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Form Wg {elev.3-2024i Page3
<br />Certain payees and payments are exemptfrom backup withholding.
<br />See Exempf payeecode, lat€r, and the separale lnstructions for the
<br />Requester of Form W-9 for more information.
<br />See also lsfabllshlng U. S. status for puryoses of chapter 3 and
<br />chapter 4 withholding. earlter.
<br />What ls FATCA Reporting?
<br />The Foreign Account Tax Compliance Act {FATCA) requires a
<br />participating foreign financial institution to report all U.S. aooount
<br />holders that are specified U.S. persons. Certain payees are exempt from
<br />FATCA reporting. See Exemption from FATCA reporting code, later, and
<br />the lnstructions for the Requester of Form W-9 for more information.
<br />Updating Your lnformation
<br />You must provide updated information lo any person to whom you
<br />claimed lo be an exempt payee lf you are no longer an exempt payee
<br />and anticipate receiving reportable payments in tlle future from this
<br />person. For example, you may need to provide updated information if
<br />you are a C corporation that elects to be an S corporation, or if you are
<br />no longer tax exempt. ln addition, you must furnish a new Form W-9 if
<br />the name or TIN changes for the account, for example, if the granlor of a
<br />grantor trusl dies.
<br />Penalties
<br />Failure lo furnish TlN. li you fail to furnish your correct TIN to a
<br />requester, you are subject to a penalty of $50 for each such failure
<br />unless yourfailure is due to reasonable cause and notto willful neglect.
<br />Civil penalty for false information with respect to withholding. lf you
<br />make a false statement with no reasonable basis tllat results in no
<br />backup withholding, you are subject to a $500 penalty.
<br />Criminal penalty tor falsifying information. Willfully falsifying
<br />certifications or affirmations may subject you to criminal penalties
<br />including fines and/or imprisonment.
<br />Misuse of TlNs. lf tlle requester discloses or uses TlNs in violation of
<br />federal law, the requester may be subject to civiland criminal penalties.
<br />Speciific lnstructions
<br />Line 1
<br />You mustenter one of the following on this line; do not leave this line
<br />blank. The name should match the name on your tax return.
<br />lf this Form W-9 is for a Joint account (other than an account
<br />maintained by a foreign financial institution (FFQ), list first, and then
<br />circle, lhe name of the peason or entity whose number you entered in
<br />Part I of form W-9. lf you are providing Form W-9to an FFlto document
<br />a joint aocount, each holder of the account lhal is a U.S. person must
<br />provide a Forrn W-9.
<br />,lndividual-Generally, enter the name shown on your tax retum. lf you
<br />have changed your last name witlout informing the Social Security
<br />Administration (SSAI of the name change, enter your l iirst name, the last
<br />name as shown on your social security catd, and your new las! name.
<br />Note for lTlN applicant: Enter your individual name as it was entered
<br />on your Form W-7 application, line 1a. This should also be the same as
<br />the name you entered on the Form 104!0 you filed with your application.
<br />. Sole proprietor. Enter your individual name as shown on your Fbrm
<br />1O4O on line 1. bnleryourbusiness, trade. or"doing business as" (OBA)
<br />name on line 2.
<br />. Partnership, C corporation, S oorporatfon, or LLC., otherthan,a
<br />dlisregarded entity. Enter the entily's name as shown on the entiiy's lax
<br />relum on line 1 and any business, trade, or DBA name on line 2
<br />. Other entities. Enteryour name as stiown on required U.S. federal tax
<br />documents on line 1. This name should match tlle name shown on the
<br />charteror other legal document creaiing ihe entity- Enter any business'
<br />trade ,.or DBA name on line 2.
<br />. Disregarded entity. ln general, a business entity that has a single
<br />owner, including an LLC, and is not a corporation, is disregarded as an
<br />entity separate from rts owner (a disregarded entity). See Regulalions
<br />section 301.7701-2(cX2). A disregarded enlily should check the
<br />appropriate box iorthe tax classification ol its owner. Enter the owner's
<br />name on line 1, The name,of the owner entered on line 1 shou'ld never
<br />be a disregarded entity. The name on line 1 should be lhe name shown
<br />on tlle inoome lax return on which the income should be reported. for
<br />Kittitas County Agreement for Services (rev. 5/L4/251
<br />Page 15 of 19
<br />example, if a foreign LLC that is treated as a disregarded entity for U.S.
<br />federal tax purposes has a single owner lha! is a U.S. person, the U S.
<br />ownels name is required to be provided on line 'l- If lh e direct owner of
<br />the enlity is also s disregarded entity, enter the first owner tllat is not
<br />disregarded for federal tax purposes. Enter the,disregarded entity's
<br />name on line 2. lf lh,e oAivner of the disregarded enlity is a foreign percon,
<br />Itl e owner must complete an appropriate Form W-8 instead of a Form
<br />W-9. This is the case even if the foreign person has a U.S TlN.
<br />Line 2
<br />lf you have a business name, trade name, DBA name. or disregarded
<br />entity name, enter ii on line 2.
<br />Line 3a
<br />Check the appropriate box on line 3a forthe.U.S. lederal tax
<br />classilication of the person whose name is entered on line 1. Check only
<br />one box on line 3a.
<br />Line 3b
<br />Check this box if you are a partnership r rncluding an LLC classified as a
<br />partnership for U.S. federal tax purposes), lrust, o. estale that has any
<br />foreign partners, owners, or beneficiaries, and you are providing this
<br />form to a partnership, irust, or eslaile. in which you have an,ownership
<br />interest. You mlrst check the.box on line,3b if you receive a Form W-8
<br />(or dooumenlary evidencel from any partner, owner' or beneflciary
<br />establishing foreign status or if you receive a Forrn W-9 from any
<br />partner, owner, or beneficiary lhat has checked lhe box on llne 3b.
<br />Note: A partnership lha! provides a Forrn \M9 and checks box 3b may
<br />be required to complete Schedules K-2 and i<-3 (Form 1 065). For more
<br />information,.see the Pa.tnership lnstructions for Schedules K-2 and K-3
<br />(Form 1065).
<br />lf you are required to complete line 3b but fail lo do so, you may not
<br />receive the intoamation necessary to lile a oorreci information relum with
<br />It1 e IRS or furnish a correct payee statement to your partners or
<br />beneficiaries. See, for example, sections 6698, 6722, and 6724 fo(
<br />penalties that may aPPIY-
<br />Line 4 Exemptions
<br />lf you are exempt lrom backup wi;lhholding and/or FATCA reporting,
<br />enter in the appropriate space on line 4 any code(s) that may apply to
<br />you.
<br />Exempt payee code.
<br />. Generally, individuals (including sole proprietors) are noi exempt from
<br />backup withholding.
<br />. Except as provided below, corporations are,exempt from baokup
<br />withholding for certain payments, including interesl and dividends.
<br />. Corporations are no! exempt from backup withholding for payments
<br />made in settlement of paymenl card or third-party network lransaooons.
<br />. Corporations are nol exempt from backup withholding with respect to
<br />attorneys' fees or gross proceeds paid to attorneys. and oorporationg
<br />that provide medical or health care services are not exempt witll respect
<br />to payments reportable on Form 1099-M|SC.
<br />The following codes identify payees thal are exempt from backup
<br />withholding. Enter the appropriate code in the space on line.4.
<br />1- An organizaiion exempt from tax under section 501(a)' any IRA' or
<br />a custodial account under section 403(bX7) if !he account satisfies the
<br />requirements o.f section 401 (0(2).
<br />lF the entitylindi:vidualon line 1
<br />isaln) ...
<br />THEN check the box for,...
<br />Corporation Corporation-
<br />r lndividual or
<br />. Sole proprietorship
<br />lndividuallsole proprietor.
<br />LL\/ qas$nQ a5 a pat u lctsl xP
<br />f o r U.S..federal tax purposes or
<br />. LLGtha! hasfiled Forrn 8832 or
<br />2553 electing to be taxed as a
<br />corporation
<br />Limited liability company and
<br />enter the appropriate tax
<br />classification:
<br />P = Partnership,
<br />C=Ccorporation,or
<br />S = S corporation.
<br />Partnership Partnership.
<br />Trusvesiate Truslleslate.
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