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Form W-s (Rev. a-2m4)
<br />Part If. Certification
<br />'fo establish to the uiUtitofding agent that you area U.S, person, or
<br />restdent alien. sign Form YT•& yOu may ba requested to sign by the
<br />vrilhhofdir:g agent even it ilem 1. 4. or 5 b�3fov1 indicates other% -A",
<br />For a joint account. oftly 010 person %,Agse T1p1 is sho+vn In part I
<br />should sign {when r•7qurred), fn lite case of a disregarded entity, the
<br />parson identifies) on line I must sign. Exempt payees. see &emF: oyez
<br />Cad@, earlier.
<br />Signature requirements. Complete the certification as indicated in
<br />items 1 through 5 below.
<br />1- interest, dividend, and barterexchange accounts opened
<br />hefore 1884 and broker accounts considered active during 1983.
<br />You must give Your correct TIN, but you do not have to sign the
<br />certificatiorL
<br />2. Interest, dividend, broker. and barter exchange accounts
<br />Opened after t993 and broker accounts considered iiiactive during
<br />IS83. You must sign the cellificaflon or backup wilhholding wAI apply. If
<br />YOU ara subject to backup withholding and you are merely providing
<br />your correct VI to 111* requester. you must cross out item 2 in lhr
<br />certificado n before signing the form.
<br />3. Real estate transactions. You must sign the certification. You may
<br />cross out item 2 of the certificadon.
<br />a. Qther payments, YOU must give your corr.?ct TIN, but you do nor
<br />have to sign the :crli<rarion unless you have bean notified It+al you
<br />have previously given an incorrect TIN, 'Other paynlenrs' u1Clude
<br />paymsnts made in the course of the tvquesier's trade or bustness for
<br />rants, royallios, goods (ocher than belts for merchandise), rrt decal and
<br />health :.are seAlces (Pcluding paymenr5 to corpora lions), payments to
<br />a nor;-mplaye0 rrr services, payments made ;n seitlemeni a[ paymsnr
<br />ard and Ilved•party netrrorfl Iransactions. payments to t?rtam 5,1-.1
<br />boat crew members and fisherman. and gross proceeds paid to
<br />attorneys lincludrr:g laayrr4nt5 to corr4ralionq
<br />5, htOAgage inte►esl paid by you, acqulyition or abaurtanment or
<br />secured propart�j, canceltaiton of debt. qualfried tuition 1)rogiam
<br />payments (under section $29), A13LE accounts (under secriorr 529A),
<br />iRA. Coveroelf ESA, Art ILet MSA er HSA contribuZia ns or
<br />distributions, and pension distributions. You must give your coiraci
<br />TIN, but you do not have to sign the ceri6cation.
<br />What Name and (dumber To Give the Requester
<br />For this rypa of account Give name and SSN of.
<br />1. Individual The individual
<br />2. rt,; or more ndividua� h4pat account) The actual owner of the account or,
<br />other than an account maintained by if combined funds, the first individual
<br />n^ FFI on the account'
<br />3. Two or more U.S, pension, Each holder of the account
<br />(joint account maintained by an FFI)
<br />4. Custodial account of a minor The minorz
<br />(Unibrm Gift 10 Miners Ad)
<br />S. a. The usual revocable savings trust The grantor -trustee'
<br />(grantor is also trustee)
<br />b. So-called trust account that is not The actual owner'
<br />a legal or valid trust under state law
<br />6. Sale P10Pncl0t5lcp or disregarded The owneia
<br />anlrly awndd by an iiffiWdual
<br />7- Grylrw tusd firNu under Oplianal The grantor'
<br />Filing Uathod I (sou R"Lilalions
<br />:la]n 1.d71-J0,1X2j,Al)••
<br />Kittitas County Agreement for Services (rev. 5/14/25)
<br />Page 17 of 19
<br />For this type of account
<br />Give name and EIN of:
<br />8. Oi:rtcprd_d _ntity not netted by an
<br />The owner
<br />individual
<br />9. A valid trust; estate, or pension trust
<br />Legal entity'
<br />10. Corporation or LLC c':r,`..ng corporate
<br />The corporation
<br />status an Forth BW at ;cm, 2553
<br />11.A%ociatioo,dub, re69gous,rhwoble,
<br />The organization
<br />cducrtianal, or ather tsr-aenpl
<br />organi=tion
<br />12. Partnership or mWb7nanber LLC
<br />The partnership
<br />13. A broker or regetered nominee
<br />The broker or nominee
<br />14. a._ccunt will the4epartment of
<br />The public entity
<br />Anr;ruth" in the name of a public
<br />entity (such as a state or local
<br />government, schooldrsvict, or pnson)
<br />that r*ceives agdeviturW program
<br />payments
<br />15. Grantor trust afalg Form 10 41 or
<br />The trust
<br />under the 1306 l FXrQ (Keened 2.
<br />iequ nog farm 1099 (.ce Regulations
<br />section 1.671.4(b)(2) iM—
<br />' List first and circle the name of the person whose number you furnish.
<br />If only one person on a joint account has an SSN, that person's number
<br />must be furnished.
<br />'Circle the minor's name and furnish the minor's SSN.
<br />' Yotr must shiny your mdi',riCual name on fine I, and enter your nusiness
<br />or GOA name, if any, on fine 2 You nlay use ellher your SSN or EIN (if
<br />you have aae1, but 111e IFIS encourages you to use your SRI.
<br />`List first and cirtie the narrte of the trust ?srate, or pension trust. (Do
<br />not fumish the TIN of file personal representa Ova or trustee unless the
<br />legal enuly itself is not designated in the aeeount title.)
<br />'Note. The grantor must also provide a Form W-9 to the trustee of the
<br />trust.
<br />"For more information on optional filing methods for grantor busts, see
<br />lha Instructions for Form 1a41.
<br />Note: If no name is cilcied when more than one name is listed, the
<br />number will be considi', a to be that of the first name listed.
<br />Secure Your Tax Records From Identity Theft
<br />U?r•.tr ,- In .2.-. x.;urs vrheo Sosn1 -,; -- :,s=s yrrur Y'rarso,-.ai aiiu m i atfgn,
<br />YIICn as yuttr nam3 Wt. Ar+,N er IQanhtying tnfor..•rtaiion, :lithout your
<br />pemtrssion to _ammit fraud er other cnrt�, An identity thi3i may use
<br />VOW SSN rn oat a ;ob of may 81s a tax return us % ycur WJ !e, eeca:vF
<br />a refund.
<br />To reduce your risk
<br />• Protect your SSN,
<br />• Ensure your employer is protecting your SSN, and
<br />• a? •-arafvl wher. choosing a iax Nbini prepaf%f
<br />If your iax rr7rds ]r: a eCtzc by Identity theft and you a
<br />not:cc rota tlrw lf?$, r3spond helm at-1ay ro !it ham? and ppdn_ number
<br />primed 4n ttl?'.RSr.Op,e or letter.
<br />If your tax :arordsall? :urenI1�- alf9c!ed b{,demitf:teff but you
<br />think ;vju are at rfak du- to a foss or stoten pursa yr vrall-w, questro rnacie
<br />Curti! ^Ord acrerty. or a qua tlionable credit f4pryr. conuicl t" IRS
<br />r?obey Theft knttin_ at wo-goe-:ego orsubmrt i•afm tsa39•
<br />For rnore infornation. sc-? Pub 3027_ IdenttP/ Theft In(ormalran r"or
<br />Taxpayers.
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