Laserfiche WebLink
Page 5 <br />Form W-9 (Flev. 3-20?{} <br />1 . lndividual <br />2 f wc or more individuab *sflt e*4tl <br />olher ths an rcwnt maintanal bY <br />an FFI <br />3. lwo or more U S. Pelws <br />(oint nccount maintaned b? m FFll <br />r Custodial account o{ a mnq <br />tlJnifom Gifl tc l{lirsrs Act} <br />5. a- The cual ravg€abi* :avings ttwt <br />fgrmtor is als lrusttri <br />b. S+ca{led trust actc'rnl llEl is ffit <br />a legal or valid irul 'Jnd{ stlie hcr <br />6. Solc pmpnttorsh'f, cr 'lisr*ggd"ci <br />entity ovned bY m indiwiual <br />7. Grantor',tust fiting unda Opumal <br />Filinq i\,{efitd I {see Regulaii€ns <br />s*tion 1.67! -.libi{?ifii61f' <br />For this of accoune <br />3. OisregardeJ enth,' rct or$ledbrym T1i,z'svr'x <br />Give nsne anq{ <br />LFt$ rfltfC <br />Ti-e .:;rFordi.en <br />-{h:,, agenintoo <br />T]lt Fat'ntrsltp <br />Itg "ltlrk<r or ntmne <br />3le Fshiii; *tit:; <br />Tks iru:t <br />EIN of <br />Part ll. Certification <br />To establish to the urithholding agent that you are a U'S- person' or <br />;;'d;;;li;.,-"iin nom' w-e:Y; mav be.recyes.l{ t tigl,1Y tl" <br />vrittrtroUing age;t even if item t, +, or 5 below indicates olner+{l3e' <br />Fnr a ioinLaccount. onlv the pefson whose TIN is shol"'n in Part I <br />.n"riiJ'g^-('.'rh"n requireil)' ln'the case of a drsregarded entrrJ' the <br />;;; i;;";fi.; on line 1 nrust sign' Ezsnpt pavees' see E'remp{ pavee <br />code. eadier. <br />Sigrrature requiretnents' Complete the certification as indicated in <br />itemslthroughSbelow <br />I . lnterest, diviclend, and barter e{change accounls oPened- -x.ir;|rcg,t altd broker accoullls consideieci active during 1983' <br />liil;"r;i;;; y;ui correct Tll'1, but votr do not FFve to siqn the <br />certification. <br />2. lnteresl. divitiend, broker, ancl barter exch.ange accounts <br />.;#;;ft;; iban ;"j broker accounts considered.inactive durinsl <br />.t983. you must sign tne cerrftcattn sr'backup vrithho{ding will appiy. lf <br />*oJlr" "rOl..t <br />to"backup urithholdirrg anci you are merely providing <br />i"r-."Ji nru to the requester' you must cross out item 2 in the <br />Senificatjon before signing the form' <br />3. Real estate transactions. You musi sign the certification You may <br />cross out item 2 of the certification' <br />4. other Davments. You must give yorrr correct Tll'l' but you do not <br />h";; t;;i;" tli" certification unleis you have been notified that you <br />ii""" "".*i"""r" oiven an incorrect Tiltt. "other payments" include <br />li:;:;;;-;i"1"'inl lo''.'" ot the requester's trade or business for <br />I"",];';;;-"iii;;.;ooJs (other than bilts for merchandise)' medical and <br />i'.ffi ';i;'s-e*iies <br />6nltuding payment6 to corporatrons)'.payments to <br />. .^^o-.l.tee for services. oavments made in senlement of payment <br />:#;iHl;:p".tv ""nir*titl"saciions <br />pavments to certarn fishing <br />[i"t .r"- -.tiuers and ftshermen, and gross proceeds paid to <br />attomeys (including paytnents to corporattonsl' <br />5. Mortqaqe interest paid by you, acquisition or abandonntetrt ot <br />qecr rrecl o*ro-oerfu" cancetlation of debt' qualified tutton l)rogra-m^ . . <br />i-"iillrit5'rrii"7 "t."ti"" sist' ABLE accbunts {under sectior ' 529A}' <br />iRA, Coverdetl ESA' Archer MSA or HSA contributrons or <br />ii"i.ifui;tnt, and pension distributions' You must give your corect <br />ittt, grt you do not have to sign the certification" <br />icctivi Cual <br />9- A valid tnrs*" esttte' af p:fisim fri6t <br />1o- CasE!fl3tffi ot tIC +l*trhg '-rgwale <br />sbat€ s Fom 3812 ';s fog* ?55J <br />I !, A5scaii:*' Crs, retgia;s' charfabk; <br />educab'oef,i, gr olt et w.+8 fr61 <br />organirati:o <br />l2 Patrlerehip tt sr:ftmmba LLrl <br />13 A brclier or rcEi$lErdd rcFEI€r <br />1{. Ac!:!uai lrilh EE Oetatrtu53it tf <br />Aari*situe h tfle rtr'a ai a Pr:Uit <br />ariitr (scrr n a sled* 'r l*lt <br />qovemmer.l, t:hool disttct' ot snsmf <br />Grat r*eivas agrku{tur:l Proqram <br />o:ryriEots <br />i 5 . Grantor hust 6ling Fcrrn l'?-ll or <br />under the Optimal Frlirve f'lef;+d S' <br />r:,-ruidng Form 1ffd {see Regr'dri':ers <br />sarion 1.611 -.t{bl{2Xi}(Bil" <br />What Name a nd Ntlnrber To Give the Requester <br />For this of account:Give name ancl S$N of: <br />, List first and cifcle thB rrarne of the Fetr4c <br />lf only one per$n on a ioint ac-caunt hd a$ <br />must be fumished. <br />;Circle the minor.s name aftd furnish the rrunor's SSN' <br />: You must sho'+ your tndivldual name on line 1' afid enter vour business <br />.i'6bA;;;i'i;;;il"14;niavruse eittrer p:ur ssN or EllJ {if <br />ilil;"*on;i. ;ui'ui" ins *n""ucrg€etrou to use vour ssN' <br />{ List first and circle the name of the trusl ss!-dte. or pension trust' iDo <br />Jtu*i"f t'tn. fiiJ of lhe prsonal repres+rtatiie or trustee unl'3s the <br />Ie,lal +ntitY ttsalf is not Cesignat*d in tie acc:unt uue'; <br />' Note: The granto. musl also provlde a F+crm lirJ-Q to ihe trustee of the <br />tru3i, <br />.-For more iniormahoft on rpb'l{lal frlinq' r*thods ior grantor tr'Js..s' s*e <br />the lnsttuctions for Fofin 1g-l-l <br />Note: lf no narne is circlad ui'e-s; s'nor+ tft'fftr o{le nar*e is ksted' the <br />;;;;;;;ine;"ns{der*d qo i}e {hqt of dr* iir=t narne iisted <br />Sacure Ycur Tax Recsrds Frsrn ldentity Theft <br />lCentFf theft 'Jccurs Jrh€fl sorn€+:}} !rs# vclir personal rnfonnauon' <br />:;;;;'. ';,,; narm S3l!, or oliner ,*etrrrf';rn1'n?'r$natrm -*idrtu! your <br />##;fi;;tt"*11ra,i:t o'rtr\ec arffb:s Fn d*i"!rtg ltu-*f, mt! us+ <br />ffi;;5di;;;i'1"1. "i.'"r' *r* d' 3^ reiu:nT -xs'rs sou: ssFl r* n:eite <br />a refund" <br />To re-duce xraur dstl <br />. Prct*ct your S,SN- <br />" Ensura yaur ef,rxfloyar r: potecowE yctr SSsi' and <br />" 8e cargful vrheo cha*sinq a iia){ r{ttJ(rlr Fx4parei: <br />lf vrlur taq recodds are df€€te'J bf Idar;SS7 tlr*ft and yol r€csi'"'e a <br />tJiJfr# ;;. ns t*pt'tor *gL* a"r+'toiiie rrasne and pnrrne ot*rnber <br />pnrvted on tlte fRS fiotfu5 sr lstter" <br />il"rout tax rmords ar+ rm:t curiaeiti'l' aflecf,€'C t'i'r rden'lrtJ Cett ba ! 7ou <br />u,*{ you t* "t *rdi dlre to a-Gt c,t:dttitn p'gse ry wase?" qu*uo'nab'le <br />arFJi{ card sclFjiiy, * t.o*titii*tl'ft" /Y44il r%{,f' ac{l{acl d''e 1fl5 <br />il;;q'{h; t:"tfine at a{+em+ds'$' 4sr' el't&{ril F{tm 1 '1s69 ' <br />For more fni'o*rq&ee"r' eae Fo:f:' 5S27 dds{'rtttv Th*ft [nformato* for <br />Tiixpayer:- <br />xrhose number'you iumish. <br />gsll. thal Pers.n's number <br />T*e <br />Thi actrnl owner of rhn s@mt or" <br />d smbined frnds. ti''e ftei indiedval <br />tr tfEtrwmlt <br />Each hctder ct if*e meml <br />fhe nincr: <br />-!lie grsttr-frsi*' <br />tr-h* asiual ttnerl <br />Xhr svmF <br />Thegmts" <br />Kittitas County Agreement for Services (rev' 5/L4/25l' <br />Page 2O of 23