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Kittitas County Agreement for Services (rev. 5/14/25)
<br />Page 17 of 19
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<br />Form W-9 (Flev. 3-2024) Page5
<br />Part IL Certification
<br />To establish to the withholding agenl that you are a U.S. person, or
<br />resident alien, sign Form W-9. You may be requested lo sign by the
<br />withholding agent even if item 1, 4, or 5 below indicates otherwise.
<br />For a joint account, only the person whose TIN is shown in Part I
<br />shouId sign (when required). In !he case·01a disregarded entity, lhe
<br />person identified on line 1 must sign. Exempt payees, see Exempt payee
<br />code, earlier,
<br />Signature requirements. Complete !he certification as indicated in
<br />items 1 through 5 below.
<br />1. . Interest, dividend, and barter exchange accounts opened
<br />before 1984 and broker accounts considered active during 1983.
<br />You must give your correct TIN, but you do not have lo sign the
<br />cerlifiication.
<br />2. . Interest, dividend, broker, and barter exchange accounts
<br />openedlafter 1983 and broker accounts considered inactiive during
<br />1983. You must sign the certification or backup withholding will apply. If
<br />you are subject to backup withholding and you are merely providing
<br />your correct TIN to the requester, you must cross out item 2 in the
<br />cerlifiioation before signing the lorm.
<br />3. . Real estate transactions. You must sign lhe certification. You may
<br />cross oul item 2 of the certification.
<br />4. . -Other payments. You mus! give your correct TIN, but you do not
<br />hav,e to sign the cerlilicalion unless you have been notified that you
<br />have previously given an incorrect TIN. "Other payments" include
<br />payments made in the course o:f the requester's trade or business for
<br />rents, royalties, goods (other than bills for merchandise), medical and
<br />health care services �ncluding payments to corporations), payments to
<br />a nonemployee for services,.payments made in settlement of payment
<br />card and third-party network transactions, payments lo certain fishing
<br />boat crew members and fishermen, and gross prooeeds paid to
<br />attorneys (including payments to corporations).
<br />5. . Mortgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debt, qualified tuition program
<br />payments (under sect1ion 529), ABLE accounts (under section,529A),
<br />IRA, Coverdell ESA, Archer MSA or HS.A contributions or
<br />distributions, and pension distributions. You must give your correct
<br />TIN, but you do not have to sign the certification.
<br />What Name and Number To Give the Requester
<br />For this type of account: Give name and SSN of:
<br />1. Individual The individual
<br />2. Two or more individuals ij;oim account)
<br />other than an account maintained by
<br />an FR
<br />The actual owner of the account or,
<br />if combined funds, the fast individual!
<br />on the accoun11
<br />3. Two or more U.S. persons
<br />noinl account maintained by an RR)
<br />E,,_dl, holder ol the account
<br />4. Custodial account of a minor
<br />(U"iform Gift lo Minors Act)
<br />The minor2
<br />5, a, The usual revocabl'e savings trust
<br />(grantor is also trustee)
<br />The grantor-trustee
<br />b, So-called lrust account that is not
<br />a legal or valid trust under state law
<br />The actual owner1
<br />6, Sole proprietorship or disregarded
<br />entity owned by an individual
<br />The owner"
<br />7, Granlor trust filing under Optional
<br />Filing Method 1 (see Flegulations
<br />section l671-4{b)l2)(i)[A))~
<br />The grantor•
<br />
<br />
<br />For this type of account: Give name and EIN of:
<br />
<br />8. Disregarded entity not owned by an The owner
<br />individual
<br />9. A valid trust, estate, or pension trust Legal entity•
<br />10. CDrporation Dr LLC electing corporate The corporation
<br />status on Form 8832 or Form 2553
<br />11. Associ:otion, dub, religious, charfable, The organizmion
<br />educational, or other tax-exem,pt
<br />Drganizalion
<br />12. Partnership or multi-memberlLC The partnership
<br />13. A broker or registered nominee The broker-or nominee
<br />14. Acoount with the Oeparlmenl of The publ'ic entity
<br />Agriculture in the name of a public
<br />entity (such as a state or local
<br />government, school districi1 or prison)
<br />that receives agriculitu ral program
<br />payments
<br />15. Granlortruslliling1form 1041 or The trust
<br />under the Optional Filing Method 2,
<br />requiring,Form 1099 (see Regulations
<br />section 1.67,41jb){2)(i)(B))*'
<br />
<br />1 List first and circle !he name of the person whose number you rumish.
<br />If only one person on a joint aocount has an SSNI, that person's number
<br />must be furnished.
<br />'Circle lhe minor"s name and furnish the minor's SSNI.
<br />3You must show your individual name on line 1, and enter your business
<br />or OBA name, if any,.on line .2. You may use either your SSN or EIN �f
<br />you have one), but the IRS encourages you to use your SSN.
<br />• List first and circle !he name of lhe trust, estate, or pension trust. jDo
<br />nol furnish the TIN of the personal representative or trustee unless the
<br />legal entity itself is not designated in the account title.)
<br />• Note: The gran,tor must also provide a Form W-9 to the trustee of the
<br />trust.
<br />.. For more information on optional fiiling methods for grantor trusts, see
<br />the Instructions for Form 1041.
<br />Note: If no name is circled when more than one name is listed, the
<br />number will be considered to be that of the first name listed.
<br />Secure Your Tax Records From Identity lheft
<br />Identity !heft occurs when someone uses your personal information,
<br />such as your name, SSN, or other identifying information, without your
<br />permission to commit fraud or0th.er crimes. An identity thief may use
<br />your SSN to get a job or may file a tax retum using your SSN lo receive
<br />a refund.
<br />To reduce your risk:
<br />• Protect your SSN,
<br />• Ensure your employer is protecting your SSN, and
<br />• Be careful when choosing a tax return preparer.
<br />If your tax records are affected by identity theft and you receive a
<br />notice from the IRS, respond right. away to the name and phone number
<br />printed on the IRS nolice or letter..
<br />If your tax records are not currently affected by identity theft but you
<br />think you are at risk due to a lost or stolen purse or wallet, questionable
<br />credit card activity, or a questionable credit report, contact the IRS
<br />Identity Theft.Hotline at 800-908-4490 or submit form 14039.
<br />For more information, see Pub. 5027, Identity Theft Information for
<br />Taxpayers.
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