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Form W-9 {Rcv.3-2024)Pogc 5
<br />Part ll. Certification
<br />To establish to the withholding ag€nt that you are a U.S. peison, or
<br />resident alien, sign Fom W-9. You may be requested to srgn by the
<br />withholding agent gven if item 1, 4, or 5 bdow indicales otherwise.
<br />For a joint account, only the person whose'IlN is shown in Pan I
<br />should sign (when reguircd). ln the case ol a disregarded entity, the
<br />person identifed on line 1 must sign. Exempt payees, see Exempt oeyee
<br />code, earlier.
<br />Signature requiremenls. Complete the ceriification as indicated in
<br />itemslthrough5below.
<br />l. lnterest, dividend, and barter exchange accounls opened
<br />before 199{ and btok€r accounts considered active during l9&?.
<br />You must give your correct TlN, but you do not have to sign the
<br />ceilification.
<br />2. Interesl, dividend, broker, and barter exchange accounts
<br />opened after 1983 and broker accounts considered inactive during
<br />lil83. Yor.r must sign the c€rtificaiion or backup withholding will apply. lf
<br />you are subliect to backup withholding and you are merely providing
<br />your conect TIN to tho requestet, you must cross out item 2 in lhe
<br />certification before signing lhe form.
<br />3. Reat estate transactions. You must sign the certification' You may
<br />cro€s out item 2 of lhe certilicalion.
<br />4. Other paynrents. You must giv€ your corect TlN, but you do not
<br />have to sign ths certification unless you have been notified that you
<br />have previously given an inconect TlN. 'Other payments' include
<br />paym'ents mad'ein lhe course of the r€questert t-rade or business lor
<br />rents, royalties, goods (other than bills for merchandise), medical and
<br />heallh care services fncluding payments to corporations), payments to
<br />a nonemployee for services, paym€nts made in setdemenl of-Pa_yment
<br />card and third-party network transactions, Paytnents to certain fish,ng
<br />boat crew members and fishermen, and gross proceeds paid to
<br />attomeys $ncluding payrnents to corporaiions).
<br />5. Mortgage interest paid by you, acquisition or abandonment ol
<br />secured property, cancellalion ol debt, qualified tuilion prograln
<br />payment3 (undei section 529), ASLE accounts {under section 529A1,
<br />lRA, Coverdell ESA, Aicher MSA or HSA contributions or
<br />dislributions, and pension distributions. You must give your conect
<br />TlN, but you do not have to sign the certificalion.
<br />What Name and Number To Give the
<br />For ihis of account:Give name and SSN ol:
<br />1. lndiu:duql
<br />2. Two or more hdivkiuals {ioint accounl)
<br />other thon an accounl mahtained by
<br />an FFI
<br />3. Two or more U.S. p€rsons
<br />toint oc€ount mainrained by an FFI)
<br />4. Cuslodial account of a mhor
<br />(ljniform Gift lo MhorsAa)
<br />5. a. Thc usual revocable savings kust
<br />(grantor b also tustee)
<br />b. Secalled trust accorint thal is not
<br />a lcAal or valirJ trust under state hw
<br />6. Sole propdelorchip or disregarded
<br />entig owned by an hdividual
<br />7. Grontor bust filing under Optional
<br />Filhg Method 1 (see Pegulalions
<br />section 1.671 -a{bX2XiXA)"
<br />Kittitas County Agreement for Services (rev.5/t4/25)
<br />Page 18 of 19
<br />For this of account:
<br />8. Dbregadcd cntiV not owncd by an
<br />individual
<br />9. A valid trust. cstaie, or pcFion ttust
<br />10. Corporatio. or LLC cbaing corporatc
<br />staius on Fofm 8832 or Form 2553
<br />11 . Associatiqr, dub, religiots, charitoblc,
<br />cducational. or othcr tax-excmpt
<br />orgranizalbn
<br />12. Partncrship or mufti-mcrnbcr LLC
<br />13. A broker or rcgbtcrsd nomince
<br />14. Account with lhc Oepartm€nt ol
<br />Agicullure h lhc narnc ol a public
<br />cntiU (sudr as a statc or local
<br />govcmmcnt, school dbttic{, ot pri3on}
<br />that rcceives agriculh,rral program
<br />paymcnts
<br />15. Grantor tnusl filitg Form 1041 or
<br />undcr lho Optional Filing Mothod 2.
<br />rcquiring Form 10@ {sce Rcgulatbns
<br />secnon 1.671 -4(bX2XiX8))"
<br />Give name and EIN ot
<br />Thc owncr
<br />Legal entittd
<br />Thc csporation
<br />The organization
<br />Thc partncrship
<br />The brokcr or nomircc
<br />Th€ public 6lity
<br />The aclual omer of the account or,
<br />il combined funds. lhe first individual
<br />on the accountr
<br />Each holder ol the account
<br />The minor2
<br />The grantor-trustee!
<br />The ac,tual ownerl
<br />ihe omeF
<br />The grantor'
<br />Thc truet
<br />'Ust first and circle the name of lhe peson whose number you fumish.
<br />lf only one person on a ioint accounl has an SSN, lhat pe6on's number
<br />must be fumished.
<br />2Oircle the mino/s name and fumish the minor's SSN.
<br />3You must show vour individual name on line 1, and enter your business
<br />or DBA name, if ahy, on line 2. You may use eilher your SSN or EIN (f
<br />you have one), but the IRS encourages you to use your SSN.
<br />'List lirst and circle the name of lhe trusi, €state, or p€nsion trust. (Do
<br />not lumish the TIN of the personal represenlalive or truste€ unless the
<br />legal enlity itself is not designaled in the account title.)
<br />'Note: The grantor must also provide a Form W-9 to the truslee of lhe
<br />trust.
<br />" For more information on oplional filing methods for grantor trusts, see
<br />the lnstructions for Fotm 1041.
<br />Note: lf no name is circled when more than otre name is lisled, the
<br />number will be considered to be that of the first name listed.
<br />Secure Your Tax Records From ldentity Theft
<br />ldentity theft occurs when someone uses your p€rsonal information,
<br />such al your name, SSN, or other identifiTing information, withot t your
<br />permission to commit kaud or other crimes. An identity thief .may use
<br />your SSN to get a job or may file a tax retum using your SSN to receive
<br />a refund.
<br />To redr.rce your risk:
<br />o Protect your SSN,
<br />. Ensure your employer is protecting your SSN, and
<br />. Be careful when choosing a tax relum preparer.
<br />lf your tax records are aflected by identity theft and you receive a
<br />notiae trom the lRS, respond right away to the name and phone number
<br />printed on the IRS notice or letter.
<br />lf vour tax records are not cunently affected by identity theft but you
<br />thinli pu are at risk due to a lost or atolen purse or wallet, questionable
<br />crediicard activity, or a questionable credit report. contact the IRS
<br />ldentity Theft Hotline at 800-90&4490 or submit Form 14039'
<br />For more information, see Pub. 5027, ldentily Theft lnformalion for
<br />Taxpayers.
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