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Form W-9 (Flev.3-2024i Page5
<br />Part lL 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 l, 4, or 5 below indicates otherwise
<br />For a joint account, only the person whose TIN is shown in Part I
<br />should sign (when required). ln lhe case'o1a disregarded entity, lhe
<br />person identified on line 1 must sign. Exempt payees, see Exempt payee
<br />code, earlier,
<br />Signature requirements. Complete lhe certification as indicated in
<br />itemsl throughsbelow.
<br />1 . lnlerest, dividend, and barter exchange accounts opened
<br />before 1 984 and broker accounts considered ac{ive during 1 983.
<br />You must give your correct TlN, but you do not have lo sign the
<br />cerlifiication.
<br />2 . lnterest, dividend, broker, and bartel exchange accounts
<br />opened,after 1983 and broker accounts considered inactiive during
<br />1983. You must sign the certification or backup withholding will apply lf
<br />you are subiecl 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 transac{ions. You must sign lhe certification. You may
<br />cross oul iiem 2 of the certification.
<br />I . -Other payments. You mus! give your correct TlN, 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 : including payments to corporations). payments to
<br />a nonemployee for seNices, payments made in setdement 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 />attomeys (including payments to corporations).
<br />5. Mortgage interest paid by you, acquisition or abandonment of
<br />secured property, cancellation of debl, qualified tuition program
<br />payments (under sectlion 529), ABLEaccounts (under section,529A),
<br />lRA, Coverdell ESA, Archer MSA or HS.A contributions or
<br />distributions, and pension distributions. You must give your correct
<br />TlN, but you do not have to sign the certification.
<br />For this of account:Give name and SSN ot
<br />8. Disregarded entity not omed by an
<br />individual
<br />9- A valid trust, eslale, or pension trust
<br />1 0. CDrporation Dr LLC electing corporate
<br />status on Form 8832 or Fotm 2553
<br />1 1. Associ:otion, dub, religious. charfable,
<br />edu€tional, or othet tax-exem,Pt
<br />Drganizalion
<br />12. Partnership or multi-membedLc
<br />1 3. A broker or regislered nomine€
<br />l4.Acoountwith the Oepadmenl of
<br />Agriillture ifl lhe name of a Public
<br />entity (such as a stale or loml
<br />government, school districi. or prison)
<br />that receives agriculitu ral program
<br />payments
<br />15. Granlortrusllilingiform 1041 or
<br />under the OptionalFiling Malhod 2.
<br />requiring,Form 1 099 (see Regulations
<br />section 1.67,41 jb)t2XiXB)).'
<br />For this of acount:Give name encl FIN of
<br />Tho oMer
<br />Legal slity.
<br />Thesrporation
<br />The organizmion
<br />The parlnsship
<br />The broker-or nmin€
<br />Tho publ ic entiiy
<br />'1. hdividual
<br />2. Twoormore individuals i:oim account)
<br />other than an amunt maintained bY
<br />an FR
<br />3. Two or more U.S. peFons
<br />noinl account maintained by an RR)
<br />4, Custodial account of a minor
<br />(U"iform Gift lo Minors Acti
<br />5. a, The usualrevocabl'e savings trust
<br />{grantor is also trustee)
<br />b, So-called lrust account that is ncd
<br />{ legal or valid trust under state le
<br />6, Sole proprietorship or disregarded
<br />entity owned by an individual
<br />7, Granlor trust filing under Optional
<br />Filing Method 1 (see Flegulations
<br />section 1671 4{bi12Xi)[A))-
<br />Ths individual
<br />The actual owner of the account or,
<br />if combined iunds, the fast individual:
<br />on ihe a€oun1 I
<br />E.-dt, holder ol the amunt
<br />The minorz
<br />The grantor-trustee
<br />The actual ownerl
<br />The ownea'
<br />The grantor,
<br />Thetrust
<br />l List first and circle lhe name of the person whose number you rumlsh.
<br />lf only one person on ajoint 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 enteryour business
<br />or OBA name, if any,.on line 2. You may use either your SSN or EIN i-lf
<br />you have one), but the IRS encourages you to use your SSN-
<br />List first and circle lhe name of lhe trust, esiate, or pension trust. jDo
<br />nol furnish the TIN of the personal representative or trustee unless the
<br />legal entity itselt is not designated in the account title.)
<br />. Note: The gran,tor must also provide a Form W-9 to lhe trustee of the
<br />trust.
<br />.. For more !nformation on optional fiiling methods for grantor trusts, see
<br />the lnstructions for Form t041.
<br />Note: lt no name is circled when more than one name is Iisted' the
<br />number will be considered !o be that of the first name listed'
<br />Secure Your Tax Records From ldentity lheft
<br />ldentity lheft occurs when someone uses your personal information,
<br />such as your name, SSN, or other identifying information, without your
<br />permission to commit fraud oroth er crimes. An identity thief may use
<br />yourSSN to get a job or may file a tax retum using your SSN lo receive
<br />a refund.
<br />To reduce your risk:
<br />. ProtectyourSSN,
<br />. Ensure your employer is protecting your SSN, and
<br />. Be careful when choosing a tax return pleparer.
<br />lf your tax records are affected by identity theft and you receive a
<br />notice from the lRS, respond right. away to the name and phone number
<br />printed on the IRS nolice or letter..
<br />lf your lax r€cords are not currently atfected 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 reporl, contact the IRS
<br />ldentity Theft.Hotline al 800-908-4490 or submit form 14039.
<br />For more information, see Pub. 5027. ldentity Theft lnformation for
<br />Taxpayers.
<br />Kittitas County Agreement for Services (rev. 5/L4/251
<br />PageLT of t9
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