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pase 4 <br />Form t4t'9 (Rev. 3-:'lcr24) <br />above, 1 13. <br />lF the paYmenl is for <br />. lnterest and dividend PaYments <br />. Barter exchangP <br />and <br />p.ior to 2012. <br />lransactions Exempt payees 1 through 4' <br />dividends <br />lHEll the payment is exemPt <br />tot ., . <br />All exempt PaYEes except <br />for 7. <br />Generally, exempt Payees <br />1 firough 5.'z <br />of Exempt payees 1 through 4. <br />2-The Uniled Stales o. any 6l ils agencies or inslrumenlaliti€$' <br />3-A state, the Oisttict of Cofumbia a U'S' comm.orwealth or tenitory <br />oiany of their political subdivisions or insuumenlalities' <br />4-A foreign govemment or any of its pol-rtical suMivisions' agencies' <br />or instumentalilies' <br />5-A corporation. <br />6-A dealer in securilies or commodrlies required to register in the <br />u-"it"i Siti*t, the Distict of Columbia' or a U'S' commonwealth or <br />tenitory. <br />7 -A {t tures commission merchant registered wilh the Comtnodity <br />Futures Trading Commission- <br />8--A real estaG investment tust. <br />g -An gntity registered €t all fimes during the lax year undar the <br />lnvestment C'omPanY Act of t9'lO <br />1o-A common ttust fund op€rated by a bank under section 584(a)' <br />1 1 *A financial institution as delined under s€clion 541' <br />12-A middleman known in lhe investrnent community as a nominee or <br />cusiodian, <br />13-A trust exempt ftom tax under section 664 or described in section <br />4947. <br />ThE lollovrina chart 3holvs lypes of paymsnts lhat ntay be exempt <br />rr"t"i..r.rp ,it'noic,ng. nu'in"d aipiies to ihe exempt payees listed <br />F - A deaiet rn secunlies. comrnoditles' or derivatrv€ financral. <br />i"ttru*i'ni' inciudinq nodonal principar contracts' fu lures' toflt ards' <br />;;;ft;il;;i,s .{is re'ea as such und:r the la\rs of lhe united <br />Slate$ or sny state. <br />G-A real €staie ttl$*sltfleni trust- <br />t { -.A rmulated rnve€lment compsny as d+fined in 3€clion 851 ot an <br />"^ii v og'Jri*J it all trm?s dunng tha rdx year under the Investment <br />Company Act of 1940. <br />l-A common Uust fund as defined in s€clron 584(a)' <br />J-A bank as defined in section 581 ' <br />K-A broker. <br />L-A tust exempt lrom tax undersecfon 5€4 or described in section <br />aeaT(a)(1). <br />M -A tax-exempt trust und6r a section 403(b) plan or secdon 457(9) <br />plan, <br />Note:Youmaylvishtoaccsultwtththefinancialinslitulionr€qre{lrng <br />irli*iorrn io Aufn*ine vrhelher the FATCA esde and/or ex€mp! payea <br />code should be completed- <br />Line 5 <br />Fntpr vour address lnrrrnber' str€el. and apartment or suita number|' <br />;il;;J;;;;;;i"oGi "r this Form lAi'e vrrll mail vourinfomation <br />iii'rir".]iini, Iioois aitt"o fronr rhe sne rhe requesler atready has.on <br />;j;:"i"; ;iiiw;itt" t"p- lf a new addrss is provided' there is sdll a <br />"iiiol rir* oia aadress wilt be used unbl the payor changes your <br />address in {heir records. <br />Line 6 <br />Enter your city, slste' and ZP code' <br />Part l. Taxpayer ldentification Number (TlN) <br />Entgr vour TIN in the appropnate box' ll you are.a 'esidenl alien and <br />;;;l;J;;i it""u. *a are not'etgbte to get' an SSN' vour TIN is vour <br />ilid ilt'i;;i;;li ; in- *rw spJce ior tie social securitv nrrmber' lf vou <br />do not have an fflN, see How to get aTlNbdow' <br />lf you are a sole prcprietor and you have an EIN' you may enter either <br />your SSN or ElN. <br />lf vnr, ere a srnol*memb€r LLC that rs drsregarded as 'm <br />gnlity <br />.";#i" ;;; n.iiunti. *ntet ths ovrne''s SSN (or EIN' if lhe o*ner has <br />;ffi i' fi <br />'il ii& "r;;;iia'; ; <br />"arpsration <br />or partnershrp' €nt€r lhe <br />entity's ElN. <br />Note: Se€ Wha{ lr/arre and rYuftb€r <br />'o <br />GtvE ffe Reqrresfer' latet for <br />furlher clarification ol name and TIN combinallons' <br />I'low lo {Iel a Tlil- ll vou do not hav+ a nf't. appty fo' one rm-mediately' <br />;;;;;1"'6 ;" bsll. ier Form ss-5. Apprcation ror a soctal secunly <br />cit-d?ti'* yort local -SSA office or gel lht$ lorm onl'ne at <br />paav .S-$A-oov. You mav also qei lh;s fotm by €lliflg 600, 7?2- 1213' Uss <br />i'-- iI-; I"ori""tion ior IRS-lndividual Ta:<payer ldentifcation <br />i"ilL;;.',; J#i;ioi nn nrnr. or Form SS-'t hp'plcat'o n- to.r Em plov*r <br />il;;ircat;;iffi;r. to applv bran EIN' You can apptv foran EIN <br />"].lr^" <br />[u "l"i*"ing <br />rh€ lRb'v;bsile al tYivrr'ts govl61v" Go lo <br />;;#;.,;l;;;F;;'o vle'e ao*ntoao' ot pnn! F;rm w'7 and'/or Form <br />SS-J- or. vou can qo io ? nv.,i $i5detForms to place an order utd <br />t oua Form W-z anl/or Form SS'l mailed to you vnlhu'l l 5 buslness <br />days. <br />lf vou are asked !o compl'Bts Form W-9 bo! do not hsve 3 Tlftl' apply <br />f";'.'i;N;;;;;i;';aoplfo For rn {he space lor th*.Ilsl' sign and date <br />il;;e.#,;; qG ir ri'*re recuester' Fbr m!€r€51 and divrdend <br />guvr*ni*, *ti ""r!an <br />paytnene tnade vilh resF+ct ioreadily tradable <br />;:i;;;;;;ilil;n si"e'.tv have 60 davs to ser.a rll'l.a'td sive n rc' <br />the requestJb€fo re l')u ue zub1ecl to backuo \{lhimldrng on <br />,i* *"-ir-.. itt* oo'ia'v tule does hot apply io oth+t types ol paymentsHv;;;;;t;";;i;tio'uacttup wrnnolirngi on atl euch pa'/manrs unril <br />you provide your TIN to the tequester' <br />Note: Enlenno "Applie<l For" means lhal you havc alr+ady appfued for a <br />i,;i;;;il;;;"" int!-nJro "ppfu <br />for one goon s4€ alsoEsrtbtshns u's <br />;il'l;;#;r,p#; ii "tiF,iii e-ia chapat rvtithhotdrns' +artier rot <br />il;;;;;;"i;r*ac u"'sull*cr to \urthholdrng uncnr chapter 3 or 'l of <br />the Code. <br />Caution: A disregarded U.S. entity ttrat has a foreign owner must use <br />the approPtiale Form W€- <br />. Faymenls <br />be reported <br />over $600 requi.ed to <br />and direct sales o!'er <br />. Payrnents made in settlement <br />payment card ot.lhrtd-perty <br />nehroti( lrarrsacllons <br />1 See Form 1099-M|SC, Miscellaneous lnformation, and itis instructions. <br />I Hovrever. lho follosiing payments mad+ to a corporation and <br />reoorlable on Form 1099-&tlSC ate nol ex+mpl lronr Dackup <br />rrfifrft Jai" g, medical afl d heallh care. psyme.nts, etlome ys'.le.es' g ross <br />oroceeds data to an aflomey rePonable under s*ction 60'r5(f)' and <br />payments-{or services paid by a federal executive sqency' <br />Frenrolioc fronr FATCA reporting code' The follorving codes id*lrlify <br />;;;;;! lh"l ;;xempt ftom reportrng under FATCA' Th"-se codes <br />5;il;#;;;; iuom'n;ng thii formJor accounts maintained oulside <br />;iiil U;A-Si;r"" uv &ti"i^ forcisn financial institutions' Therefore' if <br />J"r rr""onfu ti,t*,nin'q th,. lorm (o/an account you hold in the Unrted <br />3irt".. vor't"y reauelhis lreld blank Consult vith lhe p€rson <br />,*rlin'no this lorm il you ate uncedain if lhe frnancial rnstiluton ts <br />."ii*iio"ritut" teQurrements. A request€r may rndicals lhat a code is <br />il;l*q"; Ly proiioing vo, vith aForm w-o vrrtn 'tlot Appiicable'' (or <br />;;;;;i;;;;iliion1 en-tdtea on the 'ine <br />for a FATCA exempuon code <br />A-An otaanEation ex+firpt {torn iax unde{ section 501 (al of any <br />rndividual t"iit"tent plan as defined In seclon Tiol{a)(37}' <br />8-The United Slales or any of its agenciee or insfumentalities <br />C-A state, the Disfict of Columbia. a U'S' commonwealth or <br />t"nitory, or any of their political subdivisions or inslrumentalrtes' <br />D - A corparation lhe slock ol \rhrch Is regtrlalty kaded on-one or <br />mJre estabiished securitres rnarkets' as descobed in ResUlations <br />section 1.1 472-1(cl(1)0. <br />F -A comration that !s a rr,ernber of the same expande<J affilialed <br />gt;p';;;;;tp.iation descnued in Regu'ations sectran 1'r'!-/2-1 {c}(l)('} <br />Kittitas County Agreement for Services (rev' 5/!4/25) <br />Page 15 of 19