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Pwe4
<br />Form W-9 {Rev- 3-20?4)
<br />2-The United States or any of its agencies of instumentalities"
<br />3-A glate, the District of Columbia, a U.S. commonwealth or territory'
<br />or any of their political subdivisions or instrumentalities"
<br />4- Aforeign govemment or any of ils political subdivisions, agencies,
<br />or ingtrumentalities.
<br />5-A corporation.
<br />6-A dealer in securities or commodities required to register in the
<br />United States, the District of Columbia' or a U-S- commonwealth or
<br />tenitory.
<br />7-A firtures commission merchant registered with lhe Commodity
<br />Futures Trading Commission.
<br />8-A real estate investment trust-
<br />g-An entity registered at all time3 dunng the tax year under the
<br />lnvestment Company Act of 1 940.
<br />1o-A common trust fund operated by a bank under section 584{a)'
<br />1 1 -A financial institution as defined under section 581.
<br />'12-A middleman known in the investment community as a nominee or
<br />custodian.
<br />13-A trust exempt from tax under section G64 or described in section
<br />4547.
<br />The following chart shows types of payments-that may be exempt
<br />trom backup,,,)ithholding. The'ihart aiplies to the exempt payees listed
<br />above, 1 through 13.
<br />lF the payrnent is for THEN the payntent is exenrPt
<br />tor...
<br />c lnterest and dividend payments All exenrpt payees excePt
<br />lor 7
<br />transactions Exempt payees I 4and6
<br />through 1 1 and all C corporations.
<br />F-A dealer ;n s€curities, eornmoditiet" qr deriuative final -eial
<br />lnsfnrments {including notional princi@ cdnlractl. rutur-q, fqyads'
<br />ind cpiiolrs] that is rfuistered as slrch under the la'ns of the United
<br />Stat$ or any slate.
<br />G-A real estate in\restnrent ttust
<br />ll-.A reoulated ;nrrastrnent comp€'liy as defined in section 851 or an
<br />entity regiitered at afi rirnes during Ste tax yea; unde{ dle lnve€trnent
<br />Cornpa{ry Ad ot 1948.
<br />l-A comfion trust fund as defrned in sectibn 5s4{€i,
<br />J-A bank as defined in s€ction 58tr-
<br />K-A broker.
<br />L-A tnrst exempt from tax under section 664 or de€c{ibed in gection
<br />4e47{a}{1}.
<br />M-A tax-exempt lrust uflder a seclisn 4$3tb) plan or section 457i9)
<br />plan.
<br />llote: Yqu may wish to consult wilh lhe financial institution rEque€ting
<br />lhis form to determine whelher the FAfCA e:de and/or exempl payee
<br />code strouid be comPieied.
<br />Line 5
<br />Enter vour addess (number' streel, and apartment or suite number)'
<br />irus is wtrere *re requester ol this Form W-91'rill mait yourinformation
<br />iettrms. lf this addreis differs from the one ttre requesler already has on
<br />fiie, snter "NEW" at the top. lf a new address is provided. lhere is Etill a
<br />charre the old address wilt be used until the payor changes your
<br />address in their records.
<br />Line 6
<br />Enter your city. state, and ZIP code-
<br />Part l. Taxpayer ldentification Number [lN]
<br />lnter your TIN in the appropriale box' tf you are-a rustdent alien and
<br />vou do not have, and are nol eligibfe tff get. an SSN, your I lN E your
<br />inS mru Enter it !n lhe entry spice for the Socia[ secrrity number' If you
<br />do not haue an lIlN, see Flcur to gel a TII1J below-
<br />l{ you are a sole pmpri*lor and yuu have an EIN' y:u may enter either
<br />your SSI{ or ElN.
<br />lf you are a single-member LLC thal isdis-regardTllq.an enlrty
<br />wirate lrorn ftsiwner, enter the o'$er's SSN {or Elttl, if the owner has
<br />"^!i rt rtr" LLC is classifi+d as a corparalicn or partnerehip' €nter the
<br />entu'ty's ElN.
<br />Note: See Whsf ftlarne and NumberTa Gire the ftegltestet, laler,{or
<br />{urther ciarification af nam+ afld TIN conlbtinaliotts-
<br />How to get a TIN' lf you do not have a TIN- appty lor one rmmediately'
<br />io apply"lor an SSN. get Form SS-5. Applicaticn for,a Social Securily
<br />Card, from your lccal SSA oflice oir get lhiblonn onling,{ --- -
<br />wwrr.SSAiov. You rnay aiso g*t this fom by calling- aA$.-772'12'13' U*
<br />Form W-2.-Application ior lFlS lndividral Taxpayr ld'€fllilicalbn
<br />NumUer, to jfply lot * tTlN. or Forrn SS+' Apdicatrun-for Ernployer
<br />idenmcailon'Fiuinber, to apfly {or an EllH- Yau ran apply for an El}l
<br />online by accessing the IRS weteite atwutw.ks.pvlElN'fu1o.
<br />iww.i{govlF$4; to view. download, or print Form lV-7 utdltx Form
<br />s+i. *l yo, t"n go to ururw-irs ga vl0tddrtorms lo-flace an ordet and
<br />have Form 9rt-l andrbr Forrn SS-'l nnited to you within 1 5 business
<br />days.
<br />lf wu ate asked to tomplete Form tSJ-g but do nqt hae€ a TlN, apply
<br />ior Jlru and enler ''Applied For' in t!-e space lortfreTlltl' sign.and date
<br />the form, and girc ri t6 'tfrs r*quester- For interel afid dMdend
<br />oavrnents. ani certain payments rnde fidth respect to readily &adable
<br />initruments, you wili generally ha!'e 60 days ts ger a TIN- and give it to
<br />lhe reouestei before you are sublecl lo bachup rvithholding-on
<br />oivm#ts. The go-ddv nJe does not spdy to olher tpes ol papt:r"nls'
<br />?oi: will be subiect to backup witiholcfinq an a![ such payments unlil
<br />you provide 1'our Tl$t tc the requester"
<br />Note: Entering "Applied For- means tfrat ynu hat'eelready agg.liedlor a
<br />fif,f - tnat vd indenO to appl1, for one sor:n .See dso Establishing U-5.
<br />ririr" io."irr*ies at cnabiei s arrd chaptet l wid*lr:,lding' eallier'fot
<br />*h* Vou't"y instead b€ subiert to (rithholding und{.r chapler 3 ot 4 oI
<br />the Code.
<br />Caution: A disregarded U-S- entiti/ tiat hae a loreign ol'rner must use
<br />the +propriale Form W-8,
<br />S corporations must not enter an
<br />exempt payee code because theY
<br />are exempt only for sales of
<br />noncovered securities acquired
<br />. Barter
<br />and
<br />. Payments over $600 required to
<br />be reported and direct sales over
<br />to 2012.
<br />transacliong Exempt payees .l through 4.
<br />Generally, exempi payees
<br />1 through 5.?
<br />$s,ooo'
<br />. Payments made in settlement of Exempt payec-s 1 thraugh 4.
<br />paym€nt card or third-partY
<br />n€trvork transactions
<br />l See Form 1099-MISC. Miscellaneous Information, and its instructions'
<br />2 However. the followinq Davments made to a ccrporation and
<br />reoortable'on Form 109-9-MISC are not exempt from backup
<br />*uilhholding, medical and heallh care paymenls, attgrneys'fees" gross
<br />groceeds 6"id to an attomey raportable under section 6oa5{fl. and
<br />payments {or services pard by a federal executive agency
<br />Exemption from FATCA repcrting code..The follolvilg code6 idenlify
<br />p"vr"'" th"t are exempt from reporting under FATCA These codes
<br />Loolv to peoon" submitting thii form lor accotints maintained outside
<br />oFinl Uriit"o States by cei'ain loreign financial instituttons' Therelore, i{
<br />vrJ.rJ o"iv submittinb this form f,rian accounl you hold in the Unitecl
<br />btates, yorr may leave this field blank. Consult with lhe person
<br />."qu."ting thisiorm if you are uncertain if the financial institution is
<br />sublect to"these requirlments. A requester may indicate lhat a. code ie
<br />not'reouired bv orovidinq vou with aForm W-9 rvith "Not Applicable" ior
<br />anv eiirir"r inoi"ition) en"tdred on the line for a FATCA exemption code'
<br />A-An organization exempt from tax under section 501(a) or any
<br />incfividual relirement plan as delined in section 77O1(a1l37l'
<br />B-The United States or any of its agencies or inetrumentalities'
<br />C-A etate, the Disuict of Columbia, a U-S- commonwealth or
<br />tenitory. or any of lheir political subdivisions or instrumentalities'
<br />D-A corporation lhe stock of which is regularly traded on one or
<br />more estabiished gecurities markets, as described in Flegulations
<br />section 1 .1 a72-1 {c){1 }(i).
<br />E-A corporation that is a nrember of the sarne expanded affiliated
<br />group as a cotporation describecl in Regulations section 1 1472-1{cX1)[d-
<br />Kittitas County Agreement for Services (rev.5/7a/251
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