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Form $l-9 (Rev. 3-20241 Pase 3
<br />Certain payees and payments are €x€mpt from backup withholding.
<br />See Exempt pyee cods, later, and the separate lnslructions tor lhe
<br />Requester of Form W-9 for more information.
<br />See also Establishing U.S. slatus /orpurposes of chaPtar 3 and
<br />chapter 4 withhdding, earliar.
<br />What ls FATCA Reporting?
<br />The Foreign Account Tax Compliance Act (FATCA) requires a
<br />participaiing foreign financial institution lo rsport all U.S. accounl
<br />holders lhat are specified U.S. p6tsons. C€rtain paye€s are exsmpt from
<br />FATCA reporting. See Exemption from FATCA repading cade,later, and
<br />the lnstructions for the Requester of Form W-9 for more inlormalion.
<br />Updating Your lnformation
<br />You must provide updated information to any person to whom you
<br />claimed to be an exempt payee if you are no longer an exempt pays€
<br />and anlicipate receiving reportable payments in the future from lhis
<br />person. For example, you may need to provide updated information il
<br />you are a C corporation that elecls to be an S corporalion, or if you are
<br />no longer lax exempi. ln addition, you must fumish a new Form W-9 if
<br />the name or TIN changes for the acrount, for example, if lhe grantor of a
<br />grantor trust dies.
<br />Penalties
<br />Failure to fumish TlN. lf you fail to furnish your conect TIN to a
<br />r€quester. you are subiect to a penally of $50 for each such failure
<br />unless your failure is due to reasonable cause and not to willful neglect-
<br />Civil penalty lor false information with respect to withholding. lf you
<br />make a false slatement with no reasonable basis that resuhs in no
<br />backup withholding, you are subject to a $500 penalty.
<br />Criminal penahy for falsilying inlormation. Willfully talsifuing
<br />certilications or affirmations may subiect you to criminal penatties
<br />including fines and/or imprisonment.
<br />Misuse of TlNs. lf the requester discloses or uses TlNs in violatbn of
<br />federal law, lhe requester may be subject to civil and criminal penalties.
<br />Specific lnstructions
<br />Line I
<br />You must enter one of the following on this line; do not leave lhis line
<br />blank. The name should match the nam€ on your lax retum.
<br />lf this Form W-9 is for a ioint account (othsr than an account
<br />maintained by a foreign financial inslitution (FFl)), list fint, and then
<br />circle, the name ol the person or entity whose number you antered in
<br />Part I of Form W-9. lf you are providing Form W-9 to an FFI to docunrent
<br />a ioint account, each holder of the account that is a U.S. p€Gon must
<br />provide a Form Vt/-9.
<br />. lndividual. Generally, enter the name shown on your tax return. lf you
<br />have changed your last name withotd informing lhe Social Security
<br />Adminislration (SSA) of the name change. enter your first name, the last
<br />name as shown on your social security card, and your new last name.
<br />Note for lTll.l applicant: Enter your individual name as il was entered
<br />on your Form W-7 application, line 1a. This should also be ths 3ame as
<br />lhe name you entered on the Form 104o you filed wilh your application"
<br />. Sole proprielor, Enter your individual name as shown on your Form
<br />1040 on line '1. Enter your business, trade, or "doing businees as" (DBA)
<br />name on line 2.
<br />. Pannership, C corporation, S corporation, or LLG, oiher than a
<br />disregardod ontity. Enter the €ntity's name as shown on the entity's tax
<br />retum on line 'l and any business, trade, or DBA name on line 2.
<br />r Other entilies. Enter your name as shown on required U.S. federal tax
<br />documsnts on line 1. This name should match ths name shown on the
<br />charter or other l€gal documsnt croating the €ntity. Enter any business.
<br />trade, or DBA name on line 2.
<br />r Disregarded entity. ln general, a business entity that hae a singla
<br />owner, including an LLC, and is not a co.poralion, is disregarded as an
<br />entity separate from ils owner (a disregarded entity). See Regulations
<br />sectibn 301 .7701 -2(cX2). A disregarded enlity should check the
<br />appropriate box tor the tax classification ol ilg owner. Enter ths ownetrs
<br />neme on line t. The name of lhe owner entered on line 1 should never
<br />be a disregarded entity. The name on line 1 should be the name shown
<br />on the income tax retum on which lhe income should be reported. For
<br />Kittitas County Agreement for Services (rev.5/14/251
<br />Page 15 of 20
<br />example, if a foreign LLG that is t€ated as a diwegarded entity for U.S.
<br />federil tax purposes has a aingle owner that is a U.S. person, the U.S.
<br />owner's nam€ is required to be provided on line 1. lf the direcl owner ol
<br />the enlity is also a disr€garded entity, entsr the tirst owne. that is not
<br />disregarded for lederal tax pu.poses. €nter lhe disregarded entity's
<br />nilne on line 2" lf the owner ol the disregarded enlity is a foreign person,
<br />the owner must complet€ an appropriate Form W-8 irBtead of a Form
<br />W-9. This is lhe cas€ €ven if the foreign persor has a U.S. TlN.
<br />Line 2
<br />lf you have a businsss name. lrade name, DBA name, or disregarded
<br />entity name, ent€r it on lin6 2.
<br />Line 3a
<br />Check the appropriate box on line 3a for the U.S. lederal tax
<br />classification of the person whose name is enlered on line 1. Check only
<br />cne box on line 3a.
<br />Line 3b
<br />Check this box il you are a partnership {including an LLC classified as a
<br />partrrership for U.S- federal tax purposesl. trust. or estats lhat has any
<br />foreign partners, owners, or beneftciaries, and you are providing this
<br />{orm lo a partnersftip, lrust, or eslale, in which you have an ownership
<br />interest. You must check the box on line 3b il you recelve a Form W-8
<br />{or documentary evidencef from any partner, owner, or benef}ciary
<br />establishing foreign status or it you receive a Form W-9 from any
<br />partsrer. owner, or beneficiary thal has check6d the box on line 3b'
<br />Note: A parlnership that provides a Form W-9 and checks box 3b may
<br />be required lo complelo Schedules K-2 and K-3 {Form 1065}. For more
<br />information, se€ the Partnership lnstruciions for Schedules K-2 and K-3
<br />tForm 10651.
<br />lf you are required to complete line 3b but fail to d-o so, you may not. .
<br />receive the info'rmation necessary to file a correct information refum with
<br />the IRS or fumish a corecl paye€ statement to your partners or
<br />benefrciaries. See, for example, sections 6698, 8722, and6724lor
<br />penalties that may apply.
<br />Line 4 Exemptions
<br />tf you are exempt from backup withholding andlor FATCA reporling,
<br />eniter in the appropriate space on line 4 any code(s) that may apply to
<br />you,
<br />Er€npt payee code.
<br />. Generally, individuals {including sole proprietors) ar€ not €xemPt from
<br />backup withholding.
<br />. Excepl as provided below, corporations are exempl from backup
<br />withholding lor certain payments, including interest and dividends.
<br />. Corporalions are not exempt from backup withholding for payments
<br />made in setdement o{ payment card or third-party network transactions.
<br />r Corporalions are not ex€mpt from backup withholding with respecl to
<br />attomeys'fees or grcs proceeds paid to attomeys, and corporations
<br />that provide medical or health care services are not ex€mpl witb rospoct
<br />to payments reportable on Form 1099-M|SC.
<br />The lollowing codes identify pay€€s that are exempt trom backup
<br />wilhholding. Enter the appropriate code in the spaca on line 4.
<br />'| -An organization axempt from tax undet section 501(a), any lRA, or
<br />a custodial account under section 403(bX7) il the account satisfies the
<br />requir€ments of section ao1{l)(2}.
<br />lF the entity/individual on line I
<br />is a(n) ...
<br />THEN check the box lor
<br />. Co.poration Corporation,
<br />r lndividual or
<br />. Sole proprietotship
<br />lndividual/sole proprietor
<br />o LLC classiti€d as a parlnership
<br />for U.S. federal tax purposes or
<br />r LLC that has filed Form 8832 or
<br />2553 ol€cting lo be taxed as a
<br />corporalion
<br />Limited liability company and
<br />enter the appropriate tax
<br />classificalion:
<br />P = Partnership,
<br />C-Ccorporation,or
<br />S - S corporation.
<br />. Partnership Parlnership.
<br />o Trusvestate Trusuestate"
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