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<br />Form W-9 (Rev.3-2024)
<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-S^ Vou may be requested to sign by the
<br />rvilhholding age,it even if item '1, 4, or 5 below indicates olherwise'
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign (when required). ln the case of a disregarded entity' the
<br />person id-entrfied on line 1 must sign. Exempt payees, see Exempt payee
<br />code, earlier.
<br />Signature requiremetrts' Complete the certi{ication as indicated in
<br />itemslthrough5below.
<br />l. lnterest, cliviclencl, ancl l>arter excltange accounts operred
<br />before 1984 ancl broker accounts considered aclive during l98il'
<br />iou must give your correct TlN, but you do not have to sign the
<br />certification.
<br />2. lnterest, divi<Jend, broker, ancl barter exchange accortnts
<br />ooened aftei 19&3 arr<l broker accounts cotrsiclered inactive during -
<br />itiae-io, *u"t sign the certificalion or backup withholding rvill apply" lf
<br />vou are sublect to-backup withholding and you are nrerely providing
<br />i,ou, "on""i TIN to the requester, you must cross out item 2 in the
<br />certificatjon before signing the form.
<br />3. Heal eslate lransactions. You musl sign the certification' You may
<br />cross out item 2 of the cerlification.
<br />4. Other paynrents. You must give your conect TIN' but you do not
<br />have to sign tlie certification unless you have been notified thal you
<br />have previously given an inconect TlN "Other payments" include
<br />"r"rnlnit maOein tt'a course of the requester's tiade or business for
<br />ierits, royalties, goods (other than bills for merchandise), medical and
<br />health cire services Including payments to corporations), payments to
<br />a nonemolovee for services, payments made in settlenrent of payment
<br />".iO "nJ'tt
<br />iiO parry nelrlork'trdnsactions' payments to certain fishing
<br />boat crew membeis and fishermen, and gross proceeds paid lo
<br />attomeys (including payments to corporations).
<br />5. Mortgage interest paid by yotr, acquisition or abandonment of
<br />securecl p-rJrrerW, cancellatioir ol clebt, qualilied tuiliorl prograrn- -.riui"J"t! (uh<lei section 529), ABLE accounts (trnder seclion 5294)'
<br />iHA, Cou"t,t"tl ESA, Archer MSA or HSA contributions or
<br />distributions, ancl pensiotr distribtttions. You must give your conect
<br />TlN. but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />'Ust first and circle the name of the person whose number you
<br />tf ontv one person on a joint account has an SSN, that person's
<br />nrust'be fumished.
<br />rCircle lhe n:ino/g name and fumish the minols SSI'I'
<br />lYou musl shorv vour lndividual name on line 1. and enter your business
<br />";b"BA;ilii'ainv.
<br />on ti,ie z. You may use erlher your ssN or EIN 1if
<br />you have one). but the IRS encourages you to use your SSN'
<br />I List lirst and circle the name of the trust. estate, or pension trust' (Do
<br />noiir.iaf' the TIN of the personal representative or trustee unless the
<br />legal antrty itself is not desrgnated in the account title')
<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 grantor trusts' see
<br />the lnstructions for Form 1041 .
<br />Note: lf no name is circled when mrrre than one name is listed' the
<br />number will be considered to be that of the lirst name listed'
<br />Secure Your Tax Records From ldentity Theft
<br />ldentiti lheft occurs lvhen someone uses your personal tnformatron'
<br />rrin i'* yout nu.e. SSN' or other iclenufrTing informatioo rvithr:ut your
<br />plrmissi,rn lo commit fraud or other crimes. An identity thief may use
<br />V.r, SSU to get a lob or may file a tax return using your SSN to receive
<br />a refund.
<br />To reduce Your risk:
<br />. Protect your SSN.
<br />. Ensur,a your employer is protecting your SSN, and
<br />. Be careful when choosing a tax relum preparer'
<br />lf vour tar records are atfected by identity theft and ','ou recet'te a
<br />nottJ* frot the lRS. respond right away lo the name and phone number
<br />printed on the IRS nolice or letter.
<br />lf ,rour tax records are nol cunently affected by rdentity theft but you
<br />th;d;;;;t;i;sk due to a lost or itolen purse'or vrallet' questionable
<br />iiiri"^raa6ti'/aty, or a questionable eredit report, contact-the IRS
<br />ldentity Theft Hotiine at 800-90g-4490 or submit Form 1'lo3s'
<br />For more infonnation, see Pub. 5027, tdentity Theft lnformahon for
<br />Taxpayers-
<br />For this of accouni:
<br />8. Oisregrded entity not ov/ned by an
<br />individual
<br />9" A valid trust. estate. or pansion trust
<br />1o- Corporalion or LLC electing corporatE
<br />stalus on Form 8832 or Fom 2553
<br />! 1 . Asociatifi, ctub, religious, churtabla.
<br />educational, or other tu-exP-mPt
<br />orqan i:ati€ n
<br />12- Partnership or mullinrmber LLC
<br />1J. A L'roker or r:gistered nonrinee
<br />1{. Accounl ryith lha DePartm*t of
<br />Aqriculture in the name of a Public
<br />entity {such as a slate or la:al
<br />Eovemmffil. school district, qr prisonl
<br />that r.ceives agricultural program
<br />payments
<br />15. Gnnior trust filing Fom 10'11 or
<br />under the OptionalFiling Method 2.
<br />r*luiring Fom 1O99 (se€ Regulations
<br />section 1.671 -aibX?X0(B))"
<br />Give name and EIN oft
<br />The owner
<br />Legal entityr
<br />The coporation
<br />The organi:auon
<br />The prtnership
<br />The broker or nominee
<br />The public tntity
<br />The trust
<br />fumish.
<br />number
<br />For this of account:
<br />1. lndividual
<br />2.f wo or more indNiduals ljoint account)
<br />other than an rccount maintained by
<br />an FFI
<br />3- Two or more U.S- Pesons
<br />(t-oint account maintained by u FFI)
<br />'3. Custodial account ot 3 minor
<br />(Uniform Gift to ['linors Actl
<br />5. a- The usu;l revomble savings trust
<br />{grml6t is also trusiee)
<br />b- Secalled tust acctunt that is not
<br />a legal or valid trusl under stata lav
<br />6. Sols F,ropnetochip or disregarded
<br />enlit-v ovrned by an individual
<br />7. Gmnlor ttust filing under Oplional
<br />filinq !Uethcd 1 {see Regulations
<br />s*tion 1.671 -1{b)(2)ti)(A})"
<br />Give name an<l SSN of:
<br />individual
<br />The actual oYcer of the account lr.
<br />if combined funds. the fist individu:l
<br />on the accountl
<br />Each holder of the account
<br />The minor:
<br />Thr grantot-t usteel
<br />The actual otn:rr
<br />The ovrn*f'
<br />The grmtot'
<br />Kittitas County Agreement for Services (rev.5/14/251
<br />Page 2O of 23
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