrantor is also trusleel
<br />b. S*calfed trust accent that is not
<br />a legal or valid trust under stat. lac/
<br />6- Sole proprietorship or disregarded
<br />entity cr, ned by an individual
<br />7. Grantor tust filing under Optional
<br />Filinq fvtethod I {see Regulations
<br />seciion 1.671 -4(bl(21fi l{A))'"
<br />Give name and SSN of:
<br />The individual
<br />The actual c*ner of the account or,
<br />if combined funds. the fisl individual
<br />on the accountl
<br />Each holder of the accsunl
<br />The minor:
<br />The g.mttr-trusteet
<br />The aetual own*rl
<br />The ovrner3
<br />The grantor'
<br />Kittitas County Agreement for Services (rev.5/U/25)
<br />Page 2L of 23
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