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Form W-9 (Rev.3-2024)Pase 5
<br />Part ll. Certification
<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 requested to sign by lhe
<br />withholding agent even if item 1, 4, or 5 below indicates otherwise.
<br />For a joint accounl, only the person whose TIN is shown in Part I
<br />should sign (when required). ln the cass of a disregarded entity. lhe
<br />person identified on line 1 must sign. Exempt payees, see Exempt payee
<br />code, earlier.
<br />Signature requirements. Complete the certification as indicated in
<br />itemsl through5below.
<br />1. lnterest, dividend, and barter exchange accounts opened
<br />before 1984 and broker accounts considered aclive 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 bader exchange accounls
<br />opened after 1983 and broker accounts considered inactive during
<br />1983. You must sign the certificalion or backup withholding will apply. lf
<br />you are subject to backup withholding and you are merely providing
<br />your conect TIN to lhe requester, you must cross out item 2 in the
<br />certification before signing lhe form.
<br />3. Real estate transactions. You must sign the cerlilication. You may
<br />cross out item 2 of the certificalion.
<br />4. Other payments. You must give your conecl TlN. but you do not
<br />have to sign the certification unless you have been notified that you
<br />have previously given an inconect TlN. 'Other paymenls" include
<br />payments made in lhe course of lhe requesler's trade or business for
<br />rents, royallies, goods (orher than bills for merchandise), medical and
<br />heallh care services (including payments to corporations), paymenls to
<br />a nonemployee for services, payments made in settlement of payment
<br />card and third-party nelwork lransactions, payments to certain fishing
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attomeys {including payments to corporalions).
<br />5. Mortgage interest paid by you, acquisition or abandonment ol
<br />secured property, cancellation of debt, qualilied tuition program
<br />payments (under section 529), ABLE accounts (under section 529A).
<br />lRA, Coverdell ESA, Archer MSA or HSA contributions or
<br />distributions, and pension distributions. You must give your conecl
<br />TlN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this of accourrt:Give name and SSN of:
<br />1. lndividual
<br />2. Two or more individuals (ioin! account)
<br />other than an account maintained by
<br />an FFI
<br />3. Two or more U"S. pemons
<br />{oinl accounl maintained by an FFI}
<br />4. Custodial account of a minor
<br />(ljniform Gitl to Minors Acl)
<br />5. a. The usual revocable savings lrust
<br />{grantor is also truslee)
<br />b. So-called lrust accounl that is noi
<br />a legal or valid lrust under slate lav,
<br />6. Sole proprietorship or disregarded
<br />enlity ov/ned by an individual
<br />7. Grantor trust tiling under Optional
<br />Filing Method 1 (see Regulalions
<br />section 1.671 -abX2[iXAD"
<br />Kittitas County Agreement for Services (rev.5/L4/251
<br />Page 31 of 32
<br />For this of account:
<br />8. Disregarded enlity not ovned by an
<br />individual
<br />9. A valid lrust. eslale. or pension lrust
<br />10- Corporalion or LLC electing corpotale
<br />stalus on Form 8832 or Fom 2553
<br />1 1 . Associalion, club. reliqious, eharhable,
<br />educational, or other tax-exmpt
<br />organization
<br />12. Partnership or multi-member LLC
<br />t3. A broker or registered nominee
<br />14- Account rvitr the Departtnenl ot
<br />Agriculture in the name of a public
<br />enlity {slch i}s a slate or local
<br />govemmenl, school dbtricl. or prisonl
<br />that receives agricultural program
<br />paymenls
<br />15. Grantor trusl {iling Form 1O41 or
<br />under the OptionalFiling Method 2.
<br />requiring Form 1099 {see Flegulations
<br />section 1.671 -4{b}(2}{ilE}}"
<br />Give name and FIN of
<br />The owner
<br />Legal entity{
<br />The corporalion
<br />The organization
<br />The parhership
<br />The broks or nominee
<br />The public entity
<br />The aclual owner of the account or,
<br />if combined funds, lhe first individual
<br />on lhe accountl
<br />Each holder of the accwnt
<br />The minor2
<br />The grmtor-trustee!
<br />The actualomerl
<br />The ovrnerg
<br />The grantor'
<br />The trust
<br />rUst firsl and circle the name of the person whose number you fumish.
<br />lf only one person on a joinl account has an SSN. thal person's number
<br />must be fumished.
<br />?Circle the mino/s name and fumish lhe minor's SSN.
<br />3You must show vour indruidual name on line 1. and enter vour businets
<br />or DBA name. if ahy. on line 2. You may use eilher your SSN or EIN Gf
<br />you have one), but the IRS encourages you to use your SSN.
<br />{Ust lirst and circle the name of the trusl, estate, or pension trust- {Do
<br />noi fumish the TIN of the personal representalive or trustee unless the
<br />legal entity itself is not designated in lhe account tille.)
<br />'Note: The grantor must also provide a Form W-9 to the irustee of lhe
<br />trust.
<br />"For more information on optional filing methods {or grantor trusts, see
<br />the lnstructions for Form 1041.
<br />Note: lf no name is circled when more lhan one name is listed, the
<br />number will be considered to be lhat of lhe lirst name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity lheft occurs when someone uses yout personal information,
<br />such as your name, SSN. or other identifoing information, trithout your
<br />permission lo commit {raud or other crimes. An idenlity ihief may use
<br />your SSN to get a iob or may file a tax retum using your SSN to receive
<br />a refund.
<br />To reduce your risk:
<br />. Protect your SSN,
<br />. Ensure your employer is protecting your SSN, and
<br />. Be careful when choosing a tax relum preparer.
<br />lf your lax records are affected by identity theft and you receive a
<br />nolice from the lRS, respond right away to the name and phone number
<br />printed on the IRS notice or letler.
<br />lf your tax records are nol currently affected by identry thet bul you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activity, or a questionable credit report, contact the IRS
<br />ldentity Theft Holline at 900-908-4490 or submit Fonn 14039.
<br />For more information, see Pub" 5027, ldenlity Theft lnformalion for
<br />Taxpayers.
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